Dergi Ara >>
Yıl:2011; Cilt: 4; Sayı: 2>> Özet
Türkiye Klinikleri Psikiyatri Özel Dergisi; 2011;4(2):57-65
Şizofreni Hastalarında Şiddet
AG Gönen, SU Kaymak, H Soygür
Samsun Ruh Sağlığı ve Hastalıkları Hastanesi, Samsun
Şizofreni %1 yaygınlığa sahip, bireyin kendisi dışında ailesini ve toplumu da etkileyen ciddi bir ruhsal hastalıktır. Tedavisinde ilaçların yanı sıra psikososyal girişimler de gerekmektedir. Şizofreni hastalarının genel populasyona oranla daha fazla şiddet davranışı gösterip göstermedikleri bir merak konusudur. Şizofreni hastaları ve çevresi/toplum arasındaki çok yönlü etkileşimden medyaya sıklıkla şiddet içeren manzaralar yansıtılmakta ve bu durum mevcut riskin olduğundan daha fazlaymışçasına algılanmasına yol açarak bireylere yönelik damgalanmayı artırıcı bir faktör olarak rol oynamaktadır. Yapılan araştırmalar sonucunda birinci eksen herhangi bir psikiyatrik tanısı olan bireylerin şiddet gösterme riski sağlıklı bireylerden yüksek bulunmuş ve şizofrenide bu riskin ortalama 6,5-8 kat artabildiği saptanmıştır. Bununla birlikte toplumda gözlenen şiddetin ne kadarının şizofreniye atfedilebileceğinin araştırılmasının daha önemli olduğu ileri sürülmektedir. Bir şizofreni hastası tarafından öldürülme olasılığı on dört milyonda birdir. Bu riski etkileyen faktörlerde önemli olup özellikle madde kullanımı komorbiditesinde risk belirgin olarak artmaktadır. Ayrıca cinsiyetin, aktif psikotik belirti varlığının, kişilik özelliklerinin, mevcut sosyal şartlar ve gelişimsel faktörlerin de risk üzerinde etkisi olduğu gözlenmektedir. Hasta tedavi ediliyorsa saldırganlık riski azalır. Şiddet gösteren hastalara akut ve kronik dönemde farklı yaklaşımlar gerekir. Görüşmelerde uygun iletişim becerilerinin kullanılması uygulanacak psikofarmakolojik tedaviler kadar önemlidir. Şizofreni hastalarının toplumla uyumunun arttırılması problemin önemli ölçüde önüne geçecektir ve bu nedenle toplumun bu konuda bilgilendirilmesi ruh sağlığı politikaları içinde yer almalıdır.
Violent in Patient with Schizophrenia
Schizophrenia is a serious disorder with a 1% prevalence which effects not only the individual himself but also the family and the society. Treatment of schizophrenia requires psychosocial approaches as well as medical treatments. An important research topic is to understand whether or not people with schizophrenia are more likely to be violent compared to the general population. The attitude of the media, by presenting many scenes involving violent acts or behaviors from multidimensional interactions between schizophrenia patients and his or her surrounding, has lead people to perceive that the risk of violence is greater than it is in reality. Hence, stigmatization of schizophrenia patients has increased. Various studies have confirmed that the risk of violence in people who have axis I disorder is significantly higher than for healthy people and is 6.5-8 times more in schizophrenia patients. However it has been suggested that examining the percentage of violence in the population that can be ascribed to schizophrenia is more useful. For example, the probability of being killed by a schizophrenia patient is less than1/14.000.000. Risk factors for violence are also very important, especially comorbidity of substance abuse, which is associated with a higher risk. Furthermore, gender, the existence of active psychotic symptoms, personality, and the current social context and developmental factors also affect this risk. Moreover if patients are being treated, the risk declines. Approaches to a violent patient exhibit differences during acute and chronic psychotic episodes. It has been shown that using the appropriate communication skills is as important as medical treatment. It is important to note that conformity of schizophrenia patients to the society can reduce the problem significantly, so the education of the society must be a priority when determining mental health policies.

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