A\u011f\u0131r strese reaksiyon, ki\u015finin g\u00fcnl\u00fck olaylar d\u0131\u015f\u0131nda beklenmedik durumlarla kar\u015f\u0131la\u015fmas\u0131 sonras\u0131nda verdi\u011fi psikolojik ve bedensel tepkilerdir. Bu rahats\u0131zl\u0131k \u201cakut stres tepkisi\u201d ve \u201ctravma sonras\u0131 stres bozuklu\u011fu\u201d olarak iki farkl\u0131 isim alt\u0131nda ancak belirtilerin birbirine benzedi\u011fi tablolarla ortaya \u00e7\u0131kar.<\/p>\n
AKUT STRES BOZUKLU\u011eU<\/p>\n
Sava\u015f, do\u011fal felaketler, kazalar, beklenmedik \u00f6l\u00fcmler, tacizler gibi ki\u015finin ya\u015fam\u0131n\u0131 tehdit eden olaylardan sonraki 1 Ay i\u00e7inde geli\u015fen psikiyatrik bir rahats\u0131zl\u0131kt\u0131r. Bir olay\u0131n travma olarak kabul edilmesi i\u00e7in o olayla do\u011frudan temas etmek \u015fart de\u011fildir. \u00d6rne\u011fin ki\u015fi \u00f6l\u00fcm tehdidiyle kar\u015f\u0131la\u015fmasa bile bir ba\u015fkas\u0131n\u0131n \u00f6l\u00fcm\u00fcne tan\u0131k olmas\u0131 bu rahats\u0131zl\u0131\u011f\u0131n ortaya \u00e7\u0131kmas\u0131na neden olabilir. Ancak bu t\u00fcr travmalar ya\u015fayan herkeste akut stres bozuklu\u011fu g\u00f6r\u00fclmesi \u015fart de\u011fildir.<\/p>\n
Akut Stres Bozuklu\u011funun toplumda g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 %14 -33 aras\u0131ndad\u0131r. Akut stres bozuklu\u011funun belirtileri travma s\u0131ras\u0131nda yada hemen sonras\u0131nda ya\u015fan\u0131r, en az 2 G\u00fcn s\u00fcrer, travmatik olay\u0131n sonlanmas\u0131n\u0131n ard\u0131ndan ya 4 hafta i\u00e7inde yat\u0131\u015f\u0131r, devam ederse de ad\u0131 Travma Sonras\u0131 Stres Bozuklu\u011fu olarak de\u011fi\u015ftirilir. Travman\u0131n s\u00fcresinin, \u015fiddetinin ve ki\u015finin bu olaya yak\u0131nl\u0131\u011f\u0131n\u0131n fazla olmas\u0131, toplumsal deste\u011fin zay\u0131f olmas\u0131, Aile \u00f6yk\u00fcs\u00fc, \u00e7ocukluk ya\u015fant\u0131s\u0131, daha \u00f6nceden ge\u00e7irilmi\u015f psikiyatrik hastal\u0131\u011f\u0131n varl\u0131\u011f\u0131 akut stres bozuklu\u011fu geli\u015fimini kolayla\u015ft\u0131r\u0131r.<\/p>\n
BEL\u0130RT\u0130LER\u0130<\/p>\n
Akut stres bozuklu\u011fu geli\u015fen hastan\u0131n ilk g\u00f6ze \u00e7arpan belirtilerinden biri dalg\u0131n olmas\u0131d\u0131r; \u00e7evresinde olup bitenlerin tam olarak fark\u0131na varamaz. Duygusal tepkilerinde azalma vard\u0131r. \u00c7evresini hatta bazen de kendisini de\u011fi\u015fmi\u015f, farkl\u0131la\u015fm\u0131\u015f, yabanc\u0131la\u015fm\u0131\u015f gibi alg\u0131lar. Ya\u015fanan travman\u0131n bir k\u0131sm\u0131 hat\u0131rlanamayabilir ama hat\u0131rlanan k\u0131sm\u0131yla ilgili an\u0131lar\u0131 \u00e7ok Canl\u0131d\u0131r. Bazen uyan\u0131kken bu an\u0131lar\u0131 yeniden ya\u015f\u0131yormu\u015f gibi hisseder bazen de uykusunda kabus olarak g\u00f6r\u00fcr. Uykuya dalmakta ya da uykuyu s\u00fcrd\u00fcrmekte g\u00fc\u00e7l\u00fck ya\u015far. Hasta ya\u015fad\u0131\u011f\u0131 olay\u0131 nedensiz yere s\u0131k s\u0131k hat\u0131rlar. Travmay\u0131 tekrar ya\u015f\u0131yormu\u015f gibi