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Dimensional Approach in Psychiatry

Yıl 2012, Cilt 4, Sayı 3, 315 - 334, 01.09.2012
https://doi.org/10.5455/cap.20120419

Öz

In psychiatry there is a traditional categorical conception stating that several disorders like schizophrenia and bipolar disorder have distinct etiologies. On the other hand, dimensional approach claims that these entities are actually the same disorder reflecting different clinical aspects of same mental disorder in the course of time. ICD and DSM classifications are based on separate categories of different mental disorders. Howewer, it is quite difficult to consider a mental disorder as a discrete entity that has absolute boundaries from other disorders. There are patients manifesting symptoms of two or more categories but do not fulfill all diagnostic criteria for any mental disorder. Dimensional approach handles the psychopathology as a continuing process and establish the patients to the different ongoing points. According to this view, in fact, multiple diagnosis reflect dimensions of the same disease.

Kaynakça

  • Boratav C. Duygudurum bozuklukları ve nozoloji: eleştirel bir inceleme. Duygudurum Dizisi 2000; 1:18-28.
  • Jablensky A, Hugler H, Von Cranach M, Kalinov K. Kraepelin revisited: a reassessment and statistical analysis of dementia praecox and manic-depressive insanity in 1908. Psychol Med 1993; 23:843-858.
  • Shorter E. A history of psychiatry. New York, Wiley, 1997.
  • Healy D. The creation of psychopharmacology, Cambridge, MA, Harvard University Press, 2002.
  • Goodwin FK, Ghaemi SN. The impact of the discovery of lithium on psychiatric thought and practice in the USA and Europe. Aust NZJ Psychiatry 1999; 33(Suppl):S54-S64.
  • Cooper J, Kendell R, Gurland B, Sharpe L, Copeland J, Simon R. Psychiatric diagnosis in New York and London, London, Oxford University Press, 1972.
  • Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: Its application to Schizophrenia. Am J Psychiatry 1970; 126:983-998.
  • Sorias S. Bilimsel devrimler ve yeni kraepelincilik. Klinik Psikiyatri Dergisi 2011; 14:51-58.
  • Angst J, Marneos A. Bipolarity from ancient to modern times: conception, birth and rebirth. J Affect Disord 2001; 67:3-19.
  • Alda M. The phenotypic spectra of bipolar disorder. Eur Neuropsychopharmacol 2004; 14:94 -99.
  • Amerikan Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). American Psychiatric Press, Washington DC, 1994.
  • Dünya Sağlık Örgütü. Ruhsal ve Davranışsal Bozukluklar Sınıflandırılması. Ankara, Türkiye Sinir ve Ruh Sağlığı Derneği Yayını, 1993.
  • Pope HG Jr, Lipinski JF. Diagnosis in schizophrenia and manic depressive illness. Arch Gen Psychiatry 1978; 35:811-828.
  • Lake CR. Disorders of thought are severe mood disorders:the selective attention deficit in mania challenges the Kraepelinian dichotomy. Schizophr Bull 2008; 34:109-117.
  • Altınbaş K, Tunç S, Yazar MS, Özçetinkaya S, Gülöksüz S, Oral ET. Kraepelin bugün yaşasaydı dikotomi varlığını sürdürüyor olur muydu? Düşünen Adam Psikiyat- ri ve Nörolojik Bilimler Dergisi 2011; 24:321-330.
  • Moller HJ. Bipolar disorder and schizophrenia: distinct illnesses or a continuum? J Clin Psychiatry 2003; 64(Suppl 6):23-27.
