Tedaviye yeterli yanıt veren ve yetersiz yanıt veren bipolar manik atak hastalarının hscrp, CEA, WVC düzeylerinin sağlıklı kontrol grubu ile karşılaştırılması
Comparision of HSCRP, CEA WBC levels of patients with bipolar i manic episode with adequate response to treatment, i̇nadequate response to treatment and healthy control group
Yazar: SONGÜL ÇATİ
Danışman: DOÇ. DR. MAHMUT BULUT
Dicle Üniversitesi / Tıp Fakültesi / Psikiyatri Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2016
Konu: Psikiyatri = Psychiatry
Dizin: Bipolar bozukluk = Bipolar disorder ; C reaktif protein = C reactive protein ; Doz-cevap ilişkisi-ilaç = Dose-response relationship-drug ; Karsinoembriyonik antijen = Carcinoembryonic antigen ; Lenfositler = Lymphocytes ; Lökositler = Leukocytes ; Tedavi = Treatment ; İnflamasyon = Inflammation

Özet:
Amaç: Bu çalÕúmamÕzdaki amacÕPÕz poliklinikten veya yatarak takip edilen
Bipolar bozuklu÷u olan hastalarda hastalÕk patolojisiyle ilgili olabilece÷ini
düúündü÷ümüz serum hsCRP, CEA, WBC, lenfosit seviyeleri ile tedaviye yeterli yanÕt
veren ve vermeyen mani arasÕndaki iliúkiyi araúWÕrmaktadÕr.
Gereç ve Yöntem: Dicle Üniversitesi TÕp Fakültesi Hastanesi Psikiyatri
Anabilim DalÕna 2015 mayÕs ile 2016 a÷ustos aylarÕ arasÕnda baúvuran 18-65 yaúlarÕ
arasÕnda DSM- 5 ölçütlerine göre Bipolar bozukluk I tanÕVÕ almÕú ve tedavi gören 60
hasta ile 30 sa÷OÕklÕ kontrol grubu aydÕnlatÕlmÕú onamlarÕ alÕndÕktan sonra çalÕúmaya dahil
edildi. Hasta seçerken akut mani ata÷Õnda olup en az 6-8 hafta tedavi alan hastalar
de÷erlendirildi. Tedavi koúulu olarak da son aldÕ÷Õ ilaçlarÕQÕn en az birinin duygudurum
düzenleyicisi ve en az birinin antipsikotik ilaç olmasÕna dikkat edildi. 3 grup oluúturuldu.
Grup 1: 30 sa÷OÕklÕ gönüllü(kontrol grubu), Grup 2: manik atak tedaviye yeterli yanÕt
veren 30 hasta ve Grup 3: manik atak tedaviye yetersiz yanÕt veren 30 hasta çalÕúmaya
dahil edilmiútir. Hastalara; Onam Formu, Sosyodemografik Veri Formu, Young Mani
De÷erlendirme Ölçe÷i, Hamilton Depresyon De÷erlendirme Ölçe÷i, Hamilton Anksiyete
De÷erlendirme Ölçe÷i, Klinik Global øzlem Ölçe÷i (CGI). Verilerin analizinde SPSS 18.
0 istatistik paket programÕ kullanÕldÕ.
Bulgular: ÇalÕúmamÕzda hastalarÕn sosyodemografik verileri incelendi÷inde yaú,
cinsiyet, medeni hal, e÷itim, yaúadÕ÷Õ yer, sigara kullanÕPÕ, tüm gruplarda birbirine yakÕn
oldu÷u istatistiksel olarak anlamlÕ fark olmadÕ÷Õ saptandÕ (p>0.05). Tedaviye yetersiz
yanÕt veren hasta gruplarÕnda alkol ve madde kullanÕm öyküsünün daha fazla oldu÷u ve
istatistiksel olarak ise anlamlÕ olmadÕ÷Õ saptandÕ (p>0.05). Gruplar arasÕnda çalÕúma
durumu istatistiksel olarak karúÕlaúWÕUÕldÕ÷Õnda anlamlÕ farklÕOÕk bulundu (p<0.05). Grup 3
hastalarÕnda iúlevselli÷in bozuldu÷u saptanmÕúWÕr.
Gruplar arasÕnda madde kullanÕm öyküsü, alkol kullanÕPÕ açÕVÕndan anlamlÕ
farklÕOÕk saptanmamÕúWÕr (p=0.117). Gruplar arasÕnda sigara kullanÕPÕ grup 3
hastalarÕnda anlamlÕ derecede yüksekti(p<0.05).
Grup 1 kontrol grubu ve hasta gruplarÕ (Grup 2 ve Grup 3) arasÕnda YMDÖ
ortalama toplam puanÕ, HDDÖ ortalama toplam puanÕ, HADÖ ortalama toplam puanÕ, 
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KGø-S ortalama puanÕ karúÕlaúWÕUÕldÕ÷Õnda istatistiksel olarak anlamlÕ farklÕOÕk saptandÕ
(p<0.05). Grup 3'te ölçek puanlarÕ daha yüksekti.
