Alkol Madde Kullanım Bozukluklarında Ek Psikiyatrik Tanılar
Özet
Alkol madde kullanım bozukluğu (AMKB) olan bireylerde ek psikiyatrik tanıların görülme sıklığı oldukça yüksektir ve bu durum her iki bozukluğun da prognozunu olumsuz etkilemektedir. Yapılan epidemiyolojik çalışmalarda AMKB'ye en sık eşlik eden psikiyatrik tanıların majör depresif bozukluk, bipolar bozukluk, anksiyete bozuklukları, şizofreni gibi psikotik bozukluklar, dikkat eksikliği hiperaktivite bozukluğu (DEHB) ve özellikle B kümesi (antisosyal ve borderline) kişilik bozuklukları olduğu gösterilmiştir. Bu birlikteliklerin etyopatogenezinde self medikasyon çabaları, karşılıklı doğrudan nedensel ilişkiler, ortak genetik (COMT geni veya belirli genomik lokuslar gibi) ve biyolojik yolaklar ile dürtüsellik gibi ortak psikopatolojik özellikler rol oynamaktadır. Ek tanıların varlığı; tedavide uyumsuzluğa, yüksek relaps (nüks) oranlarına, daha erken yaşta hastalık başlangıcına, şiddet davranışına ve artmış intihar riskine yol açarak klinik tabloyu ve tedaviyi daha karmaşık hale getirmektedir. Bu nedenle, klinikte başvuran hastaların kapsamlı bir şekilde değerlendirilmesi, yoksunluk ve entoksikasyon belirtilerinin anksiyete gibi diğer psikiyatrik semptomlardan iyi ayırt edilmesi ve tedavinin genellikle her iki bozukluğu da kapsayacak şekilde eş zamanlı yürütülmesi kritik önem taşımaktadır.
The prevalence of additional psychiatric diagnoses is remarkably high in individuals with substance use disorder (SUD), and this condition adversely affects the prognosis of both disorders. Epidemiological studies have demonstrated that the most frequent psychiatric comorbidities accompanying SUD include major depressive disorder, bipolar disorder, anxiety disorders, psychotic disorders such as schizophrenia, attention-deficit/hyperactivity disorder (ADHD), and especially Cluster B (antisocial and borderline) personality disorders. Self-medication attempts, mutual direct causal relationships, shared genetic (such as the COMT gene or specific genomic loci) and biological pathways, as well as common psychopathological traits like impulsivity, play a significant role in the etiopathogenesis of these co-occurrences. The presence of additional diagnoses leads to treatment non-compliance, high relapse rates, an earlier age of onset, violent behavior, and an increased risk of suicide, thereby complicating the clinical picture and management. Consequently, it is of critical importance to comprehensively evaluate presenting patients, clearly differentiate withdrawal and intoxication symptoms from other psychiatric symptoms like anxiety, and conduct treatment simultaneously to cover both disorders.
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