Fibromiyalji; Bir Psikiyatrik Bozukluk Mu, Yoksa Birliktelik Mi?

Adnan Özçetin

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Year 2014, Volume: 4 Issue: 3, 34 - 44, 17.04.2014

Abstract

Fibromyalgia is an idiopathic syndrome characterized by widespread muscle-skeleton system pain and it has clinicalsymptoms accompanied by fatigue, sleep disorder and irritable colon syndrome. Furthermore it is admitted among thecentral sensitivity syndrome. American College of Rheumatology (ACR) in 2010 described new diagnosis criteria addedwith fatigue besides pain, rested wakeless, cognitive symptoms and somatic symptoms. For the investigate a significantportion of the symptoms seen in psychiatric disorders due to seen in fibromyalgia as well, and this disorder’s proximitywith psychiatric disorders literature search was done. To prepare this review that researched relationship betweenfibromyalgia and psychiatric symptoms and/or disorders and utilize from the PubMed and google scholar. The were used; fibromyalgia, psychiatric disorders, depression, anxiety, dissociation, somatoform disorders, post-traumaticstress disorder, personality traits, psychosis, anger and pain. In literature; in fibromyalgia psychiatric disorderscomorbidity and ratio of psychiatric sign are found significantly high comparing with the healthy controls and otherrheumatic disease. These are lined up dissociative disorders and somatoform disorders which are related to moreDüzce Üniversitesi, Psikiyatri A.DCorrespondence: Adnan ÖZÇETİN, adnanozcetin@duzce.edu.trdepression and anxiety disorder, childhood and adulthoodtrauma relevant with the Posttraumatic Stress Disorder(PTSD). In fibromyalgia involuntary and socialperfectionism are more, neuroticism, alexithymia,psychasthenia, and indirect aggression are high, lonelinessis low comparing with the control groups, intelligibilitygrade is low, and featured characters of patients areoccurred with high harm avoidance, low self- direction, lowpreserving, depressed and introvert anger. In treatment,Food and Drug Administration (FDA) approved pregabalin,duloxetine and milnacipran which are serotoninnorepinephrine reuptake inhibitors (SNRIs) are effective.Further, efficiency of amitriptyline, venlafaxine, and somemyorelaxant are shown. Cognitive Behavior Therapy andpatient education have important and effective role ontreatment of psychiatric disease, and also it is usedincreasingly. Especially, like somatoform disorders,physical complains are forefront, and there is no finding atdisease table for explaining physical examination andlaboratory techniques in fibromyalgia. Data of related causeof fibromyalgia, considering to clinical effect of diseaseand effective treatment method, possible psychiatricdisorders are thought for some subtype groups at least.

Keywords

Fibromyalgia; psychiatric symptoms;psychiatric disorders; personality; treatment.

References

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Fibromiyalji; Bir Psikiyatrik Bozukluk Mu, Yoksa Birliktelik Mi?

