PSİKİYATRİK BOZUKLUKLAR VE BİLİŞSEL İŞLEVLER

Psikiyatrik_Bozukluklar_ve_Bilissel_Islevler

MAJÖR DEPRESİF BOZUKLUKTA SICAK VE SOĞUK BİLİŞSEL İŞLEVLER

Kadir Aşçıbaşı

Sağlık Bilimleri Üniversitesi, İzmir Tepecik Eğitim ve Araştırma Hastanesi, Psikiyatri Kliniği, İzmir, Türkiye

Aşçıbaşı K. Majör Depresif Bozuklukta Sıcak ve Soğuk Bilişsel İşlevler. Aydemir Ö, Esen Danacı A, editörler. Psikiyatrik Bozukluklar ve Bilişsel İşlevler. 1. Baskı. Ankara: Türkiye Klinikleri; 2025. p.99-112.

ÖZET

Majör Depresif Bozukluk (MDB), yalnızca duygudurum değişiklikleriyle değil, bilişsel işlevlerde meydana gelen sıcak ve soğuk bilişsel süreçlere yönelik bozulmalarla da karakterize edilen çok boyutlu bir nöropsikiyatrik hastalıktır. Sıcak biliş, duygusal ve ödül-motivasyon temelli süreçleri içerirken, soğuk biliş, yürütücü işlevler, dikkat, bellek ve karar verme süreçlerini kapsar. MDB’de, sıcak biliş süreçleri ödül duyarlılığının azalması, anhedoni ve negatif bilişsel yanlılıklarla bozulurken; soğuk bilişsel süreçler dikkat eksikliği, yürütücü işlevlerde bozulma ve bilişsel esneklik kaybı ile karakterizedir.

Nörogörüntüleme çalışmaları, MDB hastalarında prefrontal korteks (PFC) ve limbik sistem arasındaki işlevsel dengesizliğin, sıcak ve soğuk bilişsel süreçlerdeki bozulmalara katkıda bulunduğunu göster- mektedir. Özellikle, amigdala hiperaktivitesi ve PFC hipoaktivitesi, duygusal bilgi işleme ve bilişsel kontrol süreçlerindeki aksaklıkları açıklamaktadır. Dopaminerjik, serotonerjik ve glutamaterjik nörotransmisyon sistemlerindeki düzensizlikler, ödül-motivasyon mekanizmaları ve yürütücü işlevlerde gözlenen bozulmalarla ilişkili bulunmuştur.

Tedavi yaklaşımları, farmakoterapi, bilişsel davranışçı terapi (BDT), bilişsel onarım terapisi (Cognitive Remediation Therapy – CRT) ve nöromodülasyon tekniklerini kapsamaktadır. Serotonin-noradrenalin geri alım inhibitörleri (SNRI’ler) ve çoklu etkili antidepresanlar (örn. vortioksetin), hem sıcak hem de soğuk bilişsel işlevleri iyileştirme potansiyeline sahiptir. Transkraniyal manyetik stimülasyon (TMS) ve nörofeedback gibi nöromodülasyon teknikleri, yürütücü işlevler ve ödül-motivasyon sistemleri üzerindeki etkileri nedeniyle umut vadetmektedir.

Sonuç olarak, MDB yönetiminde sıcak ve soğuk bilişsel süreçlerin bütüncül bir perspektifle ele alınması, hastalığın bilişsel boyutunun hedefe yönelik müdahalelerle iyileştirilmesi açısından kritik önem taşımaktadır. Bilişsel süreçleri merkeze alan multidisipliner tedavi yaklaşımlarının, hastalığın prognozunu iyileştirme ve işlevselliği artırma potansiyeline sahip olduğu düşünülmektedir.

Anahtar Kelimeler: Majör depresif bozukluk; Biliş bozuklukları; Yürütücü fonksiyon; Anhedoni

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