Ana Şikayet Olarak Halsizlik, Yorgunluk İle Somatizayon Arasındaki İlişki

Oturum Aç

Ana Şikayet Olarak Halsizlik, Yorgunluk İle Somatizayon Arasındaki İlişki

Zeynep Ayaz, Pemra Cöbek Ünalan

Anahtar Kelimeler: somatizasyon, tıbbi olarak açıklanamayan semptomlar, PHQ-SADS,

Amaç:

Somatizasyon, ruhsal sıkıntıların ve psikososyal stresin bedensel belirtilerle ifade edilmesidir.Halsizlik, yorgunluk, genel vücut ağrısı gibi şikayetlerle defalarca hekime başvuran hastalarda altta yatan organik patoloji bulunmaması ve bunun üç aydan uzun sürmesi Tıbbi Olarak Açıklanamayan Semptomlar(MUS) olarak tanımlanır. Birinci basamakta görülme oranı %20-30’dur. Bu çalışmanın amacı, yukarıdaki şikayetlerle aile hekimiiği polikliniğine gelen hastalarda PHQ-SADS ölçeği kullanarak alta yatan psikiyatrik komorbiditeyi ortaya koymaktır.

Gereç ve Yöntem:

Marmara Üniversitesi Pendik EAH Aile Hekimliği polikliniğine halsizlik, yorgunluk şikayetiyle Ocak2019-Mayıs 2019 tarihleri arasında başvuran hastalardan 18-65 yaş arası, herhangi bir kronik psikiyatrik hastalığı, kanser, kontrolsüz diabet, hipotiroidi ve romatizmal hastalıkları olmayan hastalar çalışmaya alındı. Demografik özellikleri içeren anket ve PHQ-SADS ölçeği uygulandı

Bulgular:

Katılımcı sayısı 65 olup, yaş ortalaması 36±10.5yıl olup katılımcıların %84.6’sı kadın, eğitim seviyesi ise ağırlıkla lise ve üstü olarak bulunmuştur. Kronik hastalık ve yaş doğru orantılı olarak artmıştır. Katılımcıların en sık başvuru şikayetinin halsizlik olduğu ve en sık istenen tetkikin hemogram (%92.2) olduğu görülmüştür. Tanı olarak en sık demir ve D vitamini eksikliği’nin bir arada kullanıldığı (n=22) görülmüştür. Katılımcılara uygulanan PHQ-SADS ölçeğinin alt başlıkları arasında somatizasyona ait semptomları tarayan PHQ-15 alt başlığının en sık çıkan düzeyi orta-ciddi olup %66.2’dir. Kronik hastalığı olanların PHQ-15 ve PHQ-9 puanları daha yüksektir (sırasıyla p=0.025, p=0.22).

Sonuç:

Tıbbi olarak açıklanmayan semptomlarla hastalar mükerrer doktor başvurusunda bulunmakta ve birini basmakta sıklıkla karşılaşılmaktadır. Bu hastaların somatizasyon düzeyi yüksek bulunmuştur. Hekimlerin bunu tanılayarak bu durumu doğru yönetebilmesi bu mükerrer başvuruların azalmasını sağlayabilir.

Kaynaklar:

