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Birinci Basamak Hekiminin Yeme Bozukluğu Yakınmasına Yaklaşımı: Bir Olgu

APPROACH OF A PRIMARY CARE PHYSICIAN TO EATING DISORDERS: A CASE PRESENTATION

Journal Name:

  • Türkiye Aile Hekimliği Dergisi

Publication Year:

  • 2004

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
A 22 year-old female patient complaining of binge eating and self-induced vomiting visited our out-patient clinic by her own interest. At the first interview, besides eating disorders and depression, dissociative symptoms were also diagnosed. Although her medical and psychosocial history included early loss of his father, family dissociation, lack of social and eco¬nomic support and decrease in self-esteem, there was no problem with her school success. The patient was told to duplicate the SSRI class antidepresant drug dosage (fluoxetine tb. 40 mg/day) combined with a low dose antipsychotic drug (olanzapine tb. 5 mg/day) which had been prescribed a month ago in a psychiatric hospital, but used irregularly. At the second interview, history taking was completed assessing risk factors for eating disorders. At the same day a psychiatric consultation was organised in order to confirm the diagnose of major depressive disorder and bulimia nervosa and to eval¬uate the patient concerning hysteric personality, dissociative disorder, sexual abuse, and suicidal intention probabilities. After two months of drug and psychotherapy, the patient had passed her final exams at school, was working at a part-time job which we had arranged for her, and had moved to a new apartment with her mother who was divorcing with her step¬father. By discussing this case, history taking, steps to be taken by a primary care physician and multi-disciplinary approach to eating disorders in primary care will be revised.
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Abstract (Original Language): 
22 yaşınd a üniversite öğrencisi bayan hasta kendi isteği ile polikliniğimize başvurdu. Tıkanırcasına yemek yeme dönemleri ardından kendi kendini kusturuyordu. ilk görüşmede yeme bozukluğu ve depresyon tanılarının yanı sıra disosiyatif belirtiler saptandı. Özgeçmişinde ve psikososyal öyküsünde erken baba kaybı, parçalanmış aile, ekonomik kısıtlılıklar ve özgüven düşüklüğü ifade etmesine rağmen okul başarısı azalmamıştı. Hasta, 1 ay önce başvurduğu psikiyatri hastanesinde verilen, anti-depresan ve düşük doz antipsikotikten oluşan tedaviyi düzensiz kullanmaktaydı. Fluoksetin, dozu iki kat artırılarak (40 mg tablet/gün), olanzapin'in ise (5 mg tablet/gün) önerildiği gibi kullanılması planlandı. ikinci görüşmede, yeme bozukluğunda-ki risk faktörleri sorgulanarak tıbbi öykü tamamlandı. Majör depresif bozukluk ve bulimiya tanısı, histerik kişilik, disosiyatif bozukluk, cinsel istismar şüphesi ve intihar eğilimi nedeniyle aynı gün psikiyatri konsültasyonu sağlandı. izlenen hastamız, 2 ay sonra, ilaç ve kombine psikoterapiye devam etmekteydi, okulunda yıl sonu sınavlarını başarı ile tamamlamış, kendisine bulduğumuz yarı-zamanlı bir işte çalışmakta, üvey babasından boşanmak üzere dava açan annesiyle ayrı bir evde yaşamaktaydı. Bu olgu aracılığı ile yeme bozukluğu şikayeti ile birinci basamağa başvuran bir hastada öykü alma sürecinin özellikleri, birinci basamak hekimine düşen görevler ve mültidisipliner yaklaşım ilkeleri gözden geçirilecektir.
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  • 2
80-84
  • Turkish

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