Dikkat eksikliği hiperaktivite bozukluğu ve ağır duygudurum düzensizliği olan çocuk ve ergenlerin nöropsikolojik performanslarının karşılaştırılması
Comparison of neuropsychological performances of children and adolescents with attention deficit hyperactivity disorder and severe mood dysregulation
- Tez No: 306332
- Danışmanlar: DOÇ. DR. BİRİM GÜNAY KILIÇ
- Tez Türü: Tıpta Uzmanlık
- Konular: Psikiyatri, Psychiatry
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2011
- Dil: Türkçe
- Üniversite: Ankara Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 110
Özet
Giriş ve amaç: Bu araştırmada Dikkat Eksikliği Hiperaktivite Bozukluğu Bileşik Tip (DEHB) ve Ağır Duygudurum Düzensizliği (ADD) olan çocuk ve ergenlerin nöropsikolojik test performanslarında, demografik özelliklerinde, ek psikiyatrik tanılarında ve davranış örüntülerindeki benzerlik ve farklılıkların ortaya konulması amaçlanmıştır.Yöntem: Araştırma grubu Ankara Üniversitesi Tıp Fakültesi Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Anabilim Dalı'na ardışık başvuran 7-18 yaş aralığında, prematür doğum öyküsü, doğum komplikasyonu, kafa travması, nörolojik hastalığı, kronik hastalığı, düzeltilmemiş görme ya da işitme kusuru, Özgül Öğrenme Bozukluğu, psikotrop ilaç alım öyküsü, mental retardasyonu (IQ
Özet (Çeviri)
Introduction: In this research, we aimed to investigate the similarities and differences in neuropsychological test performances, demographic features, psychiatric co-morbidities and behavioural patterns of children and adolescents with ADHD Combined type and SMD.Method: Research group is composed of 134 children and adolescents (89 with ADHD Combined type, 24 with SMD and 21 healthy controls) age 7 to 18 years who consecutively applied to Ankara University School of Medicine Child and Adolescent Psychiatry Department, met the research criterias and who did not have a premature birth history, birth complication, head trauma, neurologic illness, chronic illness, uncorrected vision or hearing defect, specific learning difficulties, psychotropic drug history and mental retardation (IQ?80). Control group was composed of 21 healthy volunteers whose academic success is known as on the average level, who met research exclusion criterias, did not have a psychiatric application and a psychotropic drug usage, among the friends of the children and adolescents in the research groups, willing to participate in the research. Wecshler Inteligence Scale for Children-Revised (WISC-R) was applied to research groups and the groups were are identified by using K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School Aged Children- Present and Lifetime version) and K-SADS-SMDM (Severe Mood Dysregulation Module). Behavioural patterns were compared by Conners Parent Rating Scale-revised long form (CPRS-R:L) and Conners Teacher Rating Scale-revised long form (CTRS-R:L). Neuropsychological performances were compared by Trail Making Test, Stroop Test, Controlled Oral Word Association Test and Category Naming Tests.Results: It is observed that %50 of the children and adolescents with SMD were the children of divorced parents. Most of the Children with SMD had two or more lifelong psychiatric diagnosis and %62.5 of them had diagnosis of ADHD at the same time. Opposiotional Defiant Disorder turned into Unipolar Depression and Anxiety Disorders as the age grows up. In SMD group, it was understood that the children?s %92 rate of the psychiatric co-morbidities did not decrease in time and these children and adolescents? co-morbidities? rate was not affected by whether their relatives? having psychiatric diagnosis or not. In ?oppositional?, ?hyperactivity?, ?social problems?, ?ADHD Index?, ?restless-impulsive?, ?emotional lability? and ?Conners Global Index? subscales of CPRS-R: L, especially filled by mothers, SMD group?s average scores were significantly higher than that of ADHD group. In Trail Making Test Section B and Stroop Test Section 5, ADHD group?s performances in time and error scores were lower when compared to SMD and control groups. In the Controlled Oral Word Association Test in which verbal fluency was evaluated, both ADHD and SMD groups showed worse performance than the control group, whereas showing similar performance with each other. There was not observed any performance differences between the groups in the Category Naming Test.Conclusion: In our study, most of the neuropsychological tests were used to evaluate the ?cool? executive functions. In Trail Making Test, where joint attention, planning, set shifting, response inhibition was evaluated, the performance of ADHD group was significantly found lower than SMD and the control groups. ADHD group showed partially worse performance than the other groups in Stroop Test where joint attention and response inhibition associated with the orbitofrontal cortex functions were evaluated. In Verbal Fluency Tests, ADHD group?s performance and SMD group?s performance were found similar to each other. It is emerged that there is a need for researches which ?cold? and relatively ?hot? executive functions are involved in a balanced manner, where healthy controls will be compared to children and adolescents with SMD, ADHD and Bipolar Disorder in a large clinical sample. These researches will provide us to diminish these hyperactive, impulsive children known as having impairments in motivational and reward-related processes, from each other more clearly. The illumination of etiologies, familial aggregation, genetic features, pathophysiology and neurocognitive profiles of these similar and frequently overlapped categoric diagnosis by new researches, will enable to improve the diagnosis and treatment of these disorders.
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