Ruhsal bozuklukların sistemik lupus eritematozuslu hastalarda görülme sıklığı ve hastalığa ait klinik değişkenler ile karşılaştırılması
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Karabük Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Sistemik lupus eritematozus (SLE), patojenik otoantikorların ve immün komplekslerin birçok organı hedef aldığı, kronik otoimmün bir hastalıktır. SLE'de nöropsikiyatrik tutulum, hastalığın inatçı komplikasyonlarından biridir ve özürlülüğe sebebiyet vererek, yaşam kalitesini olumsuz yönde etkiler. Çalışmamızın birincil amacı SLE tanısı almış 18-65 yaş arası hastalarda görülen psikiyatrik bozukluk sıklığını, kontrol grubu ile karşılaştırmaktır. Çalışmamızın amacı psikiyatrik bozukluğu olan ve olmayan SLE'li hastaları; klinik ve labaratuvar değişkenler açısından karşılaştırmak olarak genişletilmiştir. Gereç ve Yöntem: Bu çalışma Karabük Üniversitesi Eğitim ve Araştırma Hastanesi Ruh Sağlığı ve Hastalıkları Kliniği ile Romatoloji Kliniğinde 05.01.2019-05.01.2020 tarihleri arasında 2012 yılında yayınlanan SLICC kriterlerine göre SLE tanısı almış 18-65 yaş arası 10 erkek ve 42 kadın hasta ile 11 erkek ve 45 kadından oluşan kontrol grubunda gerçekleştirilmiştir. Tüm katılımcılara sosyodemografik form (yaş, cinsiyet, psikiyatrik hastalık öyküsü vb. ), ruhsal bozuklukların sayısal ve tanımsal el kitabı (DSM-5) bozuklukları için yapılandırılmış klinik görüşme (SCID-5 CV) formu uygulanmıştır. Bu değerlendirme sonucunda depresyon ve kaygı bozuklukları saptanan kişilere ayrıca Hamilton depresyon ölçeği (HAM-D) ve Hamilton kaygı değerlendirme (HAM-A) ölçeği de uygulanmıştır. Hasta grubuna ayrıca SLE hastalık aktivite (SLEDAI) formu ve klinik parametre veri formu doldurulmuştur. İstatistik veriler SPSS versiyon 26 ile hesaplanmıştır. Bulgular: Çalışma sonucunda, SLE'li hasta grubunda kontrol grubuna göre daha fazla sayıda kişinin psikiyatrik bozukluk tanısı aldığı görülmüştür (p=0,000). Çalışmaya dahil edilen SLE'li hastaların 23'ünde (%44.2) depresif bozukluklar, 21'inde (%40.4) kaygı bozukluklukları, 5'inde (%9.6) psikotik bozukluklar, 8'inde de (%15.4) bedensel belirti bozukluğu ve ilişkili bozukluklar saptanmış ve bu sıklıklar kontrol grubundan anlamlı bir şekilde daha yüksek bulunmuştur (p<0.05). Gruplar HAM-D ve HAM-A puan ortancaları açısından incelendiğinde ise, kontrol grubuna göre SLE hastalarının puanları istatistiksel olarak anlamlı düzeyde yüksek bulunmuştur (p<0.05). Depresif bozukluk tanısı alan SLE'li hastalar içerisinde cilt bulgusu sıklığı depresif bozukluk tanısı almayan hastalardan istatistiksel açıdan daha yüksek saptanmıştır (p=0.031). Çalışmaya alınan SLE'li hastalar içerisinde psikiyatrik bozukluğu olan ve olmayanlar; laboratuvar değerleri (ANA testi, dsDNA, anti-fosfolipid antikor, kompleman düşüklüğü), hastalık aktivite skorları, kortikosteroid kullanım sıklıkları ve dozları açısından karşılaştırıldığında, aralarında istatistiksel anlamlı farklılık saptanmamıştır (p>0.05). Araştırmaya katılan SLE'li hastalardaki psikiyatrik bozukluk sıklığı çalışma öncesi %57.7 iken çalışma sonrası %76.9'a çıkmıştır. Sonuç: SLE'de psikiyatrik bozukluklar sık olarak görülmektedir; yaptığımız çalışma ile de çoğu hastanın çalışmaya katılım öncesinde psikiyatrik tanısı olmadığı görülmüştür. Günlük pratikte SLE'li hastalar sadece fizik muayene ve labaratuvar bulguları ile değil, psikiyatrik bulgular açısından da değerlendirilerek, psikiyatrik yakınması olanların mutlaka bir psikiyatriste konsülte edilmesinin uygun olacağı, bu çalışma ile de bir kez daha net olarak görülmektedir.
