Phenomenology of Obsessive Compulsive Disorder in Children and Adoles-cents: A University Hospital Sample

Öz

Background: Obsessive-compulsive disorder (OCD) is a heterogeneous disorder and exhibits phenomenological diversity. It is also known to differ in many areas in children compared to adults. In our study, we aimed to define the phenomenological characteristics, comorbid diagnoses and sociodemographic characteristics of children with OCD and to investigate the effect of these characteristics on treatment response. Materials and Methods: Our study was designed as a retrospective five-year file review. It was conducted with 107 children and adolescents diagnosed with OCD. Yale-Brown Obsessive-Compulsive Scale for Children was used to evaluate obsessive-compulsion subtypes. The benefit of treatment was determined according to clinical evaluations. The significance level was set as p < 0.05 for all statistical tests. Results: The sample was divided into pediatric age group (37.4%) and adolescent age group (62.6%). The most common obsessions were obsessions of getting dirty and being unsure, and the most common compulsions were cleaning and check-ing. The obsessions and compulsions of hoarding were higher in the younger age group than in the other group (p= 0.049). The presence of comorbidity was 62.6% and the most common comorbidity groups were anxiety and related disorders (38.3%), disruptive behavior disorders (23.4%) and neurodevelopmental disorders (7.5%). In the adolescent age group, anxiety disorders (46.3%, 25.0% p=0.029) and in the pediatric age group, disruptive behavior disorders (37.5%, 14.9% p=0.008) were more frequent comorbidities compared to the other groups. Comorbidities of both disruptive behavior disor-ders (64%, 36% p=0.028) and neurodevelopmental disorders (87.5%, 12.5% p=0.021) were more common in boys than in girls. Sertraline (60.7%) and fluoxetine (23.4%) were the most preferred treatments in medical treatment. Benefit from medical treatment and CBT/DT was not associated with age and gender. Conclusions: In our study, the most common obsession was contamination, the most common compulsion was cleaning, and the most common comorbidity was anxiety and related disorders. It was determined that comorbidity of disruptive behavior disorders was higher in males and in the child age group. The phenomenology of OCD in children and adolescents, the evalua-tion of the differences according to comorbid psychiatric disorders, age group and gender, and the examination of the effects of these characteristics on treatment response are of great importance in terms of improving long-term prognosis.

Çocuk ve Ergenlerde Obsesif Kompulsif Bozukluk Fenomenolojisi: Bir Üniversite Hastanesi Örneklemi

Öz

Amaç: Obsesif kompulsif bozukluk (OKB) heterojen bir hastalık olup fenomenolojik açıdan çeşitlilik sergilemektedir. Ayrıca çocuklarda yetişkinlere göre birçok alanda farklılık gösterdiği bilinmektedir. Çalışmamızda OKB tanısı olan çocukların sosyo-demografik özellikleri fenomenolojik özellikleri ve komorbid tanılarının tanımlanması ve bu özelliklerin tedavi yanıtı üzerinde-ki etkisinin araştırılması amaçlanmıştır. Materyal ve metod: Araştırmamız retrospektif beş yıllık dosya taraması olarak tasarlanmıştır. OKB tanısı almış 107 çocuk ve ergen ile yapılmıştır. Obsesyon-kompulsiyon alt tiplerinin değerlendirilmesinde Çocuklar için Yale-Brown Obsesyon-Kompulsiyon ölçeği kullanılmıştır. Tedaviden görülen fayda, klinik değerlendirmelere göre belirlenmiştir. Tüm istatistiksel testler için anlamlılık düzeyi p < 0.05 olarak ayarlanmıştır. Bulgular: Örneklem çocuk yaş grubu (%37,4) ve ergen yaş grubu (%62,6) olarak ikiye ayrıldı. En yaygın obsesyonlar kirlen-me ve emin olamama obsesyonları, en sık kompulsiyonlar ise temizleme ve kontrol etme idi. Küçük yaş grubunda biriktirme obsesyon ve kompülsiyonu diğer gruptan daha yüksek tespit edildi (p= 0,049). Eş tanı varlığı %62,6 saptanmış olup, en sık eş tanı grubu anksiyete ve ilişkili bozukluklar (%38,3), yıkıcı davranış bozuklukları (%23,4) ve nörogelişimsel bozukluklardı (%7,5). Ergen yaş grubunda çocuk yaş grubuna göre anksiyete bozuklukları (%46,3 %25,0 p=0,029), çocuk yaş grubunda ise ergen yaş grubuna göre yıkıcı davranış bozuklukları (%37,5 , %14,9 p=0,008) daha sık eşlik ediyordu. Hem yıkıcı davranış bozuklukları (%64 %36 p=0.028) hem de nörogelişimsel bozukluklar (%87,5 %12,5 p=0.021) komorbiditelerinin, erkeklerde kızlara göre daha yüksek eşlik ettiği görüldü. Medikal tedavide en sık Sertralin (%60,7) ve Fluoksetin (23,4%) tedavilerinin tercih edildiği saptandı. Medikal tedavi ve BDT/DT ile fayda görme durumu yaş ve cinsiyet ile ilişkili bulunmadı. Sonuç: Çalışmamızda, en sık görülen obsesyonun kirlenme en sık kompülsiyonun temizleme olduğu, en sık eş tanının ise anksiyete ve ilişkili bozukluklar olduğu bulunmuştur. Yıkıcı davranış bozuklukları eş tanısının erkeklerde ve çocuk yaş gru-bunda daha yüksek olduğu saptanmıştır. Çocuk ve ergenlerde OKB fenomenolojisi, eşlik eden psikiyatrik bozukluklar, yaş grubu ve cinsiyete göre farklılıkların değerlendirilmesi ve bu özelliklerin tedavi yanıtına etkilerinin irdelenmesi; uzun dönem prognozu iyileştirebilmek açısından büyük önem taşımaktadır

Anahtar Kelimeler

• çocuk ve ergen
• obsesif kompulsif bozukluk
• fenomenoloj
• komorbidite
• tedavi yanıtı

Kaynakça

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