PSİKİYATRİK BOZUKLUKLAR VE BİLİŞSEL İŞLEVLER

Psikiyatrik_Bozukluklar_ve_Bilissel_Islevler

ANKSİYETE BOZUKLUKLARINDA BİLİŞSEL İŞLEVLER

Fikret Poyraz Çökmüş

İzmir Tınaztepe Üniversitesi, Tıp Fakültesi, Psikiyatri AD, İzmir, Türkiye

Çökmüş FP. Anksiyete Bozukluklarında Bilişsel İşlevler. Aydemir Ö, Esen Danacı A, editörler. Psikiyatrik Bozukluklar ve Bilişsel İşlevler. 1. Baskı. Ankara: Türkiye Klinikleri; 2025. p.143-153.

ÖZET

Anksiyete bozuklukları, yüksek yaygınlık oranları ve işlevselliği belirgin düzeyde bozma potansiyelleri nedeniyle ruh sağlığı alanında önemli bir araştırma konusu olmaya devam etmektedir. Yapılan nöropsikolojik ve nörogörüntüleme çalışmaları, bu bozuklukların yürütücü işlevler, dikkat, bellek ve bilgi işleme süreçleri üzerinde belirgin etkileri olabileceğini ortaya koymaktadır.

Nörobiyolojik düzeyde, anksiyetenin hipokampus, prefrontal korteks, amigdala ve parahipokampal girus gibi yapıların işlevselliğinde bozulmaya yol açtığı gösterilmiştir. Özellikle Hipotalamus-Hipofiz-Adrenal (HPA) aksının disregülasyonu, anksiyete bozukluklarında bilişsel işlev kayıplarının altında yatan mekanizmalardan biri olarak öne çıkmaktadır.

Panik bozukluğu (PB) hastalarında yapılan çalışmalar, bellek, dikkat ve yürütücü işlevlerde seçici bozulmalar saptamış, ancak metodolojik farklılıklar ve komorbiditeler nedeniyle sonuçlar tutarsızlık göstermektedir. PB’de amigdala hiperaktivitesinin yanı sıra prefrontal korteksin inhibisyonunun bilişsel süreçleri olumsuz yönde etkileyebileceği bildirilmiştir.

Sosyal fobi (SF) hastalarında, prefrontal, temporal ve parietal korteks bölgelerinde incelmeye işaret eden bulgular elde edilmiştir. Nöropsikolojik testlerde, SF hastalarının yürütücü işlevler, dikkat, bilişsel esneklik ve bellek işlevlerinde sağlıklı kontrollere kıyasla düşük performans sergilediği belirlenmiştir.

Yaygın anksiyete bozukluğu (YAB) ile ilişkili bilişsel bozulmalar üzerine yapılan çalışmalar sınırlı olup, özellikle yaşlı bireylerde hafıza, çalışma belleği ve yürütücü işlevlerde belirgin kayıplar olduğu gösterilmiştir. Bununla birlikte, genç erişkinlerde yapılan araştırmaların sonuçları çelişkilidir.

Gelişimsel açıdan değerlendirildiğinde, anksiyete bozukluğu olan çocuk ve ergenlerde dil becerilerinde ve bilişsel esneklikte azalmalar gözlenmiş, ancak görsel-uzamsal becerilerde belirgin farklılık saptanmamıştır.

Anksiyete bozukluklarına tedavi yaklaşımları açısından farmakoterapi ve bilişsel davranışçı terapi (BDT) ön plana çıkmaktadır. Farmakolojik tedavi seçeneklerinden serotonin geri alım inhibitörlerinin ve benzodiazepinlerin nörobilişsel işlevlere etkisi konusunda çelişkili bulgular mevcut olup, BDT’nin yürütücü işlevleri geliştirme potansiyeline sahip olduğu gösterilmiştir.

Sonuç olarak, anksiyete bozukluklarında bilişsel işlevlerde belirgin değişimler olduğu görülmekle birlikte, bu alanda yapılan araştırmalarda metodolojik heterojenite önemli bir sınırlılık olarak karşımıza çıkmaktadır. Daha geniş örneklemlerle, komorbiditelerin dışlandığı ve kapsamlı nöropsikolojik test bataryalarının kullanıldığı çalışmalara duyulan gereksinim devam etmektedir. Bu alandaki ilerlemeler, anksiyete bozukluklarının nörobilişsel temellerinin daha iyi anlaşılmasını ve bireye özgü tedavi yaklaşımlarının geliştirilmesini sağlayacaktır.

Anahtar Kelimeler: Anksiyete bozuklukları; Bilişsel işlevler; Panik bozukluğu; Sosyal fobi; Yaygın anksiyete bozukluğu; Yürütücü işlevler

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