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Bedensel belirtilerin klinik değerlendiriminde önemli bir ayrıntı: Psikobiyolojik ve psikososyal faktörler

An important detail at clinical reasoning of somatic symptoms: psychobiologic and psychosocial factors

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DOI: 
doi:10.2399/tahd.08.031

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Abstract (2. Language): 
Somatisation is not a disease, but a common and important human mechanism involving both doctors and patients. The discussion of the relationship between mind and body, with the theories and practical applications has formed the foundation of today's psychosomatic medicine. Common physical symp¬toms such as abdominal pain, irritability, chest pain, dizziness and joint pain the are main reasons of attending a health care center. Sometimes unnoticed in our country, studies about the development and maintenance of these symptoms emphasize a vicious circle with cognitive-perceptual, behavioral, and psy-chobiological components. Patients with depression, particular¬ly those seen by primary care physicians, may firstly report somatic symptoms. It is hypothesized that somatic symptom alleviation is a significant predictor of overall outcome in depressed primary care patients. It also emphasized that psy-chosocial factors have an important influence on the chronic evolution of these symptoms. Some of the studies that investi¬gated the somatisation through different ethnic groups have suggested that somatisation is seen more densely in Eastern countries rather than West. It is also suggested that this varia¬tion may reflect characteristics of physicians and health care systems, as well as cultural differences among patients. Developing the multidimensional clinical reasoning capacity of physicians of the primary care clinics can help solve this com¬plex problem.
Abstract (Original Language): 
Bu yazıda anlatılmak istenilen; bir hastalık değil fakat, insan yapısının önemli ve sık rastlanılan bir özelliği olarak hem hekim hem de hastaları kapsayan somatizasyon (bedenselleştirme) gerçeğidir. Beden ve zihin arasındaki ilişkinin, teorik ve pratik yönelimlerle tartışıla gelmesi günümüzün psikosomatik biliminin kurulmasına zemin hazırlamıştır. Karın ağrısı, hazımsızlık, göğüs ağrısı, baş dönmesi ve eklem ağrısı gibi sık rastlanılan bedensel belirtiler kişileri bir sağlık kurumuna başvurmaya yönlendiren en büyük nedenler¬dir. Bu, ülkemizde çoğunlukla gözden kaçan bir konu olsa da, bu belirtilerin gelişimi ve sürekliliği hakkında yapılan araştırmalar; bi-lişsel-algısal, davranışsal ve psikobiyolojik bileşenlerden oluşan kısır bir döngü oluşturduklarını vurgulamaktadır. Özellikle birinci basamak sağlık kurumlarında değerlendirilen depresif hastalar, baş¬langıçta yalnızca bedensel yakınmalarını aktarabilmektedir. Birinci basamak sağlık kurumlarında, bedensel belirtilerdeki hafiflemenin depresyonun sona erişi açısından önemli ölçüde tahmin değeri taşıdığı hipotezi savunulmaktadır. Ayrıca psikososyal faktörlerin bu belirtilerin kronikleşmesinde önemli bir etken olduğu da vurgulanmaktadır. Somatizasyonu farklı etnik gruplar üzerinde inceleyen bazı çalışmalar, somatizasyonun doğu ülkelerinde batıdan daha yoğun gözlendiğini belirtmişlerdir. Bu farklılığın oluşmasında hem hastaların kültürel özelliklerinin, hem de hekim ve birinci basamak sağlık kurumlarının farklı yapılarının rolü olduğu ileri sürülmüştür. Bu kurumlarda çalışan hekimlerin çok yönlü klinik değerlendirme becerilerinin geliştirilmesinin, bu karmaşık problemin çözümüne büyük yarar sağladığı gösterilmiştir.

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