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Yıl:2009; Cilt: 3; Sayı: 1>> Özet
Klinik Aktüel Tıp NöroPsikiyatri Forumu; 2009;3(1):52-60
Gastrointestinal Sistem Kanserlerinde Psikiyatrik Sorunlar
M Özmen
İstanbul Üniv. Cerrahpaşa Tıp Fak. Psikiyatri ABD, İstanbul
Özellikle yeti yitimine neden olan ya da ölümcül hastalıklarda ruhsal sorunlar daha sıklıkla ortaya çıkmaktadır. Kanser tanısı konan hastalarda psikiyatrik morbidite normal popülasyona oranla 2-3 kat daha fazla gözlenmektedir. Operasyon öncesinde ya da sonrasında hastada gelişen psikiyatrik tabloların tanınmaması ve yeterince tedavi edilmemesi hastanın daha uzun süre yatışıyla, hastane masraflarında ve ölüm oranında artışla ilişkili bulunmuştur.
Kanser tedavisi ile uğraşan hekimlerin en sık güçlük yaşadığı alanlardan biri hastaya tanısının söylenmesi sorunudur. Ülkemizde aileler, pek de nadir olmayarak hastalarına tanının söylenmesini engellemektedir. Oysa tanı bilindiği andan itibaren tüm yakınlarının hastaya tepkisi değişmekte, hâsta da bir şeylerin yolunda gitmediğini sezmekte, ancak ailesinin bu konudaki güçlüğünü fark ederek hiç tartışmamayı ve bilmezden gelmeyi seçebilmektedir. Hasta kendisine yeterli imkan ve zaman tanındığı halde hastalığını sormuyorsa, ya da bununla ilgili ruhsal tepkilerini dile getirmek istemiyorsa onun seçimine saygı göstermek gerekir. Ancak kendi gerçeğini bilmek hastanın hakkıdır, bilgilendirmek de hekimin görevidir. Hekimin durumu, gerçekçi olmayan bir tablo çizmeden, ancak hastanın umudunu söndürmeyecek bir üslupla hastaya anlatması gerekir. Örneğin "midenizde şu tür bir yara var şimdi bunu ameliyatla almamız ardından da şu nedenlerle şu tedavileri uygulamamız gerekir" gibi. Böylece hekim kanser sözcüğünü kullanmasa da, hastasına var olan patolojik durumu açıklarken bu konuda neler yapılabileceğini de anlatarak "bir şeylerin yapılabileceği" mesajını da vermiş olur ve. hastasının umudunu korumasına yardımcı olabilir.
Terminal dönemdeki bir hasta için bile yapılacak şeyler vardır; acısını azaltmak ve yalnız bırakmamak. Pek çok hasta ölümden değil acı çekmekten ve yalnız bırakılmaktan korkar. Bu konularda güvence vermek bile sakinleşmelerine yardımcı olabilir.

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