 Her 3 grubun hastalarÕQÕn hsCRP, CEA, WBC, LENFOSøT de÷erlerinin
karúÕlaúWÕUÕlmasÕ sonucu Grup3'te hsCRP, CEA, LENFOSøT de÷erlerinin yüksek oldu÷u
gözlenmiútir ancak anlamlÕ farklÕOÕk saptanmamÕúWÕr(p>0,05). Gruplar arasÕ WBC
de÷erleri karúÕlaúWÕUÕldÕ÷Õnda Grup 3 WBC de÷erleri di÷er 2 gruptan istatistiksel olarak
anlamlÕ derecede daha yüksekti (p<0.05). YapÕlan karúÕlaúWÕrmada WBC ile klinik
ölçekler arasÕnda anlamlÕ iliúki saptanmÕúWÕr(p<0,05).
CEA seviyeleri ile YMDÖ arasÕnda pozitif korelasyon saptandÕ.
Sonuçlar: Bu çalÕúmadaki verilere göre, bipolar bozukluk I tanÕVÕ olan hastalarÕn
tedaviye yetersiz yanÕt veren manik atak ve tedaviye yeterli yanÕt veren hastalarÕn,
sa÷OÕklÕ kontrollerden daha úiddetli inflamasyonu olabilir. Nitekim çalÕúmamÕzdan çÕkan
sonuç Grup 2 ve Grup 3 hastalarÕnda kontrol grubuna oranla hsCRP, CEA, WBC,
Lenfosit de÷erlerinin yüksek oldu÷u gözlenmiútir. Ancak, sonuçlarÕ etkileyebilecek bir
çok faktör olabilir ve bu çalÕúmadaki bulgular gelecekte yapÕlacak çalÕúmalarla
desteklenmelidir.

Abstract:
Aim: Our aim in this study is to investigate the relationship between serum
hsCRP, CEA, WBC, lymphocyte levels and treatment response with or without
adequate response in patients with bipolar disorder who were followed up at the
outpatient clinic or inpatient clinic for disease pathology.
Material and Method: Dicle University Medical Faculty Hospital Psychiatry
Department 60 patients who were diagnosed and treated for bipolar disorder I according
to DSM-5 criteria between the ages of 18-65 between May 2015 and August 2016 were
included in the study after receiving their informed consent from 30 healthy control
groups. Patients were evaluated for acute mania at least 6-8 weeks of treatment.
At the time of the treatment, at least one of the drugs he had recently received was noted
as a mood stabilizer and at least one of them was an antipsychotic drug. 3 groups were
formed.
Group 1: 30 healthy volunteers (control group), Group 2: 30 patients who
responded adequately to manic epilepsy treatment, and Group 3: 30 patients with
inadequate response to manic epilepsy. The disease; Attitude Form, Sociodemographic
Data Form, Young Mania Assessment Scale, Hamilton Depression Rating Scale,
Hamilton Anxiety Scale, Clinical Global Impression Scale (CGI). SPSS 18. 0 statistical
package program was used in the analysis of the data.
Results: When the sociodemographic data of the patients were examined, it was
found that there was no statistically significant difference in terms of age, gender,
marital status, education, place of residence, cigarette use, and similarity in all groups
(p> 0.05). It was found that the alcohol and substance use narrative was more frequent
in the patients with inadequate response and statistically not significant (p>0.05). There
was a statistically significant difference in working status between the groups (p<0.05).
It has been determined that your function is impaired in Group 3 patients.
There were no significant differences between the groups in terms of substance
use history and alcohol use (p = 0.117). Smoking among the groups was significantly
higher in group 3 patients (p <0.05). There was a statistically significant difference
between Group 1 control group and patient groups (Group 2 and Group 3) when 
v
compared with the mean total score of HMCS, HAMER mean total score, HADS mean
total score and CGI-S mean score (p<0.05). In Group 3, the scale scores were higher.
Comparisons of hsCRP, CEA, WBC, and LENFOSITE values of 3 groups of
patients were found to be higher in Group 3 with hsCRP, CEA, LENFOSITE values but
no significant difference (p>0,05). When the WBC values of the groups were compared,
the Group 3 WBC values were higher than the other 2 groups at a statistically
significant level (p<0.05). There was a significant correlation between WBC and
clinical scales (p<0,05).
There was a positive correlation between CEA levels and YMRS.
Conclusions: According to this study, patients with bipolar disorder I may have
more severe inflammation than healthy controls in patients who respond adequately to
treatment of inadequately responding manic episodes and treatment. As a matter of fact,
the results of our study showed that hsCRP, CEA, WBC, and Lymphocyte values were
higher in Group 2 and Group 3 patients compared to the control group. However, there
can be many factors that can affect the results and the findings in this study should be
supported by future studies.