Tip 1 Bipolar Bozuklukta Tedavi Uyumunu Etkileyen Faktörler

Öz

Medikal tedaviye uyumsuzluk, bipolar bozukluk (BB) hastalarında zorlanmanın ve yeti yitiminin yaygın nedenlerinden birisidir. Bu çalışmada, remisyonda olan BB hastalarında tedavi uyum düzeylerinin belirlenmesi, tedaviye uyum üzerine etkili olabilecek faktörlerin çok yönlü olarak tespit edilmesi amaçlanmaktadır. Araştırmaya remisyonda BB tip 1 tanılı 50 hasta dahil edilmiş, sosyodemografik veri formu, Kısa Uluslararası Nöropsikiyatrik Görüşme (MINI Plus 5.0.0), Hamilton Depresyon Derecelendirme Ölçeği (HAM-D), Young Mani Derecelendirme Ölçeği (YMDÖ), Kısa İşlevsellik Değerlendirme Ölçeği (FAST), İçgörünün Üç Bileşenini Değerlendirme Ölçeği, UKU Yan Etki Değerlendirme Ölçeği, Algılanan Sosyal Destek Ölçeği (ASDÖ) ve Tıbbi Tedaviye Uyum Oranı Ölçeği (TTUOÖ) uygulanmıştır. Grupların karşılaştırılmasında; TTUOÖ toplam puanları, cinsiyete (p<0,05), çalışma durumuna (p<0,05), medeni duruma (p<0,05), yakınına göre tedavi uyumu (p<0,05) ve yaygın anksiyete bozukluğu (YAB) eşlik edip etmemesine göre (p<0,05) göre anlamlı fark saptanmıştır. TTUOÖ toplam puanı ile düzenli ilaç kullanım süresi (p<0.01) ve içgörü toplam puanı (p<0,01) arasında aynı yönlü, YMDÖ (p<0.01) ve UKU yan psikolojik yan etkiler altölçeği (UKU1) (p<0,01) ve tüm yan etkiler toplam puanı (UKU toplam) (p<0,05) arasında ters yönlü bir ilişki saptanmıştır. Yapılan Regresyon analizinde; çalışma durumu, eşlik eden YAB ve YMDÖ toplam puanlarının TTUOÖ toplam puanı üzerinde etkili faktörler olduğu bulunmuştur (R=0.64). Araştırmanın bulgularına göre; erkek, evli, düzenli bir işte çalışıyor olmak ve yüksek içgörü düzeyi tedavi uyumunu olumlu yönde etkilerken, yan etkiler ve eşik altı manik belirtiler tedavi uyumunu olumsuz yönde etkilemektedir. Bu sonuçlar doğrultusunda, BB hastalarının iş yaşamının ve sosyal hayatının desteklenmesi, hastalık ve tedavi konularında ayrıntılı bilgilendirilmesi amacıyla psikoeğitime ağırlık verilmesinin önemli olduğu sonuçlarına ulaşılabilmektedir

Anahtar Kelimeler

• bipolar bozukluk
• tedavi uyumu
• ilaç tedavisine uyum
• eşik altı belirti

Factors Affecting The Treatment Compliance in Bipolar Disorder Type I

Öz

Non-adherence to medical treatment is one of the common causes of difficulties and disability in bipolar disorder (BD) patients. In this study it is aimed to determine the level of treatment compliance and the factors that may affect the treatment compliance in many aspects. 50 patients followed up with BD type I in remission and they were evaluated with sociodemographic data form, The Mini International Neuropsychiatric Interview (MINI Plus 5.0.0), Hamilton Depression Scale (HAM-D), Young Mania Rating Scale (YMRS), Functioning Assessment Short Test (FAST), Schedule for Assesing the Three Components of Insight, UKU Side Effect Rating Scale, The Multidimensional Scale of Perceived Social Support (MSPSS) and Medication Adherence Rating Scale (MARS). The total score of treatment compliance differed statistically among patients depending on the gender (p<0,05), employment status (p<0,05), marital status (p<0,05), treatment compliance according to a relative (p<0,05) and presence of generalized anxiety disorder (GAD) (p<0,05). The total score of MARS is statistically related with the duration of regular medication use (p<0.01) and total score of insight scale (p<0.01). On the other hand, it has statistically significant inverse relationships with YMRS total score, Psychological Side Effects Subscale of UKU (UKU1) (p<0,01) and total UKU score (UKU total) (p<0,05). In the regression analysis, employment status, accompanying GAD and YMRS total scores were found to be effective factors on the MARS total score (R=0.64). In BD, being male and married, working in a regular job, having high insight affect treatment compliance positively, side effects and presence of subthreshold manic symptoms affect treatment compliance adversely. According to these results it can be inferred that supporting the working and social life of patients with BD, focusing on psychoeducation to inform patients about the disorder and treatment issues are important.

Anahtar Kelimeler

• bipolar disorder
• treatment compliance
• medication adherence
• subthreshold symptoms

Kaynakça

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