{"id":1153,"date":"2014-10-16T17:12:21","date_gmt":"2014-10-16T17:12:21","guid":{"rendered":"http:\/\/www.harpahreins.com\/blogg\/?p=1153"},"modified":"2014-10-16T17:32:24","modified_gmt":"2014-10-16T17:32:24","slug":"sjo-melankoliskir-sudurnesjamenn","status":"publish","type":"post","link":"https:\/\/harpahreins.com\/blogg\/2014\/10\/16\/sjo-melankoliskir-sudurnesjamenn\/","title":{"rendered":"Sj\u00f6 melank\u00f3l\u00edskir Su\u00f0urnesjamenn?"},"content":{"rendered":"

\u00deessi f\u00e6rsla er framhald af V\u00edsindaleg ranns\u00f3kn \u00e1 \u00feunglyndi karla<\/a>. H\u00e9r ver\u00f0ur fjalla\u00f0 \u00f6rl\u00edti\u00f0 um kortis\u00f3lpr\u00f3f\/greiningu til a\u00f0 m\u00e6la m.a. \u00feunglyndi, s\u00f6gu \u00feess og af hverju a\u00f0fer\u00f0in var \u00fe\u00f6ggu\u00f0 ni\u00f0ur.<\/p>\n

<\/h3>\n
\"Melankoli<\/a>

Melankoli eftir Edvard Munch, m\u00e1li\u00f0 1894<\/p><\/div>\n

Kortis\u00f3l, DST-pr\u00f3f og m\u00e6ling kortis\u00f3ls \u00ed munnvatnss\u00fdnum<\/h3>\n

Kortis\u00f3l er sterahorm\u00f3n sem er framleitt \u00ed berki n\u00fdrnahettanna. \u00dea\u00f0 er oft kalla\u00f0 \u201estress-horm\u00f3ni\u00f0\u201c \u00fev\u00ed framlei\u00f0sla \u00feess eykst vi\u00f0 \u00e1lag og d\u00e6gursveiflur \u00feess \u00ed bl\u00f3\u00f0i geta veri\u00f0 miklar. \u00c1hrif kortis\u00f3ls eru margv\u00edsleg, m.a. hefur \u00fea\u00f0 \u00e1hrif \u00e1 bl\u00f3\u00f0\u00fer\u00fdsting og efnaskipti.<\/p>\n

Til er alvarlegur krankleiki sem nefnist heilkenni Cushings og stafar af ofgn\u00f3tt kortis\u00f3ls. Ein a\u00f0fer\u00f0in til a\u00f0 greina \u00feetta heilkenni me\u00f0 vissu er a\u00f0 sprauta 1 mg af dexametas\u00f3ni (sykurstera) \u00ed sj\u00fakling seint a\u00f0 kv\u00f6ldi og m\u00e6la kortis\u00f3l \u00ed bl\u00f3\u00f0i morguninn eftir. Ef kortis\u00f3li\u00f0 m\u00e6list h\u00e1tt eru yfirgn\u00e6fandi l\u00edkur \u00e1 a\u00f0 hann s\u00e9 haldinn Cushings heilkenni. \u00deessi pr\u00f3fun kallast dexamethasone suppression test (DST). Flestir a\u00f0rir m\u00e6last nefnilega me\u00f0 l\u00e1gt kortis\u00f3l a\u00f0 morgni, l\u00edka eftir svona DST pr\u00f3f. (Rafn Benediktsson, \u00e1n \u00e1rtals).<\/p>\n

N\u00fdleg a\u00f0fer\u00f0 til hins sama er a\u00f0 safna munnvatnss\u00fdnum \u00ed s\u00f3larhring og greina \u00ed \u00feeim kortis\u00f3li\u00f0: Um mi\u00f0n\u00e6tti eru kortis\u00f3l-gildi \u00ed sj\u00faklingum me\u00f0 Cushing heilkenni markt\u00e6kt h\u00e6rri en \u00ed heilbrig\u00f0u f\u00f3lki (Diagnosis and Treatment of Cushing’s syndrome, \u00e1n \u00e1rtals).<\/p>\n

Caroll og kortis\u00f3lm\u00e6ling til a\u00f0 greina melank\u00f3l\u00edu<\/h3>\n

