Bipolar Bozukluk ve Şiddet Davranışı ile Başvuran Bir Tuberoskleroz Olgusunda Lityum Tedavisi

Ürün Özer; Mert Batmaz; Zeynep Ezgi Balçık

EN TR

Lithium Treatment In a Tuberous Sclerosis Case Presented With Bipolar Disorder and Aggressive Behavior

Abstract

Tuberous sclerosis is a genetic disorder, characterized by hamartomatous growths in multiple organs such as brain, skin, eyes, heart and kidneys. Central nervous system symptoms have been reported in a majority of patients, and structural lesions in the brain may be frequently defined. In tuberous sclerosis patients, among the most common psychiatric disorders are mood disorders, autism, and attention deficit hyperactivity disorder. Psychotic disorders including schizophrenia are also additional comorbidities previously reported. Herein, a tuberous sclerosis case suffering from epileptic seizures, bipolar disorder with psychotic symptoms and aggressive behavior, treated with lithium along with antiepileptics and antipsychotics is presented. Male patient, 22 years old, previously diagosed with tuberous sclerosis, was brought by his family to the psychiatric emergency unit, and hospitalized due to aggressive behavior attacking his mother with a knife . Psychiatric evaluation revealed irritable mood, visual hallucinations, and persecutory delusions, accompanied by disorganized speech, poor thought content, and poor insight. The seizures were treated with topiramate and oxcarbazepine. Psychotic symptoms responded to risperidone and quetiapine. Finally, mood symptoms and aggressive behavior were controlled after the addition of lithium. A significant proportion of patients with tuberous sclerosis suffer from psychiatric disorders, and some of them from mood disorders and psychosis. Aggressive and disruptive behaviors also have been reported. Effective treatment is very important to relieve psychiatric symptoms as well as to increase patients’ quality of life. Lithium may be a beneficial option to control mood symptoms and aggressive behavior in tuberous sclerosis.

Keywords

Tuberous sclerosis,mood disorders,psychosis,aggressive behavior,lithium

Bipolar Bozukluk ve Şiddet Davranışı ile Başvuran Bir Tuberoskleroz Olgusunda Lityum Tedavisi

Öz

Tuberoskleroz beyin, deri, göz, kalp ve böbrek gibi çok sayıda organda hamartomatöz büyümenin gözlendiği genetik bir hastalıktır. Merkezi sinir sistemi belirtileri hastaların çoğunda bildirilmiştir ve sıklıkla beyinde yapısal lezyonlara rastlanır. Tuberoskleroz hastalarında en sık rastlanan psikiyatrik bozukluklar arasında otizm, duygudurum bozuklukları ve dikkat eksikliği hiperaktivite bozukluğu sayılmaktadır. Şizofreni dahil psikotik bozukluklar da bildirilen eştanılardandır. Burada epileptik nöbetler, psikotik belirtili bipolar bozukluk ve şiddet davranışı gözlenen, antiepileptik ve antipsikotiklerin yanısıra lityumla tedavi edilen bir olgu sunulmuştur. Yirmi iki yaşında, önceden bilinen tuberoskleroz tanısı olan erkek hasta, ailesi tarafından acil psikiyatri ünitesine getirilerek, şiddet davranışı annesine bıçakla saldırma nedeniyle yatırıldı. Psikiyatrik muayenede irritabl duygudurum, görsel varsanılar ve perseküsyon sanrıları, dezorganize konuşma, fakirleşmiş düşünce içeriği saptandı ve içgörüsü az olarak değerlendirildi. Hastanın nöbetleri topiramat ve okskarbazepinle, psikotik belirtileri risperidon ve ketiyapinle tedavi edildi. Duygudurum belirtileri ve agresif davranışları ise lityumla kontrol altına alındı. Tuberoskleroz olgularının önemli bir kısmında psikiyatrik bozukluklar görülmektedir ve bunlardan bir kısmını duygudurum bozuklukları ve psikoz oluşturmaktadır. Bu olgularda agresif ve yıkıcı davranışlar da bildirilmiştir. Etkin tedavi hastaların psikiyatrik belirtilerini iyileştirmenin yanı sıra yaşam kalitesini arttırmada da büyük önem taşımaktadır. Tuberoskleroz olgularında lityum, hem duygudurum belirtilerinin hem de agresif davranışların kontrolünde yararlı bir seçenek olabilir.

Anahtar Kelimeler

Tuberoskleroz,duygudurum bozuklukları,psikoz,agresif davranış,lityum

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Details

Primary Language

Turkish

Subjects

-

Journal Section

-

Authors

Ürün Özer

Mert Batmaz

Zeynep Ezgi Balçık

Publication Date

June 1, 2018

Submission Date

-

Acceptance Date

-

Published in Issue

Year 2018 Number: 2

IZ

https://izlik.org/JA58LT89KZ

Cite

RIS / Bibtex

EndNote

Özer Ü, Batmaz M, Balçık ZE (June 1, 2018) Bipolar Bozukluk ve Şiddet Davranışı ile Başvuran Bir Tuberoskleroz Olgusunda Lityum Tedavisi. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2 195–199.