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Yıl:2006; Cilt: 16; Sayı: 4>> Özet
TAM METİN
Klinik Psikofarmakoloji Bülteni; 2006;16(4):252-262
Prodrom şizofreni, güncel gelişmeler ve sorunlar
M Emül, MM Uğur
Afyon Kocatepe Üniversitesi TıpFakültesi, Psikiyatri AD, Afyon
Prodrom kelimesi gelişecek bir olayın habercisi anlamında kullanımaktadır. Prodrom evre şizofreni derken, kişinin belirtilerinin olduğu ve bu evreyi izleyen dönemde tam anlamıyla şizofreni gelişeceği anlatılmak istenmektedir. Kanser tarama yöntemleri gibi şizofreniyi de hastalık başlamadan tanımanın gerekliliği çok açıktır. Tedavisiz ya da müdahalesiz geçen sürenin ya da şizofren bireyin tedavisinde gecikmenin kötü sonuçları olduğuna inanılmaktadır. Ancak prodrom evreyle ilgili sorular vardır. Örneğin, her şizofreni gelişecek bireyde prodrom evre benzer midir ya da prodrom evresi sonrası her bireyde prodrom evre şizofreni mi gelişmektedir? Bu dönemi tarama amaçlı birçok ölçek geliştirilmiştir. Duyarlılığı ve öngörme gücü en yüksek olan testler aracılığıyla ultra yüksek riskli gruplar oluşturulmuştur. Ultra yüksek riskli grubun özelliklerini taşıyan bireylerin %40’ında sonradan şizofreni geliştiği saptanmıştır. Prodromal evreyi tanımayı kolaylaştırmak amacıyla şizofreniye yatkınlık, şizotipi ve şizotaksi kavramları yeniden tartışılmaya başlanmıştır. Prodrom evreyi tanımak istemenin arkasındaki bütün motivasyon, şizofreninin beyine olası toksik etkilerinden bireyi korumak, tedavisiz psikoz süresini azaltmak, çok daha az yan etkili ilaçlarla hastalığın prognozuna olumlu katkıda bulunmaktır. Bu nedenle, prodrom evrede olduğu düşünülen bireylere düşük doz antipsikotik tedavi dâhil çeşitli farmakolojik, davranışsal müdahaleler ya da çevresel düzenlemeler gündemdedir. Yanlış pozitif tanılar da düşünüldüğünde bu durum beraberinde damgalanma, hastalık tanısı almayan bireye ilaç tedavisi, aile ve bireyin yaşayabilecekleri stresi ve ilişkili etik konuları tartışmayı gerektirmektedir.
Prodrome schizophrenia: Current developments and problems
The term prodrome is used to inform that an event will happen. Inprodrome schizophrenia, the person is considered to be symptomaticand will subsequently develop schizophrenia. It is clear that there is aneed to diagnose schizophrenia before its onset as is the case incancer screening. Increased duration of untreated psychosis isbelieved to have harmful consequences. However, there arequestions regarding prodrome schizophrenia such as: do peoplehave similar features in prodrome phase who will eventually developschizophrenia or will everyone in prodromal phase developschizophrenia? Some inventories were developed to screen thisphase. Ultra high risk schizophrenia is formed by the most sensitiveand predictive tests. Forty percent of prodrome people who share thefeatures of the ultra high risk group are found to developschizophrenia. Recently, the terms of vulnerability for schizophrenia,schizotaxia, schizotypy have begun to be rediscussed to simplify theidentification of prodrome schizophrenia. The motivation behind thequest to identify prodrome schizophrenia diagnose is to prevent theindividual from the possible toxic effects of schizophrenia to the brain,to reduce the duration of untreated psychosis and to influence theprognose positively via atypical antipsychotics with less adverseeffects. Thus, early pharmacological, behavioral interventions andenvironmental arrangements for people in the prodrome phase areon the agenda. Considering the false positive diagnoses, there isneed to discuss issues as stigmatization, pharmacological treatmentto undiagnosed patients, possible stres facing the individual and hisfamily and related ethical subjects.

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