Karaci?er nakli ?ncesinde ve nakilden bir y?l sonra psikiyatrik belirti ve bozukluk yayg?nl???, ya?am kalitesi, genel bili?sel ve cinsel i?levler

Ama?: Bu ?al??man?n birincil amac? karaci?er nakli ?ncesinde ve nakilden bir y?l sonra hastalarda psikiyatrik bozukluk ve belirti yayg?nl???n?n, ya?am kalitesi d?zeylerinin, genel bili?sel i?levler ve cinsel i?levlerin kar??la?t?r?lmas?d?r. ?al??man?n di?er ama?lar? aras?nda nakil ?ncesi ve sonras?nda saptanan psikiyatrik bulgularla hastalar?n aleksitimik ?zellikleri aras?ndaki ili?kinin ve nakilden bir y?l sonra s?rece etki eden k?lt?rel etmenlerin ara?t?r?lmas? yer almaktad?r. Y?ntem: Ara?t?rmaya 15.11.2008 ve 31.07.2010 tarihleri aras?nda Dokuz Eyl?l ?niversitesi T?p Fak?ltesi Genel Cerrahi ve Gastroenteroloji b?l?mlerine yat??? yap?lan, karaci?er yetmezli?i olan ve karaci?er nakli operasyonu karar? al?nan hastalar (n:68) ve karaci?er nakli sonras? onikinci ay kontrolleri i?in Genel Cerrahi poliklini?ine ayaktan ba?vuran hastalar (n:53) al?nd?. B?ylece iki a?amada kesitsel de?erlendirmeler yap?ld? ve nakil ?ncesi ve sonras? olmak ?zere iki hasta grubu olu?turuldu(N?G, NSG). Bu iki gruptaki hastalara al?c?-veri formu, SCID-1/CV g?r??mesi, KF-36 Ya?am kKalitesi ?l?e?i(KF-36), Standardize Mini-Mental Test (SMMT), Hastane Anksiyete ve Depresyon ?l?e?i(HAD?), Toronto Aleksitimi ?l?e?i-20 (TAS-20) ve Arizona Cinsel Ya?ant?lar ?l?e?i(ACY?) uyguland?. ?al??ma sonunda elde edilen veriler kar??la?t?r?ld?. 16 hasta hem nakil ?ncesinde hem de nakil sonras?nda uzunlamas?na de?erlendirildi ve analiz edildi. Bulgular: Sosyodemografik ve klinik ?zellikler a??s?ndan iki grup aras?nda istatistiksel olarak anlaml? farkl?l?k saptanmad?. KF-36'n?n mental sa?l?k alt ?l?e?i d???nda t?m alt ?l?eklerinde nakil ?ncesi hastalar, nakil sonras?ndakilere g?re istatistiksel olarak anlaml? d???k ?l??mler g?sterdiler. SMMT ortalamalar? a?s?s?ndan iki grup aras?nda anlaml? fark saptanmad?. N?G'de hastalar?n % 29,4'?nde (n: 20), NSG'de ise % 20,8'inde (n: 11) psikiyatrik bozukluk saptand?. ?ki grup aras?ndaki psikiyatrik bozukluk yayg?nl??? aras?nda anlaml? fark saptanmad?. N?G'de NSG'ye g?re HAD? Depresyon alt ?l?e?i ortalama skorlar? anlaml? ?l??de y?ksek saptand?. ACY?'ye g?re cinsel i?lev bozuklu?u olan hastalar?n say?s? N?G'de NSG'ye g?re anlaml? say?da fazla saptand?. N?G'de psikiyatrik bozuklu?u olanlarda aleksitimi varl???, psikiyatrik bozuklu?u olmayanlara g?re anlaml? olarak fazla saptand?. Sonu?: Karaci?er nakli hastalarda ya?am kalitesinin mental sa?l?k alan? d???ndaki bir?ok alt boyutunda anlaml? iyile?meler sa?lam??t?r. Ancak nakil sonras? ge? d?nemde (birinci y?lda) psikiyatrik bozukluk s?kl???, nakil ?ncesi d?neme g?re az?msanmayacak kadar y?ksek oranda saptanm??t?r. Bu bulgular hastalar?n KN sonras? ge? d?nemde de psikiyatrik a??dan risk alt?nda olmaya devam ettiklerini g?stermektedir. Bu bak?mdan karaci?er nakil s?recindeki hastalar i?in sadece nakil ?ncesinde ve sonras?ndaki yak?n d?nemde de?il, nakil sonras? ge? d?nemde ve tedavinin her a?amas?nda d?zenli psikiyatrik de?erlendirme ve izlem sa?lanmas?n?n ?nemi b?y?kt?r. Japonya'da tan?mlanan Paradoksik Psikiyatrik Sendrom'un ?lkemizde ?ok daha d???k oranlarda g?r?lmesi bunun k?lt?re ba?l? bir sendrom olabilece?ini d???nd?rmektedir. Objective: The primary aim of this study is to compare the prevalence of psychiatric symptoms and disorders, the levels of quality of life, general cognitive functions and sexual functions in patients before and one year after liver transplantation. Other aims of the study is to determine the relationship of psychiatric symptoms and disorders with alexytimic properties and also to evaluate the cultural factors which may have impact on the course at the end of one year after transplantation. Method: The inpatients who had liver insufficiency and had been referred to liver transplantation (n: 68) and the outpatients who were evaluated for their routine controls at twelve months after liver transplantation (n:53) in the General Surgery and Gastroenterology Units of Dokuz Eylul University Hospital were included in the study which was carried out between 15.11.2008 and 31.07.2010. Patients were evaluated in two groups; the pretransplantation group and the outpatient group who were approximately twelve months posttransplant. Cross-sectional evaluations were conducted in these two patient groups; for one group before and for the other after transplantation (BTG, ATG). The patients in these two groups were given Receiver Sociodemographic Data Form, SCID-1 Clinical Interview, SF-36 Quality of Life Scale (SF-36), Standardized Mini-Mental Test (SMMT), Hospital Anxiety and Depression Scale (HADS), Toronto Alexitymia Scale-20 (TAS-20) and Arizona Sexual Experiences Scale (ASES). 16 patients were evaluated both before and after transplantation prospectively and they were also analysed. Results: There was no difference by means of the sociodemographic and clinical variables between the two groups. The patients before transplantation showed significantly lower levels in most of the SF-36 Quality of Life Scale scores bt there was no significant difference in the mental health subscale for the groups. There was no difference in the mean SMMT scores between the groups. In the BTG % 29,4 of the patients and in the ATG % 20,8 of the patients had one current psychiatric disorder. There was no significant difference in the prevalances of the psychiatric disorders of the groups. In the BTG the patients showed significantly higher depressive scores in HADS compared to the ATG. The number of patients who had sexual dysfuncton in the BTG was significantly higher compared to the ones in the ATG. The presence of alexythymia was significantly higher in patients who had psychiatric disorders in the BTG. Conclusion: Liver transplantation (LT) provides improvement in most of the domains of the quality of life of patients except the mental health domain. The prevalance of psychatric disorders one year after transplantation was high enough not to be underestimated compared to the higher prevalance before transplantation. These findings show that patients after LT continue to be under risk of psychiatric disorders even later in the follow-up. For these reasons regular psychiatric evaluations and follow-up for patients who undergo LT is very important, not only preop or post op in early stages but also at later stages. Pradoxical Psychiatric Syndrome which was described in Japan, was found to be very rare in Turkish patients. This suggests that it may be a culture-bound syndrome and needs to be validated.

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