Year 2014, Volume: 4 Issue: 3, 34 - 44, 17.04.2014

Adnan Özçetin

Abstract

Fibromiyalji, yaygın kas iskelet sistemi ağrısı ile karakterize ve beraberinde yorgunluk, uyku bozukluğu, irritabl kolon sendromu gibi farklı sistemleri de içeren klinik semptomlara sahip bir sendromdur. Santral Sensitivite sendromları arasında olduğu kabul görmektedir. Amerikan Romatoloji Derneği (ACR) 2010 yılında ağrının yanı sıra bitkinlik, dinlenmiş uyanmama, kognitif belirtiler ve somatik belirtileri de ekleyerek yeni tanı kriterleri tanımlamıştır. Psikiyatrik bozuklukların önemli bir kısmında görülen belirtilerin fibromiyaljide de görülmesi nedeniyle bu hastalığın psikiyatrik bozukluklarla yakınlığını incelemek için literatür taraması yaptım. Fibromiyalji ve psikiyatrik belirti ve / veya bozuklukları arasındaki ilişkiyi inceleyen çalışmaları araştırıp bu derlemeyi hazırlamak için pubmed ve google akademik arama motorlarından yararlanıldı. Kullanılan anahtar kelimeler; fibromiyali, psikiyatrik bozukluklar, depresyon, anksiyete, dissosiyasyon, somatoform bozukluklar, travma sonrası stres bozukluğu, kişilik özellikleri, psikoz, öfke ve ağrı idi. Literatürde; sağlıklı kontrol ve diğer romatizmal hastalık gruplarına göre fibromiyaljide psikiyatrik bozukluk eş tanısı ve psikiyatrik belirti oranı anlamlı düzeyde yüksek bulunmuştur. Bunlar daha çok depresyon ve kaygı bozuklukları, çocukluk çağı ve erişkinlik dönemi travmaları ile ilişkili travma sonrası stres bozukluğu, dissosiyatif bozukluklar ve somatoform bozukluklar şeklinde sıralanabilir. Fibromiyaljide kendine yönelik ve sosyal olarak kabul edilen mükemmelliyetçiliğin fazla, nörotizm, aleksitimi, psikasteni ve dolaylı saldırganlığın yüksek, yansızlığın ise kontrollere göre düşük, anlaşılabilirlik düzeyinin düşük ve yüksek zarardan kaçınma, düşük kendini yönetme, düşük sebat etme, bastırılmış ve içe döndürülmüş öfkenin öne çıkan kişilik özellikleri olduğu görülmektedir. Tedavide FDA onayı alan pregabalin, serotonin-norepinefrin geri alım inhibitörleri (SNRI) olan duloksetin ve milnacipran etkilidir. Ayrıca amitriptilin, venlafaksin ve bazı miyorelaksanların da etkinliği gösterilmiştir. Psikiyatrik hastalıkların tedavisinde önemli yeri olan Bilişsel Davranışçı Terapi ve hasta eğitimi etkili olup giderek daha çok kullanılmaktadır. Özellikle somatoform bozukluklarda olduğu gibi fibromiyaljide de bedensel yakınmalar ön planda olup yapılan fiziksel muayene ve laboratuvar tetkiklerinde hastalık tablosunu açıklayacak bulgu saptanamamaktadır. Fibromiyaljinin nedenlerine ilişkin veriler, hastalığın klinik özelikleri ve tedavide etkili olan yöntemler dikkate alındığında en azından bazı alt gruplarının psikiyatrik bir bozukluk olabileceğini düşündürmektedir.

Keywords

Fibromiyalji; psikiyatrik belirtiler; psikiyatrik bozukluklar; kişilik; tedavi

References

İnanıcı F. Fibromiyalji Sendromu. Beyazova M, Kutsal YG, editörler. Fiziksel Tıp ve Rehabilitasyon Güncellenmiş 2. Baskı. Ankara: Güneş Kitabevleri; 20 s. 2365-77.
Yunus MB, Masi AT. Fibromyalgia, Restless Legs Syndrome, Periodic Limb, Movement Disorder and Psychogenic Pain. In: McCarty DJ, Koopman WJ, editors. Arthritis and Allied Condition. 12th edition. Philadelphia: Lea and Febiger; 1992. p. 1383-405.
Boissevan MD, Mc Cain GA. Toward an integrated understanding of fibromyalgia syndrome, I. Medical and pathophysiological aspects. Pain. 1991; 45(3): 227
Carette S. Fibromyalgia 20 years later: What have we really accomplished. J. Rheumatol. 1995; 22(4): 590-2. Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL. Primary fibromyalgia (fibrositis): Clinical study of 50 patients with matched normal controls. Seminars in arthritis and rheumatism. 1981; 11(1): 151-71.
Kayhan Ö. Fibromiyalji. Ankara: Medikomat Basın Yayım; 1995.
Clauw DJ, Crofford LJ. Chronic widespread pain and fibromyalgia: what we know, and what we need to know. Best Practice & Research Clinical Rheumatology. 2003; 17(4): 685-701.
Kaşkari D. Fibromiyalji tanısı alan hastalarda spondiloartropati sıklığı [Romatoloji yandal uzmanlık tezi]. Ankara: Başkent Üniversitesi Tıp Fakültesi; 2012. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis care & Research. 2010; 62(5): 600-10.
Yunus MB, Kalyan-Raman UP, Masi AT, Aldag JC. Electron microscopic studies of muscle biopsy in primary fibromyalgia syndrome: a controlled and blinded study. The Journal of Rheumatology. 1989; 16(1): 97-101.
Simms RW. Fibromyalgia is not a muscle disorder. The American journal of the medical sciences. 1998; 315(6): 346-50.
Sprott H, Bradley LA, Oh SJ, Wintersberger W, Alarcón GS, Mussell HG, et al. Immunohistochemical and molecular studies of serotonin, substance P, galanin, pituitary adenylyl cyclase-activating polypeptide, and secretoneurin in fibromyalgic muscle tissue. Arthritis & Rheumatism. 1998; 41(9): 1689-94.
Moldofsky H, Scarisbrick P, England R, Smythe H. Musculosketal symptoms and non-REM sleep disturbance in patients with" fibrositis syndrome" and healthy subjects. Psychosomatic Medicine. 1975; 37(4): 341Horne JA, Shackell BS. Alpha-like EEG activity in nonREM sleep and the fibromyalgia (fibrositis) syndrome. Electroencephalography and clinical Neurophysiology. 1991; 79(4): 271-6.
Branco J, Atalaia A, Paiva T. Sleep cycles and alphadelta sleep in fibromyalgia syndrome. The Journal of rheumatology. 1994; 21(6): 1113-7.
Drewes AM, Nielsen KD, Taagholt SJ, Bjerregård K, Svendsen L, Gade J. Sleep intensity in fibromyalgia: focus on the microstructure of the sleep process. Rheumatology. 1995; 34(7): 629-35.
Russell JI, Kamin M, Bennett RM, Schnitzer TJ, Green JA, Katz WA. Efficacy of tramadol in treatment of pain in fibromyalgia. JCR: Journal of Clinical Rheumatology. 2000; 6(5): 250-7.
Affleck G, Urrows S, Tennen H, Higgins P, Abeles M. Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia. Pain. 1996; 68(2): 363-8.
Uzbay İT. Anksiyetenin nörobiyolojisi. Klinik Psikiyatri Dergisi. 2002; 5(1): 5-13.
Taycan SE. Depresyon Psikofarmakolojisi. Turkiye Klinikleri Journal of Psychiatry Special Topics. 2012; 5(2): 77-86.
Crofford LJ, Demitrack MA. Evidence that abmormalities of central neurohormonal systems are key to understanding fibromyalgia and chronic fatique syndrome. Rheum Dis Clin North Am. 1996; 22(2): 267Moldofsky H. Sleep and fibrositis syndrome. Rheum Dis Clin North Am. 1989; 15(1): 91-103.
Moldofsky H. Sleep and pain. Sleep Medicine. 2001; 5(5): 387-98.
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There are 69 citations in total.