\u00c1ri\u00f0 1968 komst \u00e1stralski ge\u00f0l\u00e6knirinn Barney Carroll a\u00f0 \u00fev\u00ed a\u00f0 DST-pr\u00f3fi\u00f0 v\u00e6ri \u00f6rugg m\u00e6ling \u00e1 \u00e1kve\u00f0inni ger\u00f0 \u00feunglyndis, \u00feess \u00feunglyndis sem \u00f6ldum saman var kalla\u00f0 melank\u00f3l\u00eda. Hann birti ni\u00f0urst\u00f6\u00f0ur s\u00ednar \u00ed British Medical Journal<\/em> (Caroll 1968). \u00deessar ni\u00f0urst\u00f6\u00f0ur v\u00f6ktu nokkra athygli \u00e1 \u00e1ttunda \u00e1ratug s\u00ed\u00f0ustu aldar en svo fjara\u00f0i \u00e1huginn \u00fat, af \u00e1st\u00e6\u00f0um sem tengjast \u00fer\u00f3un Diagnostic and Statistical Manual of Mental Disorders<\/em> (DSM). Samt var \u00feetta \u00f6ruggt pr\u00f3f og s\u00fdndi me\u00f0 \u00f3yggjandi h\u00e6tti a\u00f0 l\u00edffr\u00e6\u00f0ilega stafar melank\u00f3l\u00eda af \u00f6\u00f0ru en annars konar \u00feunglyndi \u00fev\u00ed pr\u00f3fi\u00f0 virka\u00f0i ekki \u00e1 neitt annars konar \u00feunglyndi e\u00f0a sj\u00fakd\u00f3ma sem l\u00edktust \u00feunglyndi (Shorter 2012).<\/p>\n

\u00cd greininni Saliva cortisol and male depressive syndrome in a community study. The Sudurnesjamenn study (Sigurdsson o.fl. 2013) er ein tilv\u00edsun \u00ed Carroll 1976 og vitna\u00f0 er me\u00f0 \u00f3beinum h\u00e6tti \u00ed gagnsemi uppg\u00f6tvunar hans \u00ed yfirlitsgrein (Christensen og Kessing 2001) \u00fear sem \u00fev\u00ed er haldi\u00f0 fram a\u00f0 DST pr\u00f3f Carroll hafi ekki virka\u00f0 sem skyldi. H\u00f6fundar yfirlitgreinarinnar vitna m\u00e1li s\u00ednu til stu\u00f0nings \u00ed Carroll o.fl. 1981 en hafa misskili\u00f0 textann \u00fev\u00ed skv. \u00fatdr\u00e1ttum \u00far \u00feeirri grein (\u00e9g hef ekki a\u00f0gang a\u00f0 greininni \u00ed heild) virka\u00f0i pr\u00f3fi\u00f0 \u00e1g\u00e6tlega til a\u00f0 greina melank\u00f3l\u00edu, sem \u00e1 \u00feeim t\u00edma var oftast innifalin \u00ed safni \u00feeirra \u00feunglyndissj\u00fakd\u00f3ma sem k\u00f6llu\u00f0ust innl\u00e6g ge\u00f0l\u00e6g\u00f0. A\u00f0 m\u00ednu mati hef\u00f0i veri\u00f0 skynsamlegt fyrir \u00edslensku h\u00f6fundana a\u00f0 sko\u00f0a frumheimild \u00ed sta\u00f0 \u00feess a\u00f0 taka athugasemdalaust upp misskilning Christensen og Kessing \u00ed yfirlitsgreininni.<\/p>\n

\u00c1hrif DSM<\/em><\/h3>\n

\u00c1st\u00e6\u00f0a \u00feess a\u00f0 uppg\u00f6tvun Carroll f\u00e9ll n\u00e1nast \u00ed gleymskunnar d\u00e1 var a\u00f0 \u00fea\u00f0 var ekki hagkv\u00e6mt og heppilegt fyrir ge\u00f0l\u00e6knisfr\u00e6\u00f0i og ge\u00f0l\u00e6kna a\u00f0 horfast \u00ed augu vi\u00f0 a\u00f0 til v\u00e6ri afm\u00f6rku\u00f0 tegund \u00feunglyndis, sem hef\u00f0i l\u00edffr\u00e6\u00f0ileg s\u00e9rkenni, \u00fe.e.a.s. a\u00f0 h\u00e6gt v\u00e6ri a\u00f0 greina sj\u00fakd\u00f3minn me\u00f0 l\u00edffr\u00e6\u00f0ilegum a\u00f0fer\u00f0um \u00e1 n\u00e1nast \u00f3yggjandi h\u00e1tt. Melank\u00f3l\u00eda hefur um aldir veri\u00f0 talin grafalvarlegur sj\u00fakd\u00f3mur en \u201e\u00fev\u00ed mi\u00f0ur\u201c er h\u00fan ekki algengur sj\u00fakd\u00f3mur. \u201e\u00dev\u00ed mi\u00f0ur\u201c er \u00ed \u00feessu samhengi s\u00e9\u00f0 fr\u00e1 sj\u00f3narh\u00f3li lyfjafyrirt\u00e6kja sem hafa haft beinan hag af \u00fev\u00ed a\u00f0 sem flestir v\u00e6ru greindir \u00feunglyndir og hafa haft \u00f3m\u00e6ld \u00e1hrif \u00e1 skilgreiningar alls konar \u00feunglyndis sem einungis ver\u00f0ur greint me\u00f0 hugl\u00e6gum h\u00e6tti, stundum dulb\u00fanum sem m\u00e6likv\u00f6r\u00f0um en jafn hugl\u00e6gt fyrir \u00fev\u00ed. \u00deessi \u00e1hrif hefur lyfjai\u00f0na\u00f0urinn einkum haft gegnum DSM<\/em> (Shorter 2012). \u00deau rit, einkum DSM-IV<\/em> og DSM-5<\/em>, eru bibl\u00edur og gu\u00f0spj\u00f6ll ge\u00f0l\u00e6kna um allan heim, \u00fear \u00e1 me\u00f0al \u00edslenskra. Um \u00feetta sameiginlega afrek lyfjai\u00f0na\u00f0arins og ge\u00f0l\u00e6kna ver\u00f0ur fjalla\u00f0 \u00ed n\u00e6stu f\u00e6rslu.<\/p>\n