  • Crow TJ. Nature of the genetic contribution to psychotic illness: a continuum viewpoint. Acta Psychiatr Scand 1990; 81:401-408.
  • Taylor MA. Are schizophrenia and affective disorder related? a selected literature review. Am J Psychiatry 1992; 149:22-32.
  • Pope HG, Yurgelun-Todd D. Schizophrenic individuals with bipolar first-degree relatives: analysis of two pedigrees. J Clin Psychiatry 1990; 51:97-101.
  • Yazıcı O. Psikotik affektif bozukluklar. Psikiyatri Dünyası 1999; 3:79-82.
  • Berrettini WH. Susceptibility loci for bipolar disorder: overlap with inherited vulnerability to schizophrenia. Biol Psychiatry 2000; 47:245-251.
  • Özer S, Ulusoy S, Okur H, Göğüş A, Akarsu N, Uluşahin A. Şizofreni ve bipolar bozukluğun yüklülük gösterdiği geniş bir ailede psikoza yatkınlık geninin araştırılma- sı. Türk Psikiyatri Dergisi 2003; 14:7-19
  • Verimli A. Affektif spektrum bozuklukları. Ankara, Nobel Tıp Kitabevi, 2004.
  • Bleuler E. Dementia praecox, or the group of schizophrenias. New York, International Universities Press, 1950.
  • Chapman J. The early symptoms of schizophrenia. Br J Psychiatry 1966; 112:225- 251.
  • Liem HJ. Family studies of schizophrenia an update and commentery. Schizophr Bull 1980; 5:429-455.
  • Thaker G, Adami H, Moran M. Psychiatric illness in families of subjects with schizophrenic spectrum personality disorders: high morbidity risk for unspecified functional psychosis and schizophrenia. Am J Psychiatry 1993; 150: 66-71.
  • Rossi A, Daneluzzo E. Schizotypal dimensions in normals and schizophrenic patients: a comparison with other clinical samples. Schizophr Res 2002; 54:67-75.
  • Amerikan Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). American Psychiatric Press, Washington, DC, 1980.
  • Kendler KS, McGuire M, Gruenberg AM, O'Hare A, Spellman M, Walsh D. The Roscommon family study. I Methods, diagnosis of probands and risks for schizophrenia in relatives. Arch Gen Psychiatry 1993; 50:527-540.
  • Torgersen S, Onstad S, Skre I, Edvardsen S, Kringlen E. “True” schizotypal personality disorder: a study of co-twins and relatives of schizophrenic probands. Am J Psychiatry 1993; 150:1661-1667.
  • Özer S, Ulusoy S, Kabakçı E, Uluşahin A. Şizotipal kişilik özellikleri alt ölçeği’ alt ölçeği: değerlendiriciler arası güvenilirlik çalışması. Klinik Psikiyatri Dergisi 2003; 6:141-146.
  • Cannon TD, Gasperoni TL, Van Erp TG. Quantitative neural indicators of liability to schizophrenia: implications for molecular genetic studies. Am J Med Genet 2001; 105:16-19.
  • Vollema MG, Sitskoorn MM, Appels MCM. Does the schizotypal personality questionnaire reflect the biological- genetic vulnerability to schizophrenia. Schizophr Res 2002; 54:39-45.
  • Vollema MG, Hoijtink H. The multidimensionality of self-report schizotypy in a psychiatric population: an analysis using multidimensional Rasch-models. Schizophr Bull 2000; 26:565-575.
  • Nuechterlein KH, Asarnow RF, Subotnik KL. The structure of schizotypy: relationships between neurocognitive and personality disorder features in relatives of schizophrenic patients in the UCLA family study. Schizophr Res 2002; 54:121-130.
  • Torgerson S, Edvardsen J, Oien PA. Schizotypal personality disorder inside and outside the schizophrenia spectrum. Schizophr Res 2002; 54:33-38.