hisseder. \u00c7ocuklar ise bu durumu, travmay\u0131 konu alan oyunlar\u0131 oynayarak yeniden ya\u015far. Olayla ilgili konu\u015fmaktan ve olay\u0131 hat\u0131rlatan durumlardan ka\u00e7\u0131n\u0131r. \u00d6rne\u011fin; trafik kazas\u0131 ge\u00e7iren ki\u015fi kazayla ilgili konu\u015fmak istemez ya da Televizyonda kaza haberlerini seyretmekten ka\u00e7\u0131n\u0131r. Travma ya\u015fayan hasta a\u015f\u0131r\u0131 derecede kayg\u0131l\u0131d\u0131r, kendisini \u00e7aresiz hisseder. \u00c7ocuklar bu kayg\u0131lar\u0131n\u0131 a\u015f\u0131r\u0131 hareketlilik ile d\u0131\u015fa vurabilir. Her an bir \u015fey olacakm\u0131\u015f gibi tetiktedir, huzursuzdur. Tahamm\u00fcls\u00fczd\u00fcr, kolayca \u00f6fkelenip k\u0131r\u0131c\u0131 olabilir. Telefon zili ya da d\u0131\u015far\u0131dan gelen bir Araba kornas\u0131 aniden irkilmesine neden olur. Dalg\u0131nd\u0131r, d\u00fc\u015f\u00fcncelerini belirli bir konu \u00fczerinde yo\u011funla\u015ft\u0131ramaz. Bu s\u0131k\u0131nt\u0131lar nedeniyle g\u00fcnl\u00fck ya\u015fam\u0131nda ailesiyle, arkada\u015flar\u0131yla olan ili\u015fkisinde ve i\u015f hayat\u0131nda g\u00fc\u00e7l\u00fck ya\u015far.<\/p>\n
TANI<\/p>\n
A\u015f\u0131r\u0131 bir stresle kar\u015f\u0131la\u015fman\u0131n ard\u0131ndan geli\u015fen baz\u0131 belirtiler hemen her zaman g\u00f6r\u00fclebilir ve hastal\u0131k olarak de\u011ferlendirilmez. E\u011fer belirtiler 2 G\u00fcn\u00fc ge\u00e7er ve ki\u015finin toplumsal ve mesleki alanda yapmas\u0131 gerekenleri yapamaz duruma getirirse, doktora ba\u015fvurmak gerekir. Hekim DSM-IV-TR ve ICD-10 tan\u0131 \u00f6l\u00e7\u00fctlerine g\u00f6re hastay\u0131 de\u011ferlendirme sonucu tan\u0131y\u0131 koymaktad\u0131r.<\/p>\n
PROGNOZ<\/p>\n
Hastal\u0131\u011f\u0131n seyrinde; \u00e7o\u011fu hastada hafif belirtiler kal\u0131c\u0131 olarak devam eder. Bir k\u0131sm\u0131 tam olarak iyile\u015firken bir k\u0131sm\u0131nda da hastal\u0131k kronikle\u015fir ve ad\u0131 Travma Sonras\u0131 Stres Bozuklu\u011fu olarak de\u011fi\u015ftirilir.<\/p>\n
TEDAV\u0130<\/p>\n
Tedavide ama\u00e7 ki\u015finin ba\u015f etme mekanizmalar\u0131n\u0131 kullanmas\u0131 i\u00e7in travmay\u0131 hat\u0131rlatan durumlardan ka\u00e7\u0131nmas\u0131n\u0131 ortadan kald\u0131rmak, kayg\u0131s\u0131n\u0131 azaltmak, uyku bozuklu\u011funu d\u00fczeltmek ve \u00f6fke kontrol\u00fcn\u00fc sa\u011flamakt\u0131r. Tedavide antidepresan tedaviyle birlikte,\u00a0 bili\u015fsel-davran\u0131\u015f\u00e7\u0131 terapi, psikodinamik y\u00f6nelimli psikoterapi, grup terapileri ve hipnoz teknikleri de uygulan\u0131r. Bu \u015fekilde hastan\u0131n hem mesleki i\u015flevselli\u011finde hem de sosyal ili\u015fkilerinde d\u00fczelme hedeflenir.<\/p>\n
TRAVMA SONRASI STRES BOZUKLU\u011eU<\/p>\n
Travma sonras\u0131 stres bozuklu\u011fu ki\u015finin kendisinin ya da tan\u0131k oldu\u011fu birinin ya\u015fam\u0131\u015f oldu\u011fu ger\u00e7ek bir \u00f6l\u00fcm ya da \u00f6l\u00fcm tehdidi, a\u011f\u0131r bir yaralanma ya da ki\u015finin fizik b\u00fct\u00fcnl\u00fc\u011f\u00fcne bir tehdit olay\u0131n\u0131 ya\u015faman\u0131n ard\u0131ndan geli\u015fen \u00f6zg\u00fcl semptomlar b\u00fct\u00fcn\u00fcd\u00fcr.<\/p>\n
