BİR ÜNİVERSİTE HASTANESİ ERGEN POLİKLİNİĞİNDE OBSESİF KOMPULSİF BOZUKLUKTA EŞ TANILAR VE İNTİHAR DAVRANIŞI

Öz

Giriş: Hem klinik hem de epidemiyolojik çalışmalardan elde edilen veriler Obsesif kompulsif bozuklukta (OKB) eş tanı sıklığının %25 ile %65 arasında değiştiğini ortaya koymuştur. İntihar ise OKB’li olgularda olarak yakın zamanlı çalışmalarda yeni bir sorun alanı gösterilmiştir. Bununla birlikte ergen örneklemi üzerinde bu alanda yapılmış bir çalışmaya rastlanmamıştır. Bu bağlamda bu çalışmada, ergen OKB olgularında eş tanı ve intihar davranışı sıklığının belirlenmesi amaçlanmıştır. Yöntem: Çalışmaya 2015 yılında Ankara Üniversitesi Tıp Fakültesi Ruh Sağlığı ve Hastalıkları Anabilim Dalı Ergen Ünitesine başvuran ve OKB tanısı konmuş, ayaktan tedavi görmekte olan 15-22 yaş aralığındaki 70 olgu dahil edilmiştir. Bilgiler dosya taraması yöntemiyle hekim notları üzerinden geriye dönük elde edilmiştir. Bulgular: Olguların %35’i erkek, %65’i kadındır. Yaş ortalaması 19.6 (±2.3, 15-22) olarak saptanmıştır. Depresyon OKB’ye en sık eşlik eden eş tanı olmuştur (%23.2). Bunu anksiyete bozukluğu (%15.9), dikkat eksikliği ve hiperaktivite bozukluğu (%7.2), bipolar bozukluk (%5.8), mental retardasyon (%2.9), psikotik belirtiler (%2.9), DEHB-depresyon birlikteliği (%2,9) ve epilepsi (%1,4) izlemiştir. İntihar düşüncesi OKB grubunda %4.3 (n=3) oranında izlenmiş olup intihar girişimine rastlanmamıştır. İntihar düşüncesi yalnızca depresyonu olan grupta bulunmuştur. Tartışma ve Sonuç: Çalışmalarla uyumlu olarak ergen obsesif kompulsif bozukluklu bireylerde eş tanı yüksek olarak saptanmıştır. Bununla birlikte intihar düşüncesi OKB’li ergen olgularda literatürdeki sağlıklı ergenler ve erişkin OKB’li olgulardakine göre düşük bulunmuştur. Bu durum ergen grubuyla çalışırken eş tanının sorgulanmasının önemini gösterirken OKB’li ergen olgulardaki intihar düşüncesi sıklığının başka çalışmalarla da desteklenmesi gerekmektedir.

Anahtar Kelimeler

• ergenlik,obsesif kompulsif bozukluk,intihar,eş tanı

COMORBIDITY AND SUICIDAL BEHAVIOURS IN OBSESSIVE-COMPULSIVE DISORDERED ADOLESCENTS AT A UNIVERSITY HOSPITAL

Abstract

Introduction: Data obtained from both clinical and epidemiological studies have shown that the frequency of comorbidities in obsessive-compulsive disorder (OCD) varies between 25% and 65%. Suicide has been shown as a new problem area in OCD cases in recent studies. Nevertheless, there was no study on adolescent subjects on this field. In this context, in this study, it was aimed to determine the frequency of comorbidity and suicidal behavior in adolescent OCD cases. Methods: Seventy patients in the 15-22 age range who were diagnosed with OCD and referred to the Adolescence Unit of the Department of Mental Health and Diseases, Ankara University Medical Faculty in 2015 were included in the study. The information was retrieved retrospectively on physician notes by file scanning method. Results: 35% of the cases were male and 65% were female. The mean age was 19.6 (± 2.3, 15-22). Depression was the most common comorbid diagnosis of OCD (23.2%) and followed by anxiety disorders (15.9%), attention deficit hyperactivity disorder (7.2%), bipolar disorder (5.8%), mental retardation (2.9%), psychotic symptoms (2.9%), ADHD-depression and epilepsy (1.4%). Suicide ideation was observed in 4.3% (n = 3) of OCD group and no suicide attempt was found. Suicidal ideation was only found in depression group. Conclusion: Consistent with previous studies in the literature, comorbidity was found to be high in individuals with obsessive-compulsive disorder. However, suicidal ideation was

found to be lower in adolescent OCD cases than in healthy adolescents and adult OCD cases in the literature. It is important to question the comorbidity in our clinical practice while working with the adolescent group. Further research needed about frequency of suicidal thoughts and attempts in adolescents with OCD.