 <\/p>\n

En \u00fea\u00f0 hvarflar svona a\u00f0eins a\u00f0 m\u00e9r a\u00f0 hinir sj\u00f6 \u00feunglyndu lyfjalausu Su\u00f0urnesjamenn sem skilu\u00f0u munnvatnss\u00fdnum me\u00f0 vel h\u00e1u kortis\u00f3li undir kv\u00f6ld og s\u00ed\u00f0la kv\u00f6lds (Sigurdsson o.fl. 2013), hafi, \u00feegar allt kemur til alls, ekki \u00fej\u00e1\u00f0st af s\u00e9rst\u00f6ku n\u00fduppg\u00f6tvu\u00f0u karla\u00feunglyndi heldur af gamaldags vel\u00feekktri melank\u00f3l\u00edu. \u00dea\u00f0 v\u00e6ri \u00ed fullu samr\u00e6mi vi\u00f0 uppg\u00f6tvun Carroll \u00e1ri\u00f0 1968 og k\u00e6mi kyni ekkert vi\u00f0.<\/strong><\/span><\/p>\n

Heimildir<\/strong><\/p>\n

Diagnosis and Treatment of Cushing’s syndrome<\/a>, \u00e1n \u00e1rtals. Stanford School of Medicine<\/em>.<\/p>\n

Carroll, B. J., Martin, F. I. R., & Davies, B. 1968. Resistance to suppression by dexamethasone of plasma 11-OHCS levels in severe depressive illness. British Medical Journal 3<\/em>(5613), s. 285-297.<\/p>\n

Carroll, Bernard J; Feinberg, Michael; Greden, John F.; Tarika, Janet; Albala, A. Ariav; Haskett, Roger F.; James, Norman; Kronfol, Ziad; Lohr, Naomi; Steiner, Meir; De Vigne, Jean Paul; Young, Elizabeth. 1981. A specific laboratory test for the diagnosis of melancholia: Standardization, validation, and clinical utility. Archives of General Psychiatry 38<\/em>(1), s. 15-22.
\n\u00datdr\u00e6tti \u00far greininni m\u00e1 sj\u00e1 h\u00e9r<\/a> og h\u00e9r<\/a> .<\/p>\n

Christensen MV, Kessing LV. 2001. The hypothalamo-pituitary-adrenal axis in major affective disorder: a review. Nordic journal of psychiatry 55<\/em>(5), s. 359\u2013363.<\/p>\n

Rafn Benediktsson. N\u00fdrnahettur<\/a>. Innkirtlasj\u00fakd\u00f3mar: vefs\u00ed\u00f0a fyrir l\u00e6knanema<\/em>. \u00c1n \u00e1rtals.<\/p>\n

Shorter, Edward. 2013. How Everyone Became Depressed: the Rise and Fall of the Nervous Breakdown<\/em>. New York, Oxford University Press.<\/p>\n

Sigurdsson, B., Palsson, S. P., Johannsson, M., Olafsdottir, M., & Aevarsson, O. 2013. Saliva cortisol and male depressive syndrome in a community study. The Sudurnesjamenn study. Nordic journal of psychiatry, 67<\/em>(3), s. 145-152.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u00deessi f\u00e6rsla er framhald af V\u00edsindaleg ranns\u00f3kn \u00e1 \u00feunglyndi karla. H\u00e9r ver\u00f0ur fjalla\u00f0 \u00f6rl\u00edti\u00f0 um kortis\u00f3lpr\u00f3f\/greiningu til a\u00f0 m\u00e6la m.a. \u00feunglyndi, s\u00f6gu \u00feess og af hverju a\u00f0fer\u00f0in var \u00fe\u00f6ggu\u00f0 ni\u00f0ur. Kortis\u00f3l, DST-pr\u00f3f og m\u00e6ling kortis\u00f3ls …<\/span> Read More …<\/span><\/a><\/span><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[9,10],"tags":[79,84,83,78],"class_list":["post-1153","post","type-post","status-publish","format-standard","hentry","category-gedheilsa","category-saga_gedlaekninga","tag-kortisol","tag-melankolia","tag-the-sudurnesjamenn-study","tag-thunglyndi-karla"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts\/1153","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/comments?post=1153"}],"version-history":[{"count":13,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts\/1153\/revisions"}],"predecessor-version":[{"id":1168,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts\/1153\/revisions\/1168"}],"wp:attachment":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/media?parent=1153"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/categories?post=1153"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/tags?post=1153"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}