Dikkat eksikliği/ hiperaktivite bozukluğu tanılı çocuk ve ergenlerde yürütücü işlevlerin ve uyku alışkanlıklarının tedaviyle olan ilişkisi
Küçük Resim Yok
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bolu Abant İzzet Baysal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Dikkat Eksikliği/ Hiperaktivite Bozukluğu (DEHB)'li olgularda sık görülen yürütücü işlev bozukluklarının tedaviyle iyileşme gösterdiğini bildiren pek çok çalışma mevcuttur. DEHB'li olgularda uyku problemlerinin de sık gözlendiği bilinmektedir. DEHB tedavi sürecinde metilfenidatın yan etkileri nedeniyle ilaç tatili verilip verilmemesi konusu halen tartışılmaktadır. Literatürde ise ilaç tatilinin DEHB belirti şiddeti üzerine etkilerini inceleyen kısıtlı sayıda çalışma bulunmakla birlikte ilaç tatilinin yürütücü işlevler ve uyku problemleri üzerine etkisini inceleyen çalışma bulunamamıştır. Çalışmamızda, DEHB'li olgularda tedavi öncesi, en az 8 hafta metilfenidat tedavisi sonrası ve en az 8 hafta ilaç tatili verildikten sonra olmak üzere üç kez yürütücü işlevler ve uyku problemleri değerlendirilmiş ve ilaç tedavisinin ve ilaç tatilinin yürütücü işlevler ve uyku problemleri üzerine etkilerinin incelenmesi amaçlanmıştır. Araştırmamız uzunlamasına bir çalışma olarak dizayn edilmiş ve Bolu Abant İzzet Baysal Üniversitesi Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları polikliniğinde Eylül 2018- Eylül 2019 tarihleri arasında yürütülmüştür. Araştırmamıza Eylül 2018-Kasım 2018 tarihleri arasında polikliniğe başvuran, 7-18 yaş arasında olan, DEHB tanısı almış ve dahil edilme kriterlerini karşılamış olan 51 olgu katılmıştır. Çalışmaya katılan olgulara tedavi öncesi, tedavi sonrası ve ilaç tatili verdikten sonra Stroop testi ve Klinik Global İzlenim Ölçeği (KGİÖ) uygulanmıştır. Aynı zaman dilimlerinde ebeveynler tarafından doldurulmak üzere Conners Ebeveyn Derecelendirme Ölçeği-Kısa Formu (CEDÖ) ve Çocuk Uyku Alışkanlıkları Anketi (ÇUAA) ve öğretmen tarafından doldurulmak üzere Conners Öğretmen Derecelendirme Ölçeği-Kısa Formu (CÖDÖ) verilmiştir. Çalışma sonuçlarımıza bakıldığında takip sürecinde olguların 22'sinin (%43) tedaviyi bıraktığı gözlenmiştir. Çalışmamızda tedaviye devam eden ve tedaviye devam etmeyen gruplar karşılaştırıldığında sosyo-demografik veriler açısından istatistiksel olarak anlamlı bir fark bulunmamış (p>0.05), sadece kardeş sayısı tedaviye devam etmeyen grupta anlamlı derecede daha fazla bulunmuştur (p=0.045). Tedaviye devam eden ve tedaviye devam etmeyen gruplar arasında hastalık şiddeti açısından anlamlı farklılık bulunmamıştır. Çalışmamıza katılan olgular KGİÖ ile değerlendirildiğinde, tedavi öncesine göre, tedavi sonrasında olguların istatistiksel olarak anlamlı daha düşük puan aldığı (p?0.001) ve ilaç tatili verildikten sonra puanlarda anlamlı bir artış olduğu bulunmuştur (p?0.001). Çalışmamıza katılan olguların CEDÖ alt ölçek puanları incelendiğinde, tedavi sonrasında tedavi öncesine göre DE alt ölçeğinde anlamlı derecede azalma olduğu gözlenmiştir (p?0.001). Çalışmamıza katılan olguların CÖDÖ alt ölçek puanları incelendiğinde, tedavi sonrasında tedavi öncesine göre DE ve DS alt ölçeği puanlarında azalma olduğu gözlenmiştir (p değerleri sırasıyla: 0.014, 0.012). Çalışmamıza katılan olgulara uygulanan Stroop testi verileri incelendiğinde, tedavi sonrasında, tedavi öncesine göre 5 bölümde de tamamlama sürelerinde kısaldığı saptanmıştır. Tedavi sonrasında, tedavi öncesine göre Stroop 5'te daha az hata ve daha az düzeltme yaptıkları bulunmuştur (p=0.005, p=0.007). İlaç tatili verildikten sonra ise tedavi sonrasına göre Stroop 5'te daha fazla hata yaptıkları gözlenmiştir (p=0.037). Çalışmamıza katılan olguların ebeveynleri tarafından doldurulan ÇUAA alt ölçek puanları incelendiğinde, tedavi sonrasında, tedavi öncesine göre parasomnialar alt ölçeğinde anlamlı düzelme olduğu saptanmıştır (p=0.026). Çalışmamızın sonuçları genel olarak incelediğinde; DEHB tedavisinin yürütücü işlev bozukluklarında ve uyku problemlerinde iyileşmeye neden olduğu gözlenmiştir. Yaz tatilinde verilen ilaç tatilinin ise yürütücü işlevleri bozduğu ve uyku problemleri üzerine etkisi olmadığı saptanmıştır. Sonuç olarak, ilaç tatili kararının, klinisyen tarafından bireysel olarak kar-zarar dengesi gözetilerek verilmesi uygun olacaktır.
