Erişkin Dikkat Eksikliği Hiperaktivite Bozukluğunda Psikiyatrik Eştanılar: Bir Klinik Örneklemde Cinsiyete Dayalı İçselleştirme ve Dışsallaştırma Bozuklukları Örüntüleri

Öz

Amaç: Dikkat eksikliği hiperaktivite bozukluğu (DEHB) erişkinlerin %2,5'ini etkilemekte olup, yüksek eştanı oranları (%70–80) ve cinsiyete özgü örüntüler göstermektedir. Bu çalışmanın amacı, DEHB tanılı erişkin hastalarda psikiyatrik eştanıların yaygınlığını cinsiyetler arasındaki içselleştirme ve dışsallaştırma bozuklukları örüntülerine odaklanarak incelemektir. Yöntem: Bu kesitsel gözlemsel çalışmada, Nisan 2022-Eylül 2023 tarihleri arasında Koru Ankara Hastanesi'ne başvuran hastalardan DEHB tanısı almış 70 erişkin hastanın verileri (18–60 yaş arası) incelenmiştir. Psikiyatrik eştanılar geriye dönük olarak elektronik hasta dosyalarından taranmıştır. Eştanılar dışsallaştırma (alkol/madde kullanım bozuklukları, dürtü kontrol bozuklukları ve kişilik bozuklukları) veya içselleştirme (anksiyete bozuklukları, depresif bozukluklar, yeme bozuklukları ve obsesif-kompulsif ve ilişkili bozukluklar) olarak sınıflandırılarak cinsiyetler arasındaki eştanı örüntüleri karşılaştırılmıştır. Bulgular: Hastaların %71,4'ünde en az bir psikiyatrik eştanı vardı (kadınlarda %69, erkeklerde %75). En yaygın eştanılar anksiyete bozuklukları (%34,3) ve major depresif bozukluk (%15,4), bipolar bozukluk (%2,9) ve distimi (%1,4) dahil olmak üzere duygudurum bozuklukları (%20) idi. Erkeklerde alkol/madde kullanım bozuklukları ve dışsallaştırma bozuklukları daha yüksek oranda görülürken, içselleştirme bozuklukları oranları cinsiyetler arasında anlamlı bir farklılık göstermedi. İçselleştirme ve dışsallaştırma bozukluklarının birlikte görüldüğü hastalar ise ağırlıklı olarak erkeklerden oluşmaktaydı. Sonuç: Erişkinlerde DEHB sıklıkla psikiyatrik eştanılarla birlikte görülmektedir. Çalışmamızda içselleştirme bozukluklarında cinsiyet farkı görülmezken, dışsallaştırma bozuklukları erkeklerde anlamlı düzeyde daha sık saptanmıştır. Bu bulgular, klinik uygulamada cinsiyete özgü eştanı taramalarının önemini ortaya koymaktadır. Gelecekteki çalışmaların, gelişimsel süreçleri daha iyi anlamak ve kişiselleştirilmiş tedavi stratejilerini desteklemek amacıyla daha büyük örneklemlerle, çok merkezli ve uzunlamasına tasarımlarla yürütülmesi önerilmektedir.

Anahtar Kelimeler

• erişkin DEHB
• eştanı
• dışsallaştırma bozukluğu
• içselleştirme bozukluğu

Psychiatric Comorbidities in Adult Attention Deficit Hyperactivity Disorder: Sex-Based Patterns of Internalizing and Externalizing Disorders in a Clinical Sample

Abstract

Objective: Attention-deficit/hyperactivity disorder (ADHD) affects 2.5% of adults, with high comorbidity rates (70–80%) and sex-based patterns. This study aimed to examine the prevalence of psychiatric comorbidities in adult patients with ADHD, with a focus on internalizing and externalizing disorders across sexes. Method: This cross-sectional observational study examined data from 70 adult patients (aged 18–60 years) diagnosed with ADHD who sought treatment at Koru Ankara Hospital between April 2022 and September 2023. Psychiatric comorbidities were retrospectively identified from electronic patient records. Comorbidities were categorized as externalizing (alcohol/substance use disorders, impulse control disorders, and personality disorders) or internalizing (anxiety disorders, depressive disorders, eating disorders, and obsessive–compulsive and related disorders), and comorbidity patterns between sexes were compared. Results: At least one psychiatric comorbidity was found in 71.4% of the patients (69% female, 75% male). The most common comorbidities were anxiety (34.3%) and mood disorders (20%), including major depressive disorder (15.4%), bipolar disorder (2.9%), and dysthymia (1.4%). Men had significantly higher rates of alcohol/substance use disorders and externalizing disorders, whereas internalizing disorders were not significantly different between the sexes. Patients with both internalizing and externalizing disorders were predominantly male. Conclusion: Psychiatric comorbidities are prevalent in adults with ADHD. While internalizing disorders showed no sex differences, externalizing disorders were significantly more common in men, highlighting the need for sex-specific comorbidity screening in clinical practice. Future studies should use larger, longitudinal, and multicenter designs to better understand developmental pathways and support personalized treatment strategies.

Keywords

• adult ADHD
• comorbidity
• externalizing disorder
• internalizing disorder

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