Travma sonras\u0131 stres bozuklu\u011funun ya\u015fam boyu g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 %8 civar\u0131ndad\u0131r. Tecav\u00fcze u\u011frayanlarda, askeri \u00e7at\u0131\u015fmada bulunanlarda, etnik ya da politik nedenlerle g\u00f6zalt\u0131na al\u0131nanlarda daha s\u0131k g\u00f6r\u00fclmektedir. \u00c7ocukluk d\u00f6nemi de dahil olmak \u00fczere herhangi bir ya\u015fta g\u00f6r\u00fclebilir.<\/p>\n
BEL\u0130RT\u0130LER\u0130<\/p>\n
Toplumsal deste\u011fin zay\u0131f olmas\u0131, ki\u015finin daha \u00f6nce ge\u00e7irmi\u015f oldu\u011fu psikiyatrik hastal\u0131\u011f\u0131n varl\u0131\u011f\u0131, ailede travma sonras\u0131 stres bozuklu\u011fu ve Depresyon \u00f6yk\u00fcs\u00fc kolayla\u015ft\u0131r\u0131c\u0131 etkenlerdendir. Belirtiler genellikle travmadan sonraki ilk 3 ayda ba\u015flar. Akut stres bozuklu\u011funda belirtiler 1 aydan daha fazla s\u00fcrerse tan\u0131 akut stres bozuklu\u011fundan travma sonras\u0131 stres bozuklu\u011funa de\u011fi\u015ftirilir. \u0130ki hastal\u0131\u011f\u0131n belirtileri birbirine \u00e7ok yak\u0131n olsa da baz\u0131 farkl\u0131l\u0131klar vard\u0131r. <\/p>\n
Hastalar, ba\u015fkalar\u0131 ya\u015famlar\u0131n\u0131 s\u00fcrd\u00fcremiyorken kendilerinin s\u00fcrd\u00fcrebiliyor olmas\u0131yla ilgili olarak ya da hayatta kalabilmek i\u00e7in yapmak zorunda kald\u0131klar\u0131yla ilgili \u0131zd\u0131rap veren su\u00e7luluk duygular\u0131n\u0131 akut stres bozuklu\u011funa g\u00f6re daha s\u0131k tan\u0131mlarlar. Hasta travmay\u0131 \u00e7a\u011fr\u0131\u015ft\u0131ran durumlardan s\u00fcrekli olarak ka\u00e7\u0131n\u0131r. Bu ka\u00e7\u0131nma ki\u015filer aras\u0131 ili\u015fkileri bozar ya da evlilikle ilgili \u00e7at\u0131\u015fmalar, bo\u015fanmaya ya da i\u015f kayb\u0131na yol a\u00e7ar. Kendine zarar verme, i\u015fe yaramazl\u0131k, utan\u00e7, \u00fcz\u00fcnt\u00fc ya da umutsuzluk duygular\u0131, s\u00fcrekli \u00f6rselendi\u011fi duygusu, inan\u00e7lar\u0131n\u0131 yitirme, d\u00fc\u015fmanc\u0131l duygular, toplumdan uzakla\u015fma akut stres bozuklu\u011funa g\u00f6re daha s\u0131k g\u00f6r\u00fcl\u00fcr.<\/p>\n
TANI<\/p>\n
Travma sonras\u0131 stres bozuklu\u011fu i\u00e7in onaylanm\u0131\u015f tan\u0131 koydurucu laboratuar testi, g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemi yoktur. Ancak hastalarda a\u015f\u0131r\u0131 uyar\u0131lm\u0131\u015fl\u0131k sonucu, kalp h\u0131z\u0131nda, elektromiyografide, ter bezlerinin etkinli\u011finde artm\u0131\u015f uyar\u0131lm\u0131\u015fl\u0131k g\u00f6r\u00fclebilir. Somatik yak\u0131nmalar olabilir. Hekim ICD-10 ve DSM-IV-TR’a g\u00f6re hastay\u0131 de\u011ferlendirerek tan\u0131 koyar.<\/p>\n
PROGNOZ<\/p>\n
