Prophylactic treatment in bipolar disorder

Abstract

Objective: The aim of this study was to determine the prophylactic treatment response and its relationship between clinical variables among the bipolar disorder patient group followed up in the Bipolar Disorder Unit of Psychiatry Department of Cukurova University Faculty of Medicine. Methods: One hundred patients, in euthymic period, diagnosed as bipolar disorder, were included in this study. “Affective Disorders Patient Registry Form” developed by our unit, SCID-I, Young Mani Rating Scale, Hamilton Depression Rating Scale, Prophylactic Treatment Response Scale (PTRS) were used in this study to collect the data. These forms were completed through the interviews with the patients and their relatives, and the evaluation of outpatient files. Results: In this study, 50 of the patients were female, 50 were male. A total of 153 maintenance periods of 100 bipolar patients were examined. In 60.24% of prophylactic treatment periods, mood stabilizers and antipsychotics were used together but only one type of mood stabilizer was used in 30.75% of prophylactic treatment periods. Most frequently preferred mood stabilizer was lithium (43.58%). The prophylactic treatment had an overall positive effect over the course of the illness. The average time to the first period after the prophylactic treatment was 13.32±30.7 (range=0-244) months and a significant decrease was determined in total number of epizodes, epizod frequency and the time with disease periods. When the response to prohylactic treatment was evaluated by PTRS, we determined that the full response rate was 43.8%. As the time with disease periods prolonged and the number of episodes each year got higher the need for antipsychotic use has been increased. Conclusion: Bipolar disorder is a lifelong disorder that disrupts functioning to a large extend. Because of that the consequence of prophylactic treatment is very important. When the prophylactic treatment is continued pregularly and carefully the time with disease periods decreases significantly. Developing scales that evaluate the effects of prophylactic treatment properly will help to determine specific drug treatments for the patients and their disease.

Keywords

• bipolar disorder, mood stabilizer, prophylactic treatment

İki Uçlu Bozuklukta Koruyucu Sağaltım

Öz

Amaç: Bu çalışmada, Çukurova Üniversitesi Tıp Fakültesi Ruh Sağlığı ve Hastalıkları Anabilim Dalı İki Uçlu Bozukluk (İUB) Biriminde düzenli olarak İUB tanısıyla izlenen hastaların koruyucu sağaltıma yanıtları ve sağaltıma yanıtın klinik değişkenlerle ilişkisi araştırıldı. Yöntem: Çalışmaya İki Uçlu Bozukluk tanılı ötimik dönemde olan 100 hasta alındı. Çalışma verileri tarafımızca geliştirilen “Duygudurum Bozuklukları Hasta Kayıt Formu”, SCID-I, Young Mani Derecelendirme Ölçeği (YMDÖ), Hamilton Depresyonu Değerlendirme Ölçeği (HDDÖ) ve Koruyucu Sağaltıma Yanıt Ölçeği (KSYÖ) kullanılarak toplandı. Formlar hasta ve hasta yakınları ile görüşülerek ve poliklinik kayıtları incelenerek dolduruldu. Bulgular: Çalışmaya alınan hastaların 50’si kadın, 50’si erkek’ti. Çalışmamızda 100 İUB hastasının toplam 153 koruma dönemi incelendi. Bu koruma dönemlerinin %30.75’inde tek mizaç dengeleyici ilaç, %60.24’ünde ise mizaç dengeleyiciye ek olarak antipsikotik kullanılıyordu. Mizaç dengeleyici olarak en sık seçilen ilaç lityumdu (%43.58). Koruyucu sağaltımın hastalık seyri üzerinde genel olarak olumlu bir etkisi söz konusuydu. Koruyucu sağaltım sonrası ilk döneme kadar geçen süre ortalama 13.32±30.7 (range=0-244) aydı ve dönem sayısı, sıklığı, hastalıkla geçirilen sürelerde anlamlı bir azalma vardı. Koruma dönemleri KSYÖ ile değerlendirildiğinde %43.8 oranında tam yanıt saptandı. Hastalıkla geçen süre uzadıkça ve yılda geçirilen dönem sayısı arttıkça ek olarak antipsikotik kullanma gereksinimi arttığı görüldü. Sonuç: İUB yaşam boyu süren ve işlevselliği büyük oranda bozan bir hastalıktır. Bu nedenle koruyucu sağaltımın önemi yüksektir. Koruyucu sağaltım düzenli ve özenli bir şekilde sürdürüldüğünde hastalıkla geçen süre önemli oranda azalmaktadır. Koruyucu sağaltımın etkisini doğru değerlendiren ölçeklerin geliştirilmesi hastaya ve hastalığına özgü ilaç tedavisinin belirlenmesine yardımcı olacaktır.

Anahtar Kelimeler

• iki uçlu bozukluk, mizaç dengeleyici, koruyucu sağaltım

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