  • Claridge G, McCreery C, Mason O, Bentall R, Boyle G, Slade P. The factor structure of ‘schizotypal’ traits: a large replication study. Br J Clin Psychol 1996; 35:103-115.
  • Gruzelier JH. The factorial structure of schizotypy, part I: affinities with syndromes of schizophrenia. Schizophr Bull 1996; 22:611-620.
  • Mata I, Gilvarry CM, Jones PB, Lewis SW, Murray RM, Sham PC. Schizotypal personality traits in nonpsychotic relatives are associated with positive symptoms in psychotic probands. Schizophr Bull 2003; 29:273-283.
  • Vollema MG, Van den Bosch RJ. The multidimensionality of schizotypy. Schizophr Bull 1995; 21:19-31.
  • Schürhoff F, Laguerre A, Szöke A, Meary A, Leboyer M. Schizotypal dimensions: continuity between schizophrenia and bipolar disorders. Schizophr Res 2005; 80:235- 242.
  • Squires-Wheeler E, Skodol AE, Basset A, Erlenmeyer-Kimling L. DSM-III-R schizotypal personality traits in offspring of schizophrenic disorder, affective disorder, and normal control parents. J Psychiatr Res 1989; 23:229-239.
  • Kendler KS, Walsh D. A new classification for the psychoses - in reply. Arch Gen Psychiatry 1999; 56:672-673.
  • Akiskal HS. The bipolar spectrum: new concepts in classification and diagnosis. In Psychiatry Update: The American Psychiatric Association Annual Review, Vol 2 (Ed L Grinspoon): 271-292. Washington DC, American Psychiatric Association, 1983.
  • Altınbaş K, Smith DJ, Craddock N. Rediscovering the bipolar spectrum. Nöropsikiyatri Arşivi 2011; 48:167-170.
  • Sayın A, Aslan S. Duygudurum bozuklukları ile huy, karakter ve kişilik ilişkisi. Turk Psikiyatri Derg 2005; 16:276-283.
  • Maj M, Akiskal HS, Lopez-Ibor JJ, Sartorius N. Bipolar Disorders. West Sussex, UK, Wiley, 2002.
  • Akiskal HS. The prevalent clinical spectrum of bipolar disorders: beyond DSM IV. J Clin Psychopharmacol 1996; 16 (Suppl 3):117-122.
  • Akiskal HS. Toward a temperament based approach to depression: implications for neurobiologic research, Adv Biochem Psychopharmacol 1995; 49:99-112.
  • Akiskal HS, Bourgeois ML, Angst J, Post R, Möller H, Hirschfeld R. Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord 2000; 59(Suppl 1):S5-S30.
  • Kelsoe JR. Arguments for the genetic basis of the bipolar spectrum. J Affect Disord 2003; 73:183-197.
  • Akiskal HS, Pinto O. The evolving bipolar spektrum: prototypes I, II, III, IV. Psychiatr Clin North Am 1999; 22:517-534.
  • Tynes LL, White K, Steketee GS. Toward a new nosology of obsessive compulsive disorder. Compr Psychiatry 1990; 31:465-480.
  • Hollander E, Zohar J. Beyond refractory obsessions and anxiety states: toward remission. J Clin Psychiatry 2004; 65 (Suppl 14):3-5.
  • Özsoylar G, Sayın A, Candansayar S. Panik bozukluğu ve obsesif kompulsif bozukluk hastalarının yeme tutumları açısından karşılaştırılması. Klinik Psikiyatri Dergisi 2008; 11:17-24.
  • Mataix-Cols D, Pertusa A, Leckman JF. Issues for DSM-V: how should obsessive– compulsive and related disorders be classified? Am J Psychiatry 2007; 164:1313– 1314.
  • Hollander E. Obsessive–compulsive spectrum disorders: an overview. Psychiatr Ann 1993; 23:355-358.
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Psikiyatride Boyutsal Yaklaşım