Details

Primary Language	Turkish
Journal Section	Reviews
Authors	Adnan Özçetin
Publication Date	April 17, 2014
Submission Date	April 17, 2014
Published in Issue	Year 2014 Volume: 4 Issue: 3

Cite

APA	Özçetin, A. (2014). Fibromiyalji; Bir Psikiyatrik Bozukluk Mu, Yoksa Birliktelik Mi?. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 4(3), 34-44.
AMA	Özçetin A. Fibromiyalji; Bir Psikiyatrik Bozukluk Mu, Yoksa Birliktelik Mi?. DÜ Sağlık Bil Enst Derg. November 2014;4(3):34-44.
Chicago	Özçetin, Adnan. “Fibromiyalji; Bir Psikiyatrik Bozukluk Mu, Yoksa Birliktelik Mi?”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 4, no. 3 (November 2014): 34-44.
EndNote	Özçetin A (November 1, 2014) Fibromiyalji; Bir Psikiyatrik Bozukluk Mu, Yoksa Birliktelik Mi?. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 4 3 34–44.
IEEE	A. Özçetin, “Fibromiyalji; Bir Psikiyatrik Bozukluk Mu, Yoksa Birliktelik Mi?”, DÜ Sağlık Bil Enst Derg, vol. 4, no. 3, pp. 34–44, 2014.
ISNAD	Özçetin, Adnan. “Fibromiyalji; Bir Psikiyatrik Bozukluk Mu, Yoksa Birliktelik Mi?”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 4/3 (November 2014), 34-44.
JAMA	Özçetin A. Fibromiyalji; Bir Psikiyatrik Bozukluk Mu, Yoksa Birliktelik Mi?. DÜ Sağlık Bil Enst Derg. 2014;4:34–44.
MLA	Özçetin, Adnan. “Fibromiyalji; Bir Psikiyatrik Bozukluk Mu, Yoksa Birliktelik Mi?”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, vol. 4, no. 3, 2014, pp. 34-44.
Vancouver	Özçetin A. Fibromiyalji; Bir Psikiyatrik Bozukluk Mu, Yoksa Birliktelik Mi?. DÜ Sağlık Bil Enst Derg. 2014;4(3):34-4.

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