Keywords

• adolescence,obsessive-compulsive disorder,suicide,comorbidity

References

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
2. Angelakis, I., Gooding, P., Tarrier, N., & Panagioti, M. (2015). Suicidality in obsessive compulsive disorder (OCD): a systematic review and meta-analysis. Clinical psychology review, 39, 1-15.
3. Apter, A., Horesh, N., Gothelf, D., Zalsman, G., Erlich, Z., Soreni, N., & Weizman, A. (2003). Depression and suicidal behavior in adolescent inpatients with obsessive compulsive disorder. Journal of affective disorders, 75(2), 181-189.
4. Bobes, J., Gonzalez, M. P., Bascaran, M. T., Arango, C., Saiz, P. A., & Bousono, M. (2001). Quality of life and disability in patients with obsessive-compulsive disorder. European Psychiatry, 16(4), 239-245.
5. Brem, S., Grünblatt, E., Drechsler, R., Riederer, P., & Walitza, S. (2014). The neurobiological link between OCD and ADHD. ADHD Attention Deficit and Hyperactivity Disorders, 6(3), 175-202.
6. Eskin, M. (1999). Gender and cultural differences in the 12-month prevalence of suicidal thoughts and attempts in Swedish and Turkish adolescents. Journal of Gender, Culture and Health, 4(3), 187-200.
7. Flament, M. F., Whitaker, A., Rapoport, J. L., Davies, M., Berg, C. Z., Kalikow, K., ... & Shaffer, D. (1988). Obsessive compulsive disorder in adolescence: an epidemiological study. Journal of the American Academy of Child & Adolescent Psychiatry, 27(6), 764-771.
8. Geller, D., Biederman, J., Faraone, S. V., Frazier, J., Coffey, B. J., Kim, G., & Bellordre, C. A. (2000). Clinical correlates of obsessive compulsive disorder in children and adolescents referred to specialized and non‐specialized clinical settings. Depression and Anxiety, 11(4), 163-168.

9. Geller, D., Biederman, J., Jones, J., Park, K., Schwartz, S., Shapiro, S., & Coffey, B. (1998). Is juvenile obsessive‐compulsive disorder a developmental subtype of the disorder? A review of the pediatric literature. Journal of the American Academy of Child & Adolescent Psychiatry, 37(4), 420-427.
10. Hollander, E., & Benzaquen, S. D. (1996). Is there a distinct OCD spectrum?. CNS spectrums, 1(1), 17-26.
11. Kalra, S. K., & Swedo, S. E. (2009). Children with obsessive-compulsive disorder: are they just “little adults”?. The Journal of clinical investigation, 119(4), 737.
12. Khan, A., Leventhal, R. M., Khan, S., & Brown, W. A. (2002). Suicide risk in patients with anxiety disorders: a meta-analysis of the FDA database. Journal of affective disorders, 68(2), 183-190.
13. Mataix-Cols, D., Rauch, S. L., Baer, L., Eisen, J. L., Shera, D. M., Goodman, W. K., ... & Jenike, M. A. (2002). Symptom stability in adult obsessive-compulsive disorder: data from a naturalistic two-year follow-up study. American Journal of Psychiatry, 159(2), 263-268.
14. Mol Debes, N. M. (2013). Co-morbid disorders in Tourette syndrome. Behavioural neurology, 27(1), 7-14.
15. Narayanaswamy, J. C., Viswanath, B., Cherian, A. V., Math, S. B., Kandavel, T., & Reddy, Y. J. (2012). Impact of age of onset of illness on clinical phenotype in OCD. Psychiatry research, 200(2), 554-559.
16. Nestadt, G., Samuels, J., Riddle, M. A., Liang, K. Y., Bienvenu, O. J., Hoehn-Saric, R., ... & Cullen, B. (2001). The relationship between obsessive–compulsive disorder and anxiety and affective disorders: results from the Johns Hopkins OCD Family Study. Psychological medicine, 31(3), 481-487.
17. Riddle, M. A., Scahill, L., King, R., Hardin, M. T., Towbin, K. E., Ort, S. I., ... & Cohen, D. J. (1990). Obsessive compulsive disorder in children and adolescents: phenomenology and family history. Journal of the American Academy of Child & Adolescent Psychiatry, 29(5), 766-772.
18. Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular psychiatry, 15(1), 53.
19. Swedo, S. E., Pietrini, P., Leonard, H. L., Schapiro, M. B., Rettew, D. C., Goldberger, E. L., ... & Grady, C. L. (1992). Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder: revisualization during pharmacotherapy. Archives of general psychiatry, 49(9), 690-694.
20. Swedo, S. E., Rapoport, J. L., Leonard, H., Lenane, M., & Cheslow, D. (1989). Obsessive-compulsive disorder in children and adolescents: clinical phenomenology of 70 consecutive cases. Archives of General Psychiatry, 46(4), 335-341.
21. Tamam, L., Saygılı, M., & Ünal, M. (2003). Obsesif kompulsif bozukluğu olan hastalarda diğer anksiyete bozukluklarının komorbiditesi. Anadolu Psikiyatri Dergisi, 4(2), 69-80.
22. Torp, N. C., Dahl, K., Skarphedinsson, G., Thomsen, P. H., Valderhaug, R., Weidle, B., ... & Wentzel-Larsen, T. (2015). Effectiveness of cognitive behavior treatment for pediatric obsessive-compulsive disorder: Acute outcomes from the Nordic Long-term OCD Treatment Study (NordLOTS). Behaviour research and therapy, 64, 15-23.
23. Torres, A. R., Prince, M. J., Bebbington, P. E., Bhugra, D., Brugha, T. S., Farrell, M., ... & Singleton, N. (2006). Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. American Journal of Psychiatry, 163(11), 1978-1985.
24. Valleni-Basile, L. A., Garrison, C. Z., Jackson, K. L., Waller, J. L., McKEOWN, R. E., Addy, C. L., & Cuffe, S. P. (1994). Frequency of obsessive-compulsive disorder in a community sample of young adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 33(6), 782-791.
25. Veale, D., & Roberts, A. (2014). Obsessive-compulsive disorder. BMJ, 348, g2183.