1. Xiong N , Fritzsche K, Wei J et al. Validation of patient health questionnaire (PHQ) for major depression in Chinese outpatients with multiple somatic symptoms: a multicenter cross-sectional study. J Affect Disord. 2015 Mar 15;174:636-43.
2. Manshaee GR, Hamidi E. Prevalence of Psychosomatic Symptoms among Adolescent's Computer Users. Procedia- Social and Behavioral Sciences 2013 (84); 1326-32.
3. Burton C. Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS). Br J Gen Pract. 2003 Mar;53(488):231-9.
4. Rask MT, Rosendal M, Fenger-Grøn M et al. Sick leave and work disability in primary care patients with recent-onset multiple medically unexplained symptoms and persistent somatoform disorders: a 10-year follow-up of the FIP study. Gen Hosp Psychiatry. 2015 Jan-Feb;37(1):53-9.
5. Rask MT , Andersen RS, Bro Fet al. Towards a clinically useful diagnosis for mild-to-moderate conditions of medically unexplained symptoms in general practice: a mixed methods study. BMC Fam Pract. 2014 Jun 12;15:118.
6. Özenli Y,Yoldascan E, Topal K et al. Prevalence and associated risk factors of somatization disorder among Turkish university students at an education faculty. Anadolu Psikiyatri Dergisi; Sivas Vol. 10, Iss. 2, (Jun 2009): 131-6.
7. Morriss R Lindson N, Coupland C et al. Estimating the prevalence of medically unexplained symptoms from primary care records. Public Health. 2012 Oct;126(10):846-54.
8. Smith RC, Dwamena FC. Classification and diagnosis of patients with medically unexplained symptoms. J Gen Intern Med. 2007 May;22(5):685-91.
9. Jackson JL, Passamonti M. The outcomes among patients presenting in primary care with a physical symptom at 5 years. J Gen Intern Med. 2005 Nov;20(11):1032-7.
10. Obimakinde AM, Ladipo MM, Irabor AE. Symptomatology and comorbıdıty of somatızatıon dısorder amongst general outpatıents attendıng a famıly medıcıne clınıc ın south west nıgerıa. Ann ıb postgrad med. 2014 dec;12(2):96-102.
11. Löwe B, Spitzer RL, Williams JB et al.Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hosp Psychiatry. 2008 May-Jun;30(3):191-9.
12.Rosendal M, Fink P, Falkoe E et al. Improving the classification of medically unexplained symptoms in primary care. European Journal of Psychiatry, Vol. 21, No. 1, 2007, p. 25-36.
13. Steinbrecher N, Koerber S, Frieser D et al. The prevalence of medically unexplained symptoms in primary care Psychosomatics. 2011 May-Jun;52(3):263-71.
14. Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005 Aug;62(8):903-10.
15. Barsky AJ, Ettner SL, Horsky J et al. Resource utilization of patients with hypochondriacal health anxiety and somatization. Med Care. 2001 Jul;39(7):705-15.
16. Hiller W, Rief W, Brähler E. Somatization in the population: from mild bodily misperceptions to disabling symptoms. Soc Psychiatry Psychiatr Epidemiol. 2006 Sep;41(9):704-12.
17. Konnopka A, Schaefert R, Heinrich S et al. Economics of medically unexplained symptoms: a systematic review of the literature. Psychother Psychosom. 2012;81(5):265-75.
18. Mergl R. Seidscheck I, Allgaier AK et al. Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition. Depress Anxiety. 2007;24(3):185-95.
19. Spitzer RL. Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care The PRIME-MD 1000 Study Journal of the American Medical Association, 1994; 272(22): 1749-56.
20. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999 Nov 10;282(18):1737-44.
21. Spitzer RL , Kroenke K, Williams JB et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7.
22. Kroenke K, Spitzer RL, Williams JB et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007 Mar 6;146(5):317-25.
23. Kroenke K, Spitzer RL, Williams JB et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010 Jul-Aug; 32(4): 345-59.
24. Berge T, Bull-Hansen B, Solberg EE et al. Screening for symptoms of depression and anxiety in a cardiology department. Tidsskr Nor Laegeforen. 2019 Oct 7;139(14).
25. Yazici GM, Güleç H, Simşek G et al. Psychometric properties of the Turkish version of the Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms. Compr Psychiatry. 2012 Jul; 53(5): 623-9.
26. Shedden-Mora MC, Gross B, Lau K et al. Collaborative stepped care for somatoform disorders: A pre-post-intervention study in primary care. J Psychosom Res. 2016 Jan; 80: 23-30.
27. Steinbrecher N, Koerber S, Hiller W et al. The prevalence of medically unexplained symptoPsychosomatics. .ms in primary care. 2011 May-Jun; 52(3): 263-71.
28.Aamland A, Malterud K, Werner E. Patients with persistent medically unexplained physical symptoms: a descriptive study from Norwegian general practice. BMC Fam Pract. 2014 May 29; 15:107.
29. Morriss R, Lindson N, Coupland C et al.Estimating the prevalence of medically unexplained symptoms from primary care records. Public Health. 2012 Oct; 126(10): 846-54.
30. Koch H, van Bokhoven MA, ter Riet G et al. Demographic characteristics and quality of life of patients with unexplained complaints: a descriptive study in general practice. Qual Life Res. 2007 Nov;16(9):1483-9.
31. Verhaak PF, Meijer SA, Visser AP, Wolters G. Persistent presentation of medically unexplained symptoms in general practice. Fam Pract. 2006 Aug;23(4):414-20.
32. Isaac ML, Paauw DS. Medically unexplained symptoms. Med Clin North Am. 2014 May;98(3):663-72.
33. Dirkzwager AJ, Verhaak PF. Patients with persistent medically unexplained symptoms in general practice: characteristics and quality of care. BMC Fam Pract. 2007 May 31;8:33.
34. Mejía-Rodríguez D, Rodríguez R Restrepo D. Sociodemographic Characterization and Psychiatric Symptoms of Patients With Medically Unexplained Symptoms in a Healthcare Institution in Medellin (Colombia). evista Colombiana de Psiquiatria 04 Nov 2017, 48(2):72-9.

35. Koch H, van Bokhoven MA, Bindels PJ et al. The course of newly presented unexplained complaints in general practice patients: a prospective cohort study. Fam Pract. 2009 Dec;26(6):455-65.

36. Klaus K, Rief W, Brähler E, Martin A et al. The distinction between "medically unexplained" and "medically explained" in the context of somatoform disorders. Int J Behav Med. 2013 Jun;20(2):161-71.
37. McGorm K, Burton C, Weller D et al. Patients repeatedly referred to secondary care with symptoms unexplained by organic disease: prevalence, characteristics and referral pattern. Fam Pract. 2010 Oct;27(5):479-86.

38. Richardson RD, Engel CC Jr. Evaluation and management of medically unexplained physical symptoms. Neurologist. 2004 Jan;10(1):18-30.

39. Kocalevent RD, Hinz A, Brähler E. Standardization of a screening instrument (PHQ-15) for somatization syndromes in the general population. BMC Psychiatry. 2013 Mar 20;13:91.
.
40. Hanel G et al.Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study. J Psychosom Res. 2009 Sep;67(3):189-97.

#86