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Yıl:2007; Cilt: 9; Sayı: 1>> Özet
Türkiye'de Psikiyatri; 2007;9(1):5-11
Atipik Antipsikotik Tedavi Altındaki Şizofreni Hastalarında Depresif Belirtiler ve Semptomatoloji
Ö Akay, N Konuk, D Öztürk, S Kıran, İ Kutadgu
Zonguldak Karaelmas Üniversitesi Tıp Fakültesi Psikiyatri AD, Zonguldak
Amaç: Bu çalışmada şizofreni hastalarında gözlenen depresif belirtiler ile hastalığın klinik özellikleri ve tedavide
kullanılan ilaçlar ile ilişkisinin araştırılması amaçlanmıştır.
Yöntem: Araştırma, psikiyatri polikliniğine başvuran DSM-IV şizofreni ölçütlerini karşılayan 26 hasta üzerinde
yapıldı. Hastalar yüz yüze görüşme yöntemi kullanılarak, Calgary Depresyon Ölçeği (CDÖ), Kısa Psikiyatrik
Değerlendirme Ölçeği (KPDÖ), Ekstrapiramidal Belirtileri Derecelendirme Ölçeği (EBDÖ) ve Klinik Global
İzlenim Ölçeği (KGİ) ile kesitsel olarak değerlendirildi.
Bulgular: Araştırma grubunda CDÖ? ne göre depresif belirtilerin sıklığı kesme puanı 8 ve üzerinde puan
alındığında hastaların oranı %30,7 (8/26), 12 alındığında ise %19,2 (5/26) olarak saptandı. Yaş, eğitim ve
ekonomik durum açısından depresif belirtileri yüksek olan hastalar ile olmayan hastalar arasında istatistiksel
olarak anlamlı fark saptanmadı (p>0.05). Depresif belirtiler erkeklerde daha sık olarak saptandı. CDÖ puanına
göre depresif belirtileri yüksek olan ve olmayanlar arasında CGİ ve EBDÖ bakımından istatistiksel olarak
anlamlı farklılık saptanmadı. İki grup arasında KBDÖ alt maddelerinden 'a nksiyete? , ?kendini yerme ve
suçluluk duyguları?, ? depresif duygudurum? açısından fark saptandı. Diğer maddelerde ise anlamlı farlılık
saptanmadı. CDÖ için yapılan faktör analizinde umutsuzluk ve gözlenen depresyonun faktör I, suçluluk
hezeyanlarının faktör II ve intihar düşüncelerinin faktör III olarak kümelendiği saptandı.
Sonuç: Bu çalışmada şizofreni hastalarının depresif belirtilerinin, özellikle şizofreninin negatif belirtilerinden
farklı olduğu ortaya konmuştur. Ayrıca daha önceden bildirilen Calgary Depresyon Ölçeğinin 3 faktörlü
yapısı tekrar değerlendirilmiş ve en azından iki psikopatolojik komponentin, şizofrenideki depresyonu
ayırdığı bulunmuştur. Faktör I, genel depresyon faktörü (umutsuzluk ve gözlenen depresyon) ve Faktör II,
kognitif faktör (suçluluk hezeyanları). Önceki çalışmalardan farklı olarak, katkısı daha zayıf olmakla beraber,
'de presif epizod belirteci? olarak intihar düşünceleri klinik öneme sahip III. faktör olarak saptanmıştır.
Ayrıca bu faktörlerin şizofreninin klinik psikopatoloji ile saptanan ilişkileri şizofrenideki depresyonun gerek
psikolojik gerek nöral mekanizmalarla ortaya çıktığını göstermektedir.
The Depressive Symptoms and Their Relationship with Symptomatology in Patients with Schizophrenia Treated with Atypical Antipsychotics
Objective: This study aims to explore the relationship between the depressive symptoms in schizophrenic patients, the clinical aspects of the
illness and the drugs used to treat them.
Method: The research was performed among 26 patients attended to psychiatry outpatient unit who met the DSM-IV criteria of schizophrenia.
The patients were examined and evaluated cross-sectionally by the Calgary Depression Scale (CDS), Brief Psychiatric Rating Scale (BPRS),
Extrapyramidal Symptoms Rating Scale (ESRS), Clinical Global Index (CGI)
Results: The frequency of the depressive symptoms within the research group was 5/26 (19.2%) and %30,7 (8/26), according to Calgary
Depression Scale cut-off value 12 and 8, respectively. Age, education and economical status did not show significant statistical difference
between the depressive and non-depressive patients. The depressive symptoms were more common in man. Among the patients with higher
and lower scores on CDS, there was no significant difference between the ones with Clinical Global Observation Scale (CGI) and Extrapyramidal
Signs Rating Scale (ESRS). There was a noticable difference between the two groups, by means of the items of Brief Psyciatric Rating Scale
(BPRS) ; anxiety , feeling of inferiority and guilt and depressive mood. There was no significant difference between the other items. The most
common factor analysis results of CDS was factor I hopelessness and observed, depression, factor II guilt delusions and factor III suicidality.
Conclusion: This research has shown that the depressive symptoms of schizophrenic patients are different than the negative symptoms of
schizophrenia. The three factorial structure of the CDS depression scale revaluation and at least two psychopathologic components differentiate
the depression of schizophrenia. Factor I: The general depression factor (hopelessness), observable depression. Factor II: cognitive
factor (delusions of guilt). Factor III : suicidal thoughts. Although it has less effect, suicidality is the third clinically important factor as a sign of the
depressive episode in contrast with the previous studies. In addition, these factors that have shown specific relationships of clinical psychopathology
with schizophrenia representing that the depression in schizophrenia is both emerging via psychological and neural mechanisms.

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