PSİKİYATRİK BOZUKLUKLAR VE BİLİŞSEL İŞLEVLER

Psikiyatrik_Bozukluklar_ve_Bilissel_Islevler

AFEKTİF PSİKOZLARDA BİLİŞSEL İŞLEVLER

Ece Özlem Öztürk

Sağlık Bilimleri Üniversitesi, Trabzon Kanuni Eğitim ve Araştırma Hastanesi, Ruh Sağlığı ve Hastalıkları Kliniği, Trabzon, Türkiye

Öztürk EÖ. Afektif Psikozlarda Bilişsel İşlevler. Aydemir Ö, Esen Danacı A, editörler. Psikiyatrik Bozukluklar ve Bilişsel İşlevler. 1. Baskı. Ankara: Türkiye Klinikleri; 2025. p.87-97.

ÖZET

Afektif psikozlar, psikotik belirtiler ile duygudurum bozukluklarının iç içe geçtiği, heterojen klinik tabloları içeren bir gruptur. DSM-5 sınıflandırmasına göre bu bozukluklar, psikotik özellikli majör depresif bozukluk, psikotik epizotlarla seyreden bipolar bozukluk ve şizoafektif bozukluğu kapsamaktadır.

Tarihsel olarak şizofreni ve bipolar bozukluk keskin sınırlarla ayrılmış olsa da, günümüzde bu bozuklukların kesin hatlarla birbirinden ayrılmadığı ve spektral bir model içinde değerlendirilmesi gerektiği görüşü ağırlık kazanmaktadır. Şizofrenide bilişsel bozuklukların belirgin olduğu uzun süredir bilinmekle birlikte, psikotik özellik gösteren bipolar bozukluk ve majör depresyon gibi afektif psikozlarda da benzer bilişsel bozulmaların mevcut olduğu gösterilmiştir.

Şizofrenide bilişsel bozukluklar yaygın olup; dikkat, bellek, yürütücü işlevler ve işlem hızında belirgin kayıplar görülmektedir. Bu bozuklukları değerlendirmek amacıyla çeşitli bilişsel test bataryaları geliştirilmiştir. Afektif psikozlar içinde yer alan bipolar bozuklukta da kalıcı bilişsel bozukluklar saptanmış, özellikle psikotik özellik gösteren olgularda yürütücü işlevler ve çalışma belleğinde ciddi kayıplar olduğu görülmüştür. Ayrıca psikotik özellikli majör depresyonda da; dikkat, yürütücü işlevler ve bellek alanlarındaki bilişsel bozuklukların şizofreni ile benzerlik gösterdiği bildirilmektedir.

Şizoafektif bozukluk, şizofreni ve bipolar bozukluk arasında bir ara form olarak kabul edilmekle birlikte, klinik seyri değişkendir. Psikotik belirtilerin baskın olduğu dönemlerde duygudurum belirtileri geri planda kalırken, duygudurum belirtilerinin ön planda olduğu dönemlerde psikotik semptomlar maskelenebilir. Bilişsel açıdan değerlendirildiğinde, bu hastalarda yürütücü işlevler, çalışma belleği ve sosyal biliş alanlarında belirgin bozulmalar olduğu saptanmıştır. Ancak, şizoafektif bozukluğun bilişsel açıdan şizofreniye mi yoksa bipolar bozukluğa mı daha yakın olduğu konusu netlik kazanmamıştır.

Afektif psikozların bilişsel profillerini anlamak için geleneksel tanı kategorilerinin ötesine geçerek spektral modellerin benimsenmesi önerilmektedir. Şizofreni, bipolar bozukluk ve şizoafektif bozukluk arasındaki bilişsel örtüşmeler göz önünde bulundurularak, bu hastalıklarda bilişsel işlevlerin düzenli olarak değerlendirilmesi ve tedavi süreçlerinde nörokognitif bozuklukların dikkate alınması gerekmektedir.

Anahtar Kelimeler: Afektif psikozlar; Psikotik özellikli bipolar bozukluk; Psikotik özellikli major depresif bozukluk; Şizoafektif bozukluk; Bilişsel işlevler; Nörokognisyon

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