Yıl 2012, Cilt 4, Sayı 3, 315 - 334, 01.09.2012
https://doi.org/10.5455/cap.20120419

Öz

Psikiyatride, özellikle şizofreni ve bipolar bozukluk olmak üzere, ruhsal bozuklukların farklı etyolojilere sahip olduğunu ileri süren varsayım geleneksel kategorik yaklaşımı sergiler. Boyutsal yaklaşım ise, ruhsal bozuklukların aslında tek bir hastalığın zaman içinde farklı klinik görünümler şeklinde ortaya çıkmasından ibaret olduğunu ileri sürmektedir. DSM ve ICD sistemleri, öteden beri ruhsal bozuklukları ayrı kategoriler olarak ele almış ve öyle sınıflandırmışlardır. Oysa kategorileri her zaman birbirlerinden ayırmak mümkün olmamaktadır. Hiçbir kategorinin tanımına uymayan, fakat hasta olduğu şüphe götürmeyen, iki kategorinin kısmi özelliklerini bir arada gösteren fakat hiçbirinin ölçütlerini tam olarak karşılamayan hastalar bulunmaktadır. Boyutsal yaklaşım patolojiyi sürekli bir boyut olarak ele alır ve her hastayı bu sürekliliğin farklı bir noktasına yerleştirir. Bu yaklaşıma göre çoğul tanılar aslında aynı hastalık doğasının farklı boyutlarıdır yaklaşımı ile bir hastanın bütün semptomlarını tek bir hastalıkla açıklayabilmektir.