Travma sonras\u0131 stres bozuklu\u011fu travmadan sonraki ilk 3 ayda ba\u015flarsa da belirtilerin ba\u015flamas\u0131 i\u00e7in ge\u00e7en s\u00fcre aylar ya da y\u0131llar sonra bile olabilir. S\u0131kl\u0131kla travman\u0131n hemen ard\u0131ndan Akut Stres Bozuklu\u011fu tan\u0131 \u00f6l\u00e7\u00fctleri kar\u015f\u0131lan\u0131r. Travmay\u0131 tekrar tekrar ya\u015fama, travmay\u0131 hat\u0131rlatan durumlardan ka\u00e7\u0131nma ve a\u015f\u0131r\u0131 uyar\u0131lm\u0131\u015fl\u0131k belirtilerindeki bask\u0131nl\u0131k zamanla de\u011fi\u015febilir. Belirtilerin s\u00fcresi de de\u011fi\u015fir, hastalar\u0131n yakla\u015f\u0131k yar\u0131s\u0131nda 3 ay i\u00e7inde tam d\u00fczelme olurken, bir\u00e7o\u011funda bir y\u0131ldan daha uzun s\u00fcrer.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n
TEDAV\u0130<\/p>\n
Tedavide ama\u00e7 ki\u015finin ba\u015f etme mekanizmalar\u0131n\u0131 kullanmas\u0131 i\u00e7in travmay\u0131 hat\u0131rlatan durumlardan ka\u00e7\u0131nmas\u0131n\u0131 ortadan kald\u0131rmak, kayg\u0131s\u0131n\u0131 azaltmak, uyku bozuklu\u011funu d\u00fczeltmek ve \u00f6fke kontrol\u00fcn\u00fc sa\u011flamakt\u0131r. Antidepresan ila\u00e7larla birlikte uykusuzluk, sinirlilik belirtileri i\u00e7in farkl\u0131 ila\u00e7 tedavileri kullan\u0131l\u0131r. Bunun yan\u0131 s\u0131ra, bili\u015fsel-davran\u0131\u015f\u00e7\u0131 terapi, psikodinamik y\u00f6nelimli psikoterapi, grup terapileri ve hipnoz teknikleri de uygulan\u0131r. Bu \u015fekilde hastan\u0131n hem mesleki i\u015flevselli\u011finde hem de sosyal ili\u015fkilerinde d\u00fczelme hedeflenir.<\/p>\n
HAZIRLAYAN; Do\u00e7. Dr. Sibel \u00d6RSEL, Do\u00e7. Dr. M. Hakan T\u00dcRK\u00c7APAR, Do\u00e7. Dr. M. Haluk \u00d6ZBAY<\/p>\n
KAYNAKLAR<\/p>\n
1.\u00a0Kaplan&Sadock’s Comprehensive Textbook of Psychiatry<\/p>\n
2. Ruhsal Bozukluklar\u0131n Tan\u0131sal ve say\u0131msal el Kitab\u0131- DSM-IV-TR yeniden g\u00f6zden ge\u00e7irilmi\u015f tam metin<\/p>\n","protected":false},"excerpt":{"rendered":"
A\u011f\u0131r strese reaksiyon, ki\u015finin g\u00fcnl\u00fck olaylar d\u0131\u015f\u0131nda beklenmedik durumlarla kar\u015f\u0131la\u015fmas\u0131 sonras\u0131nda verdi\u011fi psikolojik ve bedensel tepkilerdir. Bu rahats\u0131zl\u0131k \u201cakut stres tepkisi\u201d ve \u201ctravma sonras\u0131 stres bozuklu\u011fu\u201d olarak iki farkl\u0131 isim alt\u0131nda ancak belirtilerin birbirine benzedi\u011fi tablolarla ortaya \u00e7\u0131kar. AKUT STRES BOZUKLU\u011eU Sava\u015f, do\u011fal felaketler, kazalar, beklenmedik \u00f6l\u00fcmler, tacizler gibi ki\u015finin ya\u015fam\u0131n\u0131 tehdit eden olaylardan sonraki 1 Ay i\u00e7inde geli\u015fen psikiyatrik[Devam\u0131n\u0131 Oku…]<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[22524],"tags":[23333,23340],"_links":{"self":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts\/13292"}],"collection":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/comments?post=13292"}],"version-history":[{"count":0,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts\/13292\/revisions"}],"wp:attachment":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/media?parent=13292"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/categories?post=13292"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/tags?post=13292"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}