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2011, vol. 50, br. 3, str. 81-89
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Dijagnoza i tretman depresije kod osoba sa intelektualnom ometenošću
Diagnosis and treatment of depression in persons with intellectual disability
aVocational College for Preschool Teachers, Kruševac bKlinički centar Kragujevac, Klinika za psihijatriju cKlinički centar Kragujevac, Klinika za neurologiju dUniverzitet u Kragujevcu, Medicinski fakultet
e-adresa: katarinat@vaspks.edu.rs
Sažetak
Rad sa teorijskog aspekta razmatra problem dijagnostikovanja i terapije depresivnih poremećaja kod osoba sa zaostajanjem u intelektualnom razvoju oslanjajući se, pre svega, na rezultate dosadašnjih istraživanja, u kojima se naglašavaju etiološke, simptomske (patoplastične), dijagnostičke i terapijske specifičnosti kada su u pitanju depresija i njeni korelati kod ove populacije. Tek 70-tih godina prošlog veka postaje jasno da neki kognitivni i bihejvioralni simptomi nisu, kao što se do tada mislilo, deo i posledica sindroma intelektualne ometenosti, već znak postojećeg mentalnog poremećaja, što se označava terminom 'dvojna dijagnoza'. Posmatranje sindromskih skupina genetskih poremećaja koji kao posledicu imaju ometenost u intelektualnom razvoju dovelo je do svojevrsnog sužavanja kruga genetskih sindroma koji nose povećan rizik oboljevanja od depresije i njenih korelata, kao što su npr. Daunov sindrom, Fragilno X sindrom i Prader-Vili sindrom. Potencijalan dijagnostički problem kod osoba sa intelektualnom ometenošću, a kada je u pitanju depresija, mogu predstavljati tendencije 'dijagnostičke zamagljenosti' simptoma depresije, koji često ostaju prikriveni abnormalnim ponašanjem i poremećajima prilagođavanja, posebno kod osoba sa težim oblicima intelektualne ometenosti. Kao mogući način prevazilaženja tih problema neki autori su predložili koncept 'bihejvioralnih ekvivalenata depresije' ili u ponašanju evidentnih poremećaja koji se mogu dovesti u vezu sa depresijom, kao što su: socijalno povlačenje, agresivnost, hostilnost, iritabilnost i psihomotorna agitacija. Intenziviranje ovih obrazaca u ponašanju može biti znak razvijanja depresije, pa u tom smislu ovo gledište predstavlja korisnu polaznu tačku. Kada su u pitanju terapijski pristupi, postoji opšta tendencija potenciranja psihofarmakoterapije depresije, iako ima sve više istraživanja koja dokazuju povoljne efekte kognitivno-bihejvioralne i pshoanalitičke psihoterapije.
Abstract
This paper considers, from the theoretical point of view, the problem of diagnosing and treatment of depressive disorders in people with intellectual disability (ID), relying primarily on the results of previous researches, which stress the etiological, symptomatic, diagnostic and therapeutic specifics when it comes to depression and its correlates in this population. The interest in mental health and psychopathology of people with ID intensified during the seventh decade of the previous century, when it became clear that some cognitive and behavioral symptoms are not, as hitherto thought, only a part or a consequence of the syndrome of intellectual disability, but a sign of ongoing mental disorder. So, the idea of ''dual diagnosis'' was born, and now it provides guidelines for the growing number of studies which theoretically and empirically review different issues of mental health problems in people with ID. Likewise, the observation of syndrome groups of genetic disorders resulting in intellectual disability has led to the narrowing of the circle of genetic syndromes that carry increased risk for the onset of depression and its correlates, such as: Down syndrome, Fragile X syndrome and Prader-Willi syndrome. Potential diagnostic problem in people with ID, when it comes to depression, may arise from 'diagnostic overshadowing' of depression symptoms, which often remain hidden under abnormal behavior and adjustment disorders, especially in patients with severe forms of ID. As a possible way to overcome these problems some authors have proposed the concept of 'behavioral equivalents of depression' or behavioral disorders that evidently can be associated with depression, such as social withdrawal, aggression, hostility, irritability, psychomotor agitation or retardation. Intensification of these forms of behavior may be a sign of developing depression, and in that sense, this view represents a useful starting point. When it comes to therapeutic approaches, there is a general tendency in favour of psycho pharmacotherapy in the treatment of depression, although there is a growing number of researches that prove the favourable effects of cognitivebehavioral and psychoanalytic psychotherapy.
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