There have been many studies reporting that executive dysfunctions are frequently seen in the cases of Attention-Deficit / Hyperactivity Disorder (ADHD) improve with treatment. It is known that sleep problems are also frequently observed in patients with ADHD. It is still being debated whether drug holidays should be given or not due to the side effects of methylphenidate during the treatment of ADHD. In the literature, there are limited numbers of studies examining the effects of drug holidays on ADHD symptom severity, but no study investigating the effect of drug holidays on executive functions and sleep problems. In our study, we aimed to evaluate executive functions and sleep problems in ADHD patients three times: before treatment, at least 8 weeks after methylphenidate treatment and at least 8 weeks after a drug holiday. Also, we aimed to investigate the effects of drug treatment and drug holidays on executive functions and sleep habits. Our study was designed as a longitudinal study and was conducted between September 2018 and September 2019 in the Bolu Abant Izzet Baysal University Child and Adolescent Psychiatry Outpatient Clinic. Fifty-one patients aged between 7-18 years, who were admitted to our outpatient clinic between September 2018 and November 2018, diagnosed with ADHD and fulfilled the inclusion criteria were included in the study. Stroop test and Clinical Global Impression Scale (CGI) were applied to the subjects before treatment, after treatment and after drug holiday. In the same periods, Conners' Parent Rating Scale-Short Form (CPRS:S) and Child Sleep Habits Questionnaire (CSHQ) to be filled by parents, and Conners' Teacher Rating Scale (CTRS:S) to be filled by the teacher were given. When the results of the study were examined, it was observed that 22 of the patients (43%) discontinued the treatment during the follow-up period. In our study, when the groups that continued and did not continue to treatment were compared, no statistically significant difference was found in terms of socio-demographic data (p> 0.05), only the number of siblings was significantly higher in the non-treatment group (p=0.045). There was no significant difference in the severity of the disease between the groups who continued and who did not. When the subjects were evaluated with CGI, it was found that the patients received a statistically significant lower score after treatment than the pre-treatment (p<0.001), and there was a significant increase in scores after the drug holiday (p<0.001). When the CPRS subscale scores of the subjects participated in our study were examined, it was observed that there was a significant decrease in the DE subscale after treatment compared to the pre-treatment (p<0.001). When the CTRS subscale scores of the subjects participated in our study were examined, it was observed that DE and DS subscale scores decreased after the treatment compared to the pre-treatment (p values respectively: 0.014, 0.012). When the Stroop test data applied to the subjects participated in our study were examined, it was found that the duration of completion was shortened in completion of 5 sections of the Stroop test after the treatment compared to the before treatment. After treatment, it was found that they made fewer errors and less correction in Stroop 5 than before treatment (p=0.005, p=0.007). After the drug holiday, it was observed that they made more errors in Stroop 5 than the after treatment (p = 0.037). When the CSHQ subscale scores completed by the parents of participants were examined, it was found that there was a significant improvement in the parasomnias subscale after the treatment compared to the before treatment (p=0.026). When examining the results of our study in general; it has been observed that ADHD treatment leads to improvement in executive dysfunctions and sleep problems. On the other hand, it was determined that the drug holiday given during the summer holiday impaired the executive functions and had no effect on sleep problems. As a result, it would be appropriate for the clinician to decide on a drug holiday by considering the individual profit-loss balance.
