6 TARTIŞMA
6.1 KISITLILIKLAR
Çalışmamızda kontrol grubunun olmaması en temel kısıtlılığımızdı.Hiç ilaç kullanmayan hastaların sayısının az olması ve hastaların çoğunun remisyonda olması, panik bozukluğunun şiddeti ve disosiyatif belirtileri ölçmede sorun teşkil etmiştir. DES ölçeği puanları bu nedenle beklenildiği düzeye ulaşamamıştır. İlaç kullanma ile kullanmama arasında panik bozukluk şiddeti arasında ilişki saptanmamış olması diğer kısıtlılıklarımızdandır.
Komorbid kişilik özelliklerinde farklılıkların olması, geniş yaş aralığı, hastalık süresi ve eğer alıyorsa tedavi süresi farklılıkları kısıtlılığa neden olmaktaydı. Son olarak
görüşme esnasında mevcut olan anksiyete bulguları, ölçeklere odaklanma ve dikkati sürdürmede zorluğa sebebiyet vermekteydi.
7 SONUÇLAR:
Panik bozukluğu olgularında emosyon regülasyonu, bağlanma paternleri ve çocukluk dönemi travmatik yaşantılarının, disosiyatif belirtilerle ilişkisinin
araştırdığımız çalışmamızda panik bozukluğunun şiddeti ile disosiasyon arasında anlamlı ilişki bulunmuştur. Agorofobi ek tanısının da panik bozukluk şiddetini ve disosiyatif deneyimleri arttırması, ayrıca bu kişilerin anksiyöz bağlanma paternine sahip olması tedavi ve izlem takibi açısından önemli bulgulardır.
Disosiasyon şiddeti arttıkça , panik bozukluk hastalarının emosyonlarını regule edemedikleri, özellikle dürtüsellikte artma, duygusal netlikte azalma ve negatif duygudurumunda amaca yönelik davranışları başlatmada güçlük çektikleri ve daha anksiyoz bağlanma paternine sahip oldukları bulunmuştur. Duygularını
düzenleyememe sonucunda disosiyatif deneyimleme yaşamaları, bu durumun üstesinden gelmek için kompansatuar bir mekanizma olabilir.Bizim çalışmamızın en önemli bulgusu budur.
Anksiyoz bağlanma paterni şiddetlendikçe, duyguları düzenleyememe daha çok görülmektedir.
Disosiyatif yaşantıların daha çok çocukluk çağı travmalarıyla ilişkilidir şeklinde varsayımımız ise doğrulanmamakla birlikte, literatürde bu konu hakkında çok fazla çalışmaya rastlanamamış olup, mevcut çalışmaların çoğu da çalışmamızdaki sonucu desteklemektedir.
Bu bulgular ışığında duygu düzenlemede ki zorlukların , bilişsel davranışçı terapi ile yeniden şekillendirilmesi açısından önemlidir.
Çalışmamızda kontrol grubu olmaması ve hastalarımızın çoğunun medikal tedavi altında ve remisyonda olması nedeniyle yeterli düzeyde Disosiyatif yaşantılar puanına ulaşılamamıştır.Yeni tanı almış ve/ve ya tedavi almayan hastalarla güçlendirilmesi gerekmektedir.
8 ÖZET
AMAÇ: Bu çalışma, panik bozukluğu olgularında emosyon regülasyonu, bağlanma
paternleri ve çocukluk dönemi travmatik yaşantılarının, disosiyatif belirtilerle ilişkisinin araştırması amaçlamıştır.
