ÖzetAmaç: Bağlanma süreçleri, psikopatolojik gelişimleri anlamamız için kuramsal bir çerçeve sunmaktadır. Güvensiz bağlanma biçimi yaşamın ilerleyen dönemlerinde psikopatolojinin ortaya çıkışı ile sık ilişkilendirilmiştir.Yöntem: Çalışmaya, DSM-IV'e göre Panik Bozukluğu (PB) tanılı 65 kişiyle kontrol grubunu oluşturan 65 sağlıklı gönüllü alınmıştır. SCID-I uygulanarak PB tanısı alan hastalara, klinik durumlarının ve hastalık şiddetlerinin belirlenebilmesi için Panik-Agorafobi Ölçeği; Erişkinlikteki ayrılma anksiyetesini (EAA) araştırmak için EAA Ölçeği ve sahip olunan bağlanma biçimini ölçmek amacıyla İlişki Ölçekleri Anketi uygulanmıştır. Panik-Agorafobi Ölçeği dışındaki ölçekler kontrol grubu için de kullanılmıştır. Bulgular: EAA, PB olan grupta anlamlı olarak yüksekti. Bağlanma biçimleri ortalamalarında sadece "saplantılı" alt boyutuna ait bağlanma biçimi ortalamasında hem PB olan grupta hem de kontr ol grubunda, EAA düzeyleri yüksekti. Hastalar incelendiğinde kadın cinsiyet ve agorafobi varlığı ile EAA birlikteliği anlamlı oranda yüksekti. Erken yaşta anne-babasını kaybeden ve anne-baba ayrılığı olanların bağlanma biçimleri ortalamalarında "korkulu" ve "saplantılı" alt boyutlarına ait ortalamalar hasta gurubunda daha yüksekti.Sonuç: PB ile EAA birlikteliğinin yüksek, bu durumun kadınlarda daha sık ve hem PB grubunda hem de kontrol grubunda, saplantılı bağlanma biçiminin diğer bağlanma biçimlerine göre daha yaygındı. PB olan kişilerde, EAA ve/veya agorafobi varlığı ile bağlanma biçimleri arasında anlamlılık saptanmamıştır. EAA ve PB hastalarında ek tanı olarak depresyon diğer anksiyete bozukluklarından yüksekti. The attachment processes give us a theoretical framework to understand the psychopathological development. Unsafe attachment type is often associated with the emergence of psychopathology in the later periods of life.

No abstract

Grief mania that is evaluated as psychogenic mania in the literature is related to manic episode that emerges after the loss of a loved one. There are not many cases that associate causality of beginning of mania and mourning in the literature. It is known that mania is induced by traumatic events but the cases that do not suit stages of development of grief process are evaluated as pathological grief. In this case, the woman who experienced manic episode after her son's death is presented. This case is prepared because mania should be considered as possible grief reaction. Case presentation: A patient who is 40 years old, married, mother of 4 children is brought by relatives because of aggressiveness, tension, insomnia for 4 days, fast and talk a lot and nonsense laughing attacks. She was presented to hospital for stressful life events 2 years ago and started to be on medication (escitalopram 10 mg) because of depression and fibromiyaliji diagnosis. She used medication for 1.5 years and she did not use any medication for the last 6months. There is no history for mental disorder in her family. Psychological examination: her interest for the environment was increased, self-care ability got better, her temperament was cheerful, her sociability was respectful, amount of talking and tone of voice increased, mimic and gesture was appropriate for her temperament, sleeping decreased, thought flow increased and achieved goal of conversation late. Moreover, there were grandiose delusions and hypervigilance, affect was close to euphoria, her psychomotor behaviours increased and social functioning decreased. According to biochemical and radiological workup, there was no pathological situation. The client started to use Lithium 900 mg/day and Olanzapin 10 mg/day because of the bipolar disorder diagnosis. The patient's blood lithium level was 0.8mEq/L and lithium was used 1200 mg/day and then 10 days later the patient's blood lithium level was 0.72 mEq/L. According to clinical observations, the patient's manic symptoms remained. Furthermore, the patient started to cry occasionally after 1 month and her grandiosity disappeared. The patient was discharged from the hospital after 45 days. The patient met the criteria for manic episode in DSM 5. The patient did not take any medication for last 6 months. Thus, it is considered that this situation was not induced by medication. It puts the patient into risk group because she was treated for depression before but it is not considered as bipolar depression because there were psychiatric history in the family and depression that experienced 2 years ago was related to stressful life events. It is considered that this case experienced grief/funeral mania because there was contiguity between loss of her son and manic episode, the patient did not react this way to previous challenging life events and the patient was outside of the ordinary 5 stages of grief process.