There have been many studies reporting that executive dysfunctions are frequently seen in the cases of Attention-Deficit / Hyperactivity Disorder (ADHD) improve with treatment. It is known that sleep problems are also frequently observed in patients with ADHD. It is still being debated whether drug holidays should be given or not due to the side effects of methylphenidate during the treatment of ADHD. In the literature, there are limited numbers of studies examining the effects of drug holidays on ADHD symptom severity, but no study investigating the effect of drug holidays on executive functions and sleep problems. In our study, we aimed to evaluate executive functions and sleep problems in ADHD patients three times: before treatment, at least 8 weeks after methylphenidate treatment and at least 8 weeks after a drug holiday. Also, we aimed to investigate the effects of drug treatment and drug holidays on executive functions and sleep habits. Our study was designed as a longitudinal study and was conducted between September 2018 and September 2019 in the Bolu Abant Izzet Baysal University Child and Adolescent Psychiatry Outpatient Clinic. Fifty-one patients aged between 7-18 years, who were admitted to our outpatient clinic between September 2018 and November 2018, diagnosed with ADHD and fulfilled the inclusion criteria were included in the study. Stroop test and Clinical Global Impression Scale (CGI) were applied to the subjects before treatment, after treatment and after drug holiday. In the same periods, Conners' Parent Rating Scale-Short Form (CPRS:S) and Child Sleep Habits Questionnaire (CSHQ) to be filled by parents, and Conners' Teacher Rating Scale (CTRS:S) to be filled by the teacher were given. When the results of the study were examined, it was observed that 22 of the patients (43%) discontinued the treatment during the follow-up period. In our study, when the groups that continued and did not continue to treatment were compared, no statistically significant difference was found in terms of socio-demographic data (p> 0.05), only the number of siblings was significantly higher in the non-treatment group (p=0.045). There was no significant difference in the severity of the disease between the groups who continued and who did not. When the subjects were evaluated with CGI, it was found that the patients received a statistically significant lower score after treatment than the pre-treatment (p<0.001), and there was a significant increase in scores after the drug holiday (p<0.001). When the CPRS subscale scores of the subjects participated in our study were examined, it was observed that there was a significant decrease in the DE subscale after treatment compared to the pre-treatment (p<0.001). When the CTRS subscale scores of the subjects participated in our study were examined, it was observed that DE and DS subscale scores decreased after the treatment compared to the pre-treatment (p values respectively: 0.014, 0.012). When the Stroop test data applied to the subjects participated in our study were examined, it was found that the duration of completion was shortened in completion of 5 sections of the Stroop test after the treatment compared to the before treatment. After treatment, it was found that they made fewer errors and less correction in Stroop 5 than before treatment (p=0.005, p=0.007). After the drug holiday, it was observed that they made more errors in Stroop 5 than the after treatment (p = 0.037). When the CSHQ subscale scores completed by the parents of participants were examined, it was found that there was a significant improvement in the parasomnias subscale after the treatment compared to the before treatment (p=0.026). When examining the results of our study in general; it has been observed that ADHD treatment leads to improvement in executive dysfunctions and sleep problems. On the other hand, it was determined that the drug holiday given during the summer holiday impaired the executive functions and had no effect on sleep problems. As a result, it would be appropriate for the clinician to decide on a drug holiday by considering the individual profit-loss balance.
Açıklama
Tıp Fakültesi, Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
Psikiyatri, Psychiatry
