Uyku Bruksizmli Çocuk ve Ergenlerde Komorbid Psikopatolojilerin, Psikososyal Faktörlerin ve Psikiyatrik Tedavi Yaklaşımının Değerlendirilmesi

Öz

Amaç: Önceki araştırmalar çeşitli psikopatolojiler ve psikososyal faktörler ile bruksizm arasında yakın bir ilişki olduğunu ortaya koymuştur. Bununla birlikte, bruksizmli çocuk ve ergenlerde psikososyal faktörler ve psikiyatrik zorluklar yeterince araştırılmamıştır. Bu çalışmada uyku bruksizmli çocuk ve ergenlerin sosyodemografik özelliklerini, psikososyal faktörlerini ve komorbid psikopatolojilerini araştırmayı amaçladık. Materyal ve Metod: Çalışmaya 2018-2024 yılları arasında iki farklı Çocuk ve Ergen Psikiyatrisi polikliniğinde uyku bruksizmi tanısı konulan ve takip edilen 4-17 yaş arası 67 çocuk ve ergen dahil edildi. Bu hastaların davranışsal ve duygusal özellikleri, komorbid psikiyatrik bozuklukları, bruksizmin klinik özellikleri ve bruksizme yönelik tedavi yaklaşımlarına ilişkin veriler retrospektif olarak incelendi. Bulgular: Sonuçlarımız örneklemin %41.8'inde en az bir psikiyatrik bozukluk ve %10,4'ünün eşik altı psikiyatrik belirtiler olduğunu gösterdi. En sık komorbid psikiyatrik bozukluklar anksiyete bozuklukları, dikkat eksikliği hiperaktivite bozukluğu, nokturnal enürezisi ve davranım bozukluklarıydı. Olguların %41.8'inde bruksizm psikososyal faktörlerle bağlantılıydı. Eşlik eden psikiyatrik bozukluklar okul ve ergen yaş gruplarında okul öncesi çocuklara göre anlamlı derecede daha yaygındı. Benzer şekilde, bruksizm ile psikososyal faktörler arasındaki bağlantı yaş ilerledikçe daha da belirginleşti. Ailede pozitif bruksizm öyküsü %44.8 idi. Bruksizme tedavi seçeneği olarak, olguların %88.1'inde davranışsal yaklaşım ve farmakoterapi tercih edilirken, %11.9'una yalnızca davranışsal yaklaşım uygulandı. Farmakoterapide en sık kullanılan ilaçlar hidroksizin, trisiklik antidepresanlar, antipsikotikler, atipik antidepresanlar ve melatonindi. Tedaviye yanıt açısından örneklemin %83.6'sı (tam veya kısmi) yanıt verirken, %16.4'ü yanıt vermedi veya tedaviye dirençliydi. Sonuç: Bu çalışma uyku bruksizmli pediatrik popülasyonda psikiyatrik komorbiditenin oldukça yaygın olduğunu ortaya koymuştur. Sonuçlar bruksizmin sadece dental bir problem olmadığını, aynı zamanda çeşitli psikopatolojiler ve psikososyal faktörlerle de ilişkili olduğunu göstermektedir. Bu nedenle bruksizmle karşılaşabilecek sağlık profesyonellerinin bruksizm ile psikopatolojiler ve psikososyal faktörler arasındaki ilişkinin farkında olması gerekmektedir. Bruksizmli çocukların biyo-psiko-sosyal perspektiften multidisipliner ve bütüncül bir yaklaşımla dikkatle incelenmesi ve psikososyal ve psikiyatrik zorluklar açısından taranması önerilmektedir.

Anahtar Kelimeler

• Uyku bruksizmi
• çocuk ve ergen
• anksiyete
• psikopatoloji
• tedavi

Assessment of Comorbid Psychopathologies, Psychosocial Factors and Psychiatric Treatment Approach in Children and Adolescents with Sleep Bruxism

Öz

Background: Previous studies have revealed a close relationship between a variety of psychopathologies and psychosocial factors, and bruxism. However, psychosocial factors and psychiatric difficulties in children and adolescents with bruxism have not been extensively studied. In the current study, we sought to examine the sociodemographic characteristics, psychosocial factors, and comorbid psychopathologies of children and adolescents with sleep bruxism. Materials and Methods: The study included 67 children and adolescents between the ages of 4-17 who were diagnosed with sleep bruxism and followed up at two different Child and Adolescent Psychiatry outpatient clinics between 2018 and 2024. Data on behavioral and emotional characteristics and comorbid psychiatric disorders of these patients, clinical features of bruxism, and treatment approaches to bruxism were retrospectively investigated. Results: Our results indicated that 41.8 of the sample had at least one comorbid psychiatric disorder, and 10.4% had subthreshold psychiatric symptoms. The most common comorbid psychiatric disorders were anxiety disorders, attention deficit hyperactivity disorder, nocturnal enuresis, and conduct disorders. In 41.8% of cases, bruxism was linked to psychosocial factors. Comorbid psychiatric disorders were significantly more prevalent in the school and adolescent age groups than in preschoolers. Similarly, the connection between bruxism and psychosocial factors became more evident with age. The frequency of a positive family history of bruxism was 44.8%. As treatment options for bruxism, the behavioral approach and pharmacotherapy were preferred in 88.1% of cases, and only the behavioral approach was applied to 11.9%. The most common drugs used in pharmacotherapy were hydroxyzine, tricyclic antidepressants, antipsychotics, atypical antidepressants, and melatonin. In terms of response to treatment, 83.6% of the sample responded (completely or partially), while 16.4% did not respond or were resistant to treatment. Conclusions: This study yielded that psychiatric comorbidity is quite common in the pediatric population with sleep bruxism. The outcomes suggest that bruxism is not only a dental problem but is also associated with a variety of psychopathologies and psychosocial factors. Therefore, health professionals who may encounter bruxism should be aware of the relationship between bruxism and psychopathologies and psychosocial factors. It is recommended that children with bruxism be investigated carefully in a multidisciplinary and holistic approach from a bio-psycho-social perspective and screened for psychosocial and psychiatric difficulties.

Anahtar Kelimeler

• Sleep bruxism
• child and adolescent
• anxiety
• psychopathology
• treatment

Kaynakça

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