Kaynakça

  • Boratav C. Duygudurum bozuklukları ve nozoloji: eleştirel bir inceleme. Duygudurum Dizisi 2000; 1:18-28.
  • Jablensky A, Hugler H, Von Cranach M, Kalinov K. Kraepelin revisited: a reassessment and statistical analysis of dementia praecox and manic-depressive insanity in 1908. Psychol Med 1993; 23:843-858.
  • Shorter E. A history of psychiatry. New York, Wiley, 1997.
  • Healy D. The creation of psychopharmacology, Cambridge, MA, Harvard University Press, 2002.
  • Goodwin FK, Ghaemi SN. The impact of the discovery of lithium on psychiatric thought and practice in the USA and Europe. Aust NZJ Psychiatry 1999; 33(Suppl):S54-S64.
  • Cooper J, Kendell R, Gurland B, Sharpe L, Copeland J, Simon R. Psychiatric diagnosis in New York and London, London, Oxford University Press, 1972.
  • Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: Its application to Schizophrenia. Am J Psychiatry 1970; 126:983-998.
  • Sorias S. Bilimsel devrimler ve yeni kraepelincilik. Klinik Psikiyatri Dergisi 2011; 14:51-58.
  • Angst J, Marneos A. Bipolarity from ancient to modern times: conception, birth and rebirth. J Affect Disord 2001; 67:3-19.
  • Alda M. The phenotypic spectra of bipolar disorder. Eur Neuropsychopharmacol 2004; 14:94 -99.
  • Amerikan Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). American Psychiatric Press, Washington DC, 1994.
  • Dünya Sağlık Örgütü. Ruhsal ve Davranışsal Bozukluklar Sınıflandırılması. Ankara, Türkiye Sinir ve Ruh Sağlığı Derneği Yayını, 1993.
  • Pope HG Jr, Lipinski JF. Diagnosis in schizophrenia and manic depressive illness. Arch Gen Psychiatry 1978; 35:811-828.
  • Lake CR. Disorders of thought are severe mood disorders:the selective attention deficit in mania challenges the Kraepelinian dichotomy. Schizophr Bull 2008; 34:109-117.
  • Altınbaş K, Tunç S, Yazar MS, Özçetinkaya S, Gülöksüz S, Oral ET. Kraepelin bugün yaşasaydı dikotomi varlığını sürdürüyor olur muydu? Düşünen Adam Psikiyat- ri ve Nörolojik Bilimler Dergisi 2011; 24:321-330.
  • Moller HJ. Bipolar disorder and schizophrenia: distinct illnesses or a continuum? J Clin Psychiatry 2003; 64(Suppl 6):23-27.
  • Crow TJ. Nature of the genetic contribution to psychotic illness: a continuum viewpoint. Acta Psychiatr Scand 1990; 81:401-408.
  • Taylor MA. Are schizophrenia and affective disorder related? a selected literature review. Am J Psychiatry 1992; 149:22-32.
  • Pope HG, Yurgelun-Todd D. Schizophrenic individuals with bipolar first-degree relatives: analysis of two pedigrees. J Clin Psychiatry 1990; 51:97-101.
  • Yazıcı O. Psikotik affektif bozukluklar. Psikiyatri Dünyası 1999; 3:79-82.
  • Berrettini WH. Susceptibility loci for bipolar disorder: overlap with inherited vulnerability to schizophrenia. Biol Psychiatry 2000; 47:245-251.
  • Özer S, Ulusoy S, Okur H, Göğüş A, Akarsu N, Uluşahin A. Şizofreni ve bipolar bozukluğun yüklülük gösterdiği geniş bir ailede psikoza yatkınlık geninin araştırılma- sı. Türk Psikiyatri Dergisi 2003; 14:7-19
  • Verimli A. Affektif spektrum bozuklukları. Ankara, Nobel Tıp Kitabevi, 2004.
  • Bleuler E. Dementia praecox, or the group of schizophrenias. New York, International Universities Press, 1950.
  • Chapman J. The early symptoms of schizophrenia. Br J Psychiatry 1966; 112:225- 251.
  • Liem HJ. Family studies of schizophrenia an update and commentery. Schizophr Bull 1980; 5:429-455.
  • Thaker G, Adami H, Moran M. Psychiatric illness in families of subjects with schizophrenic spectrum personality disorders: high morbidity risk for unspecified functional psychosis and schizophrenia. Am J Psychiatry 1993; 150: 66-71.
  • Rossi A, Daneluzzo E. Schizotypal dimensions in normals and schizophrenic patients: a comparison with other clinical samples. Schizophr Res 2002; 54:67-75.
  • Amerikan Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). American Psychiatric Press, Washington, DC, 1980.
  • Kendler KS, McGuire M, Gruenberg AM, O'Hare A, Spellman M, Walsh D. The Roscommon family study. I Methods, diagnosis of probands and risks for schizophrenia in relatives. Arch Gen Psychiatry 1993; 50:527-540.
  • Torgersen S, Onstad S, Skre I, Edvardsen S, Kringlen E. “True” schizotypal personality disorder: a study of co-twins and relatives of schizophrenic probands. Am J Psychiatry 1993; 150:1661-1667.
  • Özer S, Ulusoy S, Kabakçı E, Uluşahin A. Şizotipal kişilik özellikleri alt ölçeği’ alt ölçeği: değerlendiriciler arası güvenilirlik çalışması. Klinik Psikiyatri Dergisi 2003; 6:141-146.
