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Yıl:2013; Cilt: 50; Sayı: 2>> Özet
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Nöropsikiyatri Arşivi; 2013;50(2):95-99
İntihar Girişimi Olan Majör Depresyon Hastalarında Üstbiliş Süreçleri
M Ak, NT Yazıhan, L Sütçigil, B Hacıömeroğlu
Gülhane Askeri Tıp Akademisi, Ankara
girişimi olmayan majör depresyon hastalar›ndan hangi üstbiliş süreçleri ba€lam›nda farkl›laşt›€›n› araşt›rmakt›r. Yöntem: Örneklem 23 intihar girişimi olan ve 28 intihar girişimi olmayan, majör depresyon tan›s› alan hastalardan oluşmaktad›r. Majör depresyon tan›s› DSM-IV Eksen-I Tan›lar› ‹çin Yar› Yap›land›r›lm›ş Klinik Görüşme Formu (SCID-I) ile konulmuştur. Depresyon ve anksiyete belirti şiddetleri Beck Depresyon Ölçe€i (BDÖ) ve Beck Anksiyete Ölçe€i (BAÖ) ile saptanm›şt›r. Üstbilişleri de€erlendirmede, üstbilişsel inançlar, yarg›lar ve süreçleri incelemek için geliştirilmiş olan Üstbiliş-30 Ölçe€i (ÜBÖ-30 ) kullan›lm›şt›r. Bulgular: ‹ntihar girişimi olan grubun BDÖ puanlar› 33,90±10,66 ve BAÖ puanlar› 28,77±13,72; intihar girişimi olmayan grubun BDÖ puanlar› 30,32±6.66 ve BAÖ puanlar› 23,75±11,17’dir. ‹ntihar girişimi olan gruba ait yaş ortalamas› 25,04±8,31 ve intihar girişimi olmayan gruba ait yaş ortalamas› 28,82±7,30 olarak kaydedilmiştir. Veriler MannWhitney-U yöntemi ile analiz edilmiş ve intihar girişimi olan ve olmayan majör depresyon gruplar›“bilişsel güven” (z=-2,39; p=0,026<0,05) ve “düşünceleri kontrol” (z=-2,22; p=0,017<0,05 ) alt boyutlar›nda anlaml› olarak farkl› bulunmuştur. Sonuç: ‹ntihar girişiminde bulunan grubun, dikkatlerine ve belleklerine olan güvenleri düşük olarak bulunmuştur. Bu durum, depresyonda beklenen benlik de€erlerindeki düşüş veya olumsuz süreçleri alg›lamada ve aş›r› genellemede gözlenen art›ş ile ilişkili olabilir. Ölçek maddelerine uçlarda verilen tepkiler, kişinin dünyay›“siyah-beyaz” şeklinde alg›lama e€iliminin bir göstergesi olabilir. Dünyay› siyah beyaz şeklinde kat› s›n›rlar ile kurgulama biçimi intihar davran›ş› için de bir risk faktörüdür. Pek çok intihar girişimi vakas›nda kişiler problemlerinin çözümüne alternatif çözüm yollar› üretememekte ve umutsuzlu€a kap›lmaktad›rlar. ‹ntihar girişimi olan majör depresyon hastalar›nda “zihinsel süreçlerini kontrol etmeye yönelik” abart›l› u€raş, bu grubun düşüncelerine daha fazla odaklanmalar› ile ilişkili olabilir.
Metacognitive Beliefs of Major Depression Patients with Suicidal Behaviour
Background: The aim of this study was to investigate the metacognitive beliefs of major depression patients with and without suicidal behavior. Methods: The sample consisted of 23 suicidal and 28 non-suicidal major depression patients whose diagnosis were made by using Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I). Anxiety and depression symptom severity were measured through Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI)). Metacognitive beliefs were measured through Metacognitive Questionnaire (MCQ) which is accepted as a measuring device of metacognitive beliefs, metacognitive processes and judgment. Results: Suicidal group’s BDI score was 33.90±10.66 and BAI score was 28.77±13.72; nonsuicidal group’s BDI score was 30.32±6.66 and BAI score was 23.75±11.17. The mean age of suicidal group was 25.04±8.31 years and the mean of age of non suicidal group was 28.82±7.30 years. Data were analyzed by using Mann Whitney- U, and the difference between major depression patients with and without suicidal behavior was found to be significant for the subtypes of “need to control thoughts” (z=-2.22; p=017<0.05) and “cognitive confidence” (z=-2.39; p=026<0.05). Conclusion: Cognitive confidence (confidence in memory and attention) of the suicidal group was found to be lower compared to non-suicidal group. This can be related with the decrement in the self esteem of the patients or increment in the perception and over generalization of the negative events. We suggest that the extreme responses to the items might be the indication of a tendency of “black–and–white” style of thinking. Black and white style of thinking is also a risk factor for suicide behavior. Most of the people with suicidal attempts are unable to produce alternative solutions to their problems and feel hopeless. The extreme effort to control the thoughts in suicidal group may be related to their over attention to the thoughts

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