Purpose: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease in which pathogenic autoantibodies and immune complexes target many organs. Neuropsychiatric involvement in SLE is one of the persistent complications of the disease and negatively affects the quality of life by causing disability. The primary aim of our study is to compare the prevalence of psychiatric disorders seen in patients aged 18-65 with SLE with a control group. The aim of our study was expanded to compare patients with SLE with and without psychiatric disorders in terms of clinical and laboratory variables. Material and Methods: This study was conducted in Karabük University Training and Research Hospital Mental Health and Diseases Clinic and Rheumatology Clinic between 05.01.2019-05.01.2020, in patient group consisting 10 male and 42 female patients aged 18-65 years and who were diagnosed with SLE according to SLICC criteria published in 2012, and in a control group consisting 11 male and 45 female. The sociodemographic form (age, gender, history of psychiatric illness, etc.), the numerical and descriptive manual of mental disorders (DSM-5), and the structured clinical interview form (SCID-5 CV) were administered to all participants. Hamilton depression scale (HAM-D) and Hamilton anxiety rating (HAM-A) scale were also applied to individuals who were found to have depression and anxiety disorders as a result of this evaluation. SLE disease activity (SLEDAI) form and clinical parameter data form were also filled in the patient group. Statistical data were calculated with SPSS version 26. Results: As a result of the study, it was observed that more people were diagnosed with psychiatric disorders in the patient group with SLE compared to the control group (p = 0.000). Depressive disorders in 23 (44.2%), anxiety disorders in 21 (40.4%), psychotic disorders in 5 (9.6%), somatic symptom disorder in 8 (15.4%) were detected in SLE patients included in the study, and these frequencies were found to be significantly higher than the control group (p <0.05). When the groups were examined in terms of HAM-D and HAM-A score medians, the scores of SLE patients were found to be statistically significantly higher than the control group (p <0.05). Among the patients with SLE diagnosed with depressive disorder, the frequency of skin findings was statistically higher than the patients not diagnosed with depressive disorder (p = 0.031). Those with and without psychiatric disorders among the patients with SLE included in the study; When compared in terms of laboratory values (ANA test, dsDNA, anti-phospholipid antibody, low complement), disease activity scores, frequency of corticosteroid use and doses, no statistically significant difference was found between them (p> 0.05). While the prevalence of psychiatric disorders in patients with SLE participating in the study was 57.7% before the study, it increased to 76.9% after the study. Conclusion: Psychiatric disorders are common in SLE; In our study, it was observed that many patients did not have a psychiatric diagnosis before participating in the study. In daily practice, it is clearly seen with this study that patients with SLE should be evaluated not only with their physical examination and laboratory findings but also in terms of psychiatric findings, and that it may be appropriate to consult a psychiatrist for those with psychiatric complaints.
Purpose: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease in which pathogenic autoantibodies and immune complexes target many organs. Neuropsychiatric involvement in SLE is one of the persistent complications of the disease and negatively affects the quality of life by causing disability. The primary aim of our study is to compare the prevalence of psychiatric disorders seen in patients aged 18-65 with SLE with a control group. The aim of our study was expanded to compare patients with SLE with and without psychiatric disorders in terms of clinical and laboratory variables. Material and Methods: This study was conducted in Karabük University Training and Research Hospital Mental Health and Diseases Clinic and Rheumatology Clinic between 05.01.2019-05.01.2020, in patient group consisting 10 male and 42 female patients aged 18-65 years and who were diagnosed with SLE according to SLICC criteria published in 2012, and in a control group consisting 11 male and 45 female. The sociodemographic form (age, gender, history of psychiatric illness, etc.), the numerical and descriptive manual of mental disorders (DSM-5), and the structured clinical interview form (SCID-5 CV) were administered to all participants. Hamilton depression scale (HAM-D) and Hamilton anxiety rating (HAM-A) scale were also applied to individuals who were found to have depression and anxiety disorders as a result of this evaluation. SLE disease activity (SLEDAI) form and clinical parameter data form were also filled in the patient group. Statistical data were calculated with SPSS version 26. Results: As a result of the study, it was observed that more people were diagnosed with psychiatric disorders in the patient group with SLE compared to the control group (p = 0.000). Depressive disorders in 23 (44.2%), anxiety disorders in 21 (40.4%), psychotic disorders in 5 (9.6%), somatic symptom disorder in 8 (15.4%) were detected in SLE patients included in the study, and these frequencies were found to be significantly higher than the control group (p <0.05). When the groups were examined in terms of HAM-D and HAM-A score medians, the scores of SLE patients were found to be statistically significantly higher than the control group (p <0.05). Among the patients with SLE diagnosed with depressive disorder, the frequency of skin findings was statistically higher than the patients not diagnosed with depressive disorder (p = 0.031). Those with and without psychiatric disorders among the patients with SLE included in the study; When compared in terms of laboratory values (ANA test, dsDNA, anti-phospholipid antibody, low complement), disease activity scores, frequency of corticosteroid use and doses, no statistically significant difference was found between them (p> 0.05). While the prevalence of psychiatric disorders in patients with SLE participating in the study was 57.7% before the study, it increased to 76.9% after the study. Conclusion: Psychiatric disorders are common in SLE; In our study, it was observed that many patients did not have a psychiatric diagnosis before participating in the study. In daily practice, it is clearly seen with this study that patients with SLE should be evaluated not only with their physical examination and laboratory findings but also in terms of psychiatric findings, and that it may be appropriate to consult a psychiatrist for those with psychiatric complaints.
Açıklama
Tıp Fakültesi, Ruh Sağlığı ve Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
Psikiyatri, Psychiatry