  • Cannon TD, Gasperoni TL, Van Erp TG. Quantitative neural indicators of liability to schizophrenia: implications for molecular genetic studies. Am J Med Genet 2001; 105:16-19.
  • Vollema MG, Sitskoorn MM, Appels MCM. Does the schizotypal personality questionnaire reflect the biological- genetic vulnerability to schizophrenia. Schizophr Res 2002; 54:39-45.
  • Vollema MG, Hoijtink H. The multidimensionality of self-report schizotypy in a psychiatric population: an analysis using multidimensional Rasch-models. Schizophr Bull 2000; 26:565-575.
  • Nuechterlein KH, Asarnow RF, Subotnik KL. The structure of schizotypy: relationships between neurocognitive and personality disorder features in relatives of schizophrenic patients in the UCLA family study. Schizophr Res 2002; 54:121-130.
  • Torgerson S, Edvardsen J, Oien PA. Schizotypal personality disorder inside and outside the schizophrenia spectrum. Schizophr Res 2002; 54:33-38.
  • Claridge G, McCreery C, Mason O, Bentall R, Boyle G, Slade P. The factor structure of ‘schizotypal’ traits: a large replication study. Br J Clin Psychol 1996; 35:103-115.
  • Gruzelier JH. The factorial structure of schizotypy, part I: affinities with syndromes of schizophrenia. Schizophr Bull 1996; 22:611-620.
  • Mata I, Gilvarry CM, Jones PB, Lewis SW, Murray RM, Sham PC. Schizotypal personality traits in nonpsychotic relatives are associated with positive symptoms in psychotic probands. Schizophr Bull 2003; 29:273-283.
  • Vollema MG, Van den Bosch RJ. The multidimensionality of schizotypy. Schizophr Bull 1995; 21:19-31.
  • Schürhoff F, Laguerre A, Szöke A, Meary A, Leboyer M. Schizotypal dimensions: continuity between schizophrenia and bipolar disorders. Schizophr Res 2005; 80:235- 242.
  • Squires-Wheeler E, Skodol AE, Basset A, Erlenmeyer-Kimling L. DSM-III-R schizotypal personality traits in offspring of schizophrenic disorder, affective disorder, and normal control parents. J Psychiatr Res 1989; 23:229-239.
  • Kendler KS, Walsh D. A new classification for the psychoses - in reply. Arch Gen Psychiatry 1999; 56:672-673.
  • Akiskal HS. The bipolar spectrum: new concepts in classification and diagnosis. In Psychiatry Update: The American Psychiatric Association Annual Review, Vol 2 (Ed L Grinspoon): 271-292. Washington DC, American Psychiatric Association, 1983.
  • Altınbaş K, Smith DJ, Craddock N. Rediscovering the bipolar spectrum. Nöropsikiyatri Arşivi 2011; 48:167-170.
  • Sayın A, Aslan S. Duygudurum bozuklukları ile huy, karakter ve kişilik ilişkisi. Turk Psikiyatri Derg 2005; 16:276-283.
  • Maj M, Akiskal HS, Lopez-Ibor JJ, Sartorius N. Bipolar Disorders. West Sussex, UK, Wiley, 2002.
  • Akiskal HS. The prevalent clinical spectrum of bipolar disorders: beyond DSM IV. J Clin Psychopharmacol 1996; 16 (Suppl 3):117-122.
  • Akiskal HS. Toward a temperament based approach to depression: implications for neurobiologic research, Adv Biochem Psychopharmacol 1995; 49:99-112.
  • Akiskal HS, Bourgeois ML, Angst J, Post R, Möller H, Hirschfeld R. Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord 2000; 59(Suppl 1):S5-S30.
  • Kelsoe JR. Arguments for the genetic basis of the bipolar spectrum. J Affect Disord 2003; 73:183-197.
  • Akiskal HS, Pinto O. The evolving bipolar spektrum: prototypes I, II, III, IV. Psychiatr Clin North Am 1999; 22:517-534.
  • Tynes LL, White K, Steketee GS. Toward a new nosology of obsessive compulsive disorder. Compr Psychiatry 1990; 31:465-480.
  • Hollander E, Zohar J. Beyond refractory obsessions and anxiety states: toward remission. J Clin Psychiatry 2004; 65 (Suppl 14):3-5.
  • Özsoylar G, Sayın A, Candansayar S. Panik bozukluğu ve obsesif kompulsif bozukluk hastalarının yeme tutumları açısından karşılaştırılması. Klinik Psikiyatri Dergisi 2008; 11:17-24.
  • Mataix-Cols D, Pertusa A, Leckman JF. Issues for DSM-V: how should obsessive– compulsive and related disorders be classified? Am J Psychiatry 2007; 164:1313– 1314.
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Ayrıntılar

Birincil Dil Türkçe
Bölüm Derleme
Yazarlar

Osman ÖZDEMİR Bu kişi benim

Yayımlanma Tarihi 1 Eylül 2012
Kabul Tarihi
Yayınlandığı Sayı Yıl 2012, Cilt 4, Sayı 3

Kaynak Göster

AMA Özdemir O. Psikiyatride Boyutsal Yaklaşım. Psikiyatride Güncel Yaklaşımlar. 2012; 4(3): 315-334.

Creative Commons Lisansı
Psikiyatride Güncel Yaklaşımlar Creative Commons Atıf-Gayriticari-Türetilemez 4.0 Uluslararası Lisansı ile lisanslanmıştır.