İnsan yaşamının süresi son elli yılda belirgin biçimde uzamıştır. Hastalıkların sağkalım süreleri tıptaki gelişmelere paralel biçimde artmıştır. Bu yüz güldürücü sonuçlar beraberinde baş edilmesi gereken yeni sorunlar ortaya çıkarmışlardır. Bu gelişmelerin yanı sıra küreselleşme, endüstrileşme ve kırsal yaşamdan kentsel yaşama geçişin daha çok gündeme geldiği yirmi birinci yüzyılda aile birimleri küçülmüş, ailelerde iş yaşamına dahil olan birey sayısı artmış,ve kronik hastalıkla mücadele eden aile bireyinin bakımını üstlenebilecek fert sayısı azalmıştır. Bakım veren yükü kavramı bakım sunarken yaşanabilen fiziksel, psikososyal veya maddi tepkileri ifade etmede kullanılmaktadır. Toplumsal, kültürel, aile birimlerinin yapılanmaları ile ilgili özellikler ve de sağlık bakımı sistemlerindeki farklılıklar bakım koşullarını etkileyebilecek faktörler arasındadır. Bakım verenin yaşı, etnik kökeni, cinsiyeti, hastaya olan yakınlığı, bakım vermeye gönüllü olup olmaması, eğitim durumu, ekonomik durumu, hastalığının olup olmaması, baş etme becerileri, inançları, sosyal desteği, yaşadığı toplumun kültürel özellikleri bakım verenin yük algılaması ile ilişkili kişisel faktörler arasındadır. Bakım vermenin getireceği yük, bakım gereksinimlerinin nitelikleri ile de yakından ilişkilidir. Fiziksel kısıtlılığı olan, aynı zamanda tıbbi bakımın da gerekli olduğu omurilik felçli hastaların bakım gereksinimleri ile kronik seyirli psikiyatrik bozuklukların, yaşamının ileri dönemindeki demanslı hastaların ya da terminal dönemindeki kanser hastalarının bakım gereksinimleri arasında farklılıklar bulunmaktadır. Bu yazıda farklı tıbbi ve psikiyatrik durumlarda bakım veren yükü araştırmaları derlenmiş ve farklı özelliklerin ortaya konması amaçlanmıştır.

Brain's alpha activity and alpha responses belong to major electrical signals that are related to sensory/cognitive signal processing. The present study aims to analyze the spontaneous alpha activity and visual evoked alpha response in drug free euthymic bipolar patients. Eighteen DSM-IV euthymic bipolar patients (bipolar I n = 15, bipolar II n = 3) and 18 healthy controls were enrolled in the study. Patients needed to be euthymic at least for 4 weeks and psychotrop free for at least 2 weeks. Spontaneous EEG (4 min eyes closed, 4 min eyes open) and evoked alpha response upon application of simple visual stimuli were analyzed. EEG was recorded at 30 positions. The digital FFT-based power spectrum analysis was performed for spontaneous eyes closed and eyes open conditions and the response power spectrum was also analyzed for simple visual stimuli. In the analysis of spontaneous EEG, the ANOVA on alpha responses revealed significant results for groups (F(1,34) = 8.703; P < 0.007). Post-hoc comparisons showed that spontaneous EEG alpha power of healthy subjects was significantly higher than the spontaneous EEG alpha power of euthymic patients. Furthermore, visual evoked alpha power of healthy subjects was significantly higher than visual evoked alpha power of euthymic patients (F(1,34) = 4.981; P < 0.04). Decreased alpha activity in spontaneous EEG is an important pathological EEG finding in euthymic bipolar patients. Together with an evident decrease in evoked alpha responses, the findings may lead to a new pathway in search of biological correlates of cognitive impairment in bipolar disorder.

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Background Superior temporal cortices include brain regions dedicated to auditory processing and several lines of evidence suggest structural and functional abnormalities in both schizophrenia and bipolar disorder within this brain region. However, possible glutamatergic dysfunction within this region has not been investigated in adult patients. Methods Thirty patients with schizophrenia (38.67 ± 12.46 years of age), 28 euthymic patients with bipolar I disorder (35.32 ± 9.12 years of age), and 30 age-, gender- and education- matched healthy controls were enrolled. Proton Magnetic Resonance Spectroscopy data were acquired using a 3.0T Siemens MAGNETOM TIM Trio MR system and single voxel Point REsolved Spectroscopy Sequence (PRESS) in order to quantify brain metabolites within the left and right Heschl's Gyrus and Planum Temporale of superior temporal cortices. Results There were significant abnormalities in Glutamate (Glu) (F(2,78)=8.52, p<0.0001), n-Acetyl Aspartate (tNAA) (F(2,81)=5.73, p=0.005), Creatine (tCr) (F(2,83)=5.91, p=0.004) and Inositol (Ins) (F(2,82)=8.49, p<0.0001) concentrations in the left superior temporal cortex. In general, metabolite levels were lower for bipolar disorder patients when compared to healthy participants. Moreover, patients with bipolar disorder exhibited significantly lower tCr and Ins concentrations when compared to schizophrenia patients. In addition, we have found significant correlations between the superior temporal cortex metabolites and clinical measures. Conclusion As the left auditory cortices are associated with language and speech, left hemisphere specific abnormalities may have clinical significance. Our findings are suggestive of shared glutamatergic abnormalities in schizophrenia and bipolar disorder.

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Theta oscillations are related to cognitive functions and reflect functional integration of frontal and medial temporal structures into coherent neurocognitive networks. This study assessed event-related theta oscillations in medication-free, euthymic patients with bipolar disorder upon auditory oddball paradigm. Twenty-two DSM-IV euthymic bipolar I (n = 19) and II (n = 3) patients and twenty-two healthy subjects were included. Patients were euthymic for at least 6 months, and psychotropic-free for at least 2 weeks. EEG was recorded at 30 electrode sites. Auditory oddball paradigm and sensory stimuli were used. Event-related Oscillations were analyzed using adaptive filtering in two different theta frequency bands (4-6 Hz, 6-8 Hz). In healthy subjects, slow theta (4-6 Hz) responses were significantly higher than those of euthymic patients upon target, non-target and sensory stimuli (p \ 0.05). Fast theta (6-8 Hz) responses of healthy subjects were significantly higher than those of euthymic patients upon target-only stimuli (p \ 0.05). Reduced theta oscillations during auditory processing provide strong quantitative evidence of activation deficits in related networks in bipolar disorder. Fast theta responses are related to cognitive functions, whereas slow theta responses are related to sensory processes more than cognitive processes.

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