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Yıl:2006; Cilt: 16; Sayı: 2>> Özet
TAM METİN
Klinik Psikofarmakoloji Bülteni; 2006;16(2):128-132
Şizofrenide remisyon: Hayal mi, hedef mi?
S Birsöz, E Işık, İ Yargıç, H Savaş, H Işıklı
Akdeniz Ü. Tıp Fakültesi Psikiyatri ABD, Antalya
Remisyon tanımıyla, duygu durum ve anksiyete bozukluklarında gerçekçi bir tedavi hedefi sağlanmış olup, uygulanan tedavi yaklaşımları­nın, karşılaştırmalı etkinlik ve yararlarının daha iyi anlaşılmasına fırsat verilmiştir. Şizofrenideki remisyon ölçütlerinin belirsizliği, son yıllarda bu konuya olan ilgiyi artırmış ve buna ilişkin uzman çalışma grupları, uzlaşı sonuçlarını tartışmaya açmışlardır. Bu makalede, böyle bir çalışma grubunda yer alan yazarların ortak görüşleri belirtilip, remisyon tanım­lamasının getireceği olası yararlar değerlendirmeye alınmıştır. Remisyon kavramı ile oluşan ortak uzman görüşleri belirlenip, konu üzerinde bir gözden geçirme ve tartışma başlatıldı. Şizofrenide remisyon ölçütlerinin belirlenmesiyle, hasta ve hekim açı­sından objektif bir hedef belirlenecek ve bunun sonucu varolan teda­vi yaklaşımlarının karşılaştırmalı değerlendirmesi mümkün olacaktır. Ancak şizofrenide bilişsel ve işlevsel düzelmenin değerlendirilmesi, hastalığa ilişkin pozitif ve negatif belirtilerin ölçümü kadar basit olma­dığından bu alanlar-şimdilik- remisyon kavramının dışında tutulmuş­tur. Dolayısıyla bu ölçütler, remisyonun tanımlanması yolunda bir ön adımdır. Remisyon ölçütlerine ilişkin ilk değerlendirmeler semptoma-tik remisyon sağlanmasının, yaşam kalitesi, sosyal ilişkiler, iş yaşamı gibi diğer alanlarında da etkili sonuçlar verebileceğini düşündürmek­tedir. Tedavide böyle bir objektif hedef saptanıp bunun sayısal değer­lendirmesinin yapılması, hastalar, aileler ve toplum kadar, klinik araş­tırmaların düzenlenme ve karşılaştırılmasında da etkili bir yöntem oluşturacaktır.
Şizofrenide tam iyilik hali olasılığı halen uzak görülürken, remisyon sağlanması ve bunun sürdürülmesi gerçekçi bir hedef olarak ele alınabilir. Süresi ve belirtilerin sayısal ölçümü tanımlanmış bir remisyon kavramı için, terapötik etkinliği belirleyen klinik ve kontrollü çalışmala­ra gereksinim vardır.
Remission in schizophrenia: An utopia or a goal?
Remission has provided a realistic treatment goal in mood and anxiety disorders and led to an improved understanding of the relative benefits of available approaches to treatment. The concept of symptomatic remission in schizophrenia has recently been the subject of renewed interest and our aim was to evaluate the potential benefits of this development. In this article, the consensus of opinions of the authors taking part in such a study group is presented and the probable benefits of a definition of remission are taken into evaluation. We critically reviewed a recently proposed consensus definition on the concept of remission.
By establishing the remission criteria in schizophrenia, an objective goal will be set for the patient and the psychiatrist and, consequently, a comparative assessment of the current therapeutic approaches will be possible. However, since the evaluation of cognitive and functional improvement in schizophrenia is not as simple as measuring the positive and negative symptoms of the disease, these areas were kept out of the concept of remission - for the time being. Therefore, these criteria are an initial step in the way to the definition of remission. The first evaluations concerning remission criteria suggest that achieving symptomatic remission could also lead to efficient results in other areas such as quality of life, social relations and professional life. Setting such an objective goal in treatment and grading this goal will create an efficient method for the patients, families and the community as well as for designing and comparing clinical studies. While the possibility of recovery in schizophrenia still seems out-of-reach, achieving and maintaining remission may be considered a realistic goal. More widespread use of these criteria, particularly in controlled clinical trials is required to fully define how they might be used in standard clinical practice.

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