YÖNTEM: Çalışmamıza, Ege Üniversitesi Tıp Fakültesi Psikiyatri polikliniğine
başvuran ve İzmir ilindendeki diğer merkezlerden bize yönlendirilen Panik Bozukluk hastaları alınmıştır. Olguların bilgilendirilmiş onamları alındıktan sonra SCİD I uygulanmıştır.
sosyodemografik veri formları ve hastalığın son bir aylık şiddetini ölçmek amacıyla Panik Bozukluğu Şiddeti Ölçeği (PBŞÖ) uygulanmıştır. DES (Disosiyatif Yaşamlar Ölçeği), YİYEII(Yakın İlişkilerde Yaşantılar Envanteri II), Duygudurumu
Düzenlemede Güçlükler ve Çocukluk Çağı Ruhsal Travmaları ölçekleri verilmiş ve doldurmaları istenmiştir. Çalışmaya toplam 85 kişi alınmıştır.
BULGULAR:
Panik bozukluğu şiddet ölçeği ve disosiyasyon varlığı şiddeti arasında anlamlı ilişki vardır.
Agorofobi varlığı; disosiyatif yaşantılar, panik bozukluğu şiddeti ve anksiyoz bağlanma ile ilişkili bulunmuştur.
Dürtüsellikte artış ,netlikte azalma ve negatif duygu durumunda amaca yönelik davranışı başlatmada güçlük başta olmak üzere ,duygu düzenlemede zorluk, disosiyatif bulguların varlığı ve şiddeti arasında anlamlı ilişki vardır
Anksiyoz bağlanma paterni ile disosiyatif deneyimler ve duygu düzenlemede güçlük arasında anlamlı ilişki bulunmuştur.
Panik ataklarında disosiyatif deneyimlemelerin , çocukluk çağı travmaları ile ilişkisi olmadığı bulunmuştur.
SONUÇ: Agorofobi, panik bozukluk şiddeti ve disosiyatif deneyimler açısından risk
oluşturmaktadır. Disosiasyon şiddeti arttıkça , duygularını düzenleyemedikleri özellikle dürtüsellikte artma, duygusal netlikte azalma ve negatif duygudurumunda amaca yönelik davranışları başlatmada güçlük çektikleri ve bu kişilerin daha anksiyoz bağlanma puanına sahip oldukları bulunmuştur.
Anksiyoz bağlanma paterni şiddetlendikçe, duyguları düzenleyememe ve disosiyatif deneyimleme şiddetinde artış ve agorofobi varlığı görülmektedir.
9 ABSTRACT
OBJECTİVE: In this study it is aimed to investigate the association between
dissociative symptoms of panic disorder patients and emotional regulation, attachment patterns and traumatic life events in childhood .
METHOD: In our study, volunteer patients who admitted or were referred from other
psychiatry centers in İzmir to psychiatry outpatient clinic of Ege University were included. After written informed consents of the cases were taken; SCID I,
sociodemographic data form were filled by the patients and Panic Disorder Severity Scale was applied in purpose of determining the severity of the disorder for the last one month. Dissociative Experiences Scale, Experiences in Close Relationships Inventory II, Emotion Regulation Questionnaire and Childhood Trauma
Questionnaire were given to and asked the patients to fill in. 85 subjects were included to the study totally.
RESULTS: There was a significant relationship between scores of Panic Disorder
Severity Scale and severity of dissociation.
Presence of agorophobia was found significantly associated with dissociative experiences, severity of panic disorder and anxious attachment pattern.
There was a significant relationship between existence and severity of dissociative experiences and difficulities in emotional regulation; predominantly increment in impulsivity, decrease in clarity, difficulity in initiating goal directed behaviour in case of negative mood state.
A significant association was found between anxious attachment patterns and dissociative experiences, emotional regulation difficulities.
It was found that dissociative experiences in panic disorder were not related to childhood psychiatric traumas.
CONCLUSION: Agoraphobia poses a risk by means of severity of panic disorder
and dissociative experiences. As the severity of dissociation increases, it was determined that these subjects had such difficulities in emotional regulation as
predominantly increment in impulsivity, decrease in clarity, difficulity in initiating goal directed behaviour in case of negative mood state and also it was found that these subjects had higher scores in anxious attachment scales. As the pattern of anxious attachment gets intensified, an increment in severity of both emotional dysregulation and dissociative experiments and besides increase in coexistence of agorophobia are observed.
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