Risk Syndromes and Scales Determining Risk in Schizophrenia and Other Psychoses

Yıl 2015, Cilt: 24 Sayı: 4, 494 - 508, 15.09.2015

Soner Çakmak Ufuk Bal Lut Tamam M. Onur Karaytuğ

https://doi.org/10.17827/aktd.61092

Öz

Schizophrenia is a chronic disorder leading to lifelong deterioration of social and vocational functioning. Prodromal period, designates the time interval starting with emerging nonspecific signs and deficits and extending up to presentation of distinct and ongoing schizophrenic symptoms, is observed in most of schizophrenia patients. In schizophrenia, poor premorbid adjustment leads to a worseprognosis and thus early detection and intervention is required in prodromal period. To this end, under the heading of risk factors for schizophrenia and psychosis, classification and scales to determine the risk are being utilized. Most frequently used scales are; Bonn Scale for the Assessment of Basic Symptoms (BSABS), Comprehensive Assessment of At-Risk Mental States (CAARMS), Structured Interview for Psychosis-Risk Syndromes (SIPS). Through the light of these latest developments, recent edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) added psychosis risk syndrome or attenuated psychosis syndrome to indicate risk of transition to psychosis. These approaches revealed that the risk of progression to psychosis was not reliably correlated with fulfilled criteria, but abscence of criteria credibly predicted the unlikelihood of psychosis emergence. Evidently, concomitant premorbid features and prodromal symptoms significantly increase the risk of progression to psychosis and schizophrenia in comparison to normal population. Nevertheless, specification and elaboration of risk criteria will enhance reliability of risk determination.

Anahtar Kelimeler

Psychotic disorders, schizophrenia, prodromal, psychosis risk syndrome

Şizofreni ve Diğer Psikozlarda Risk Sendromları ve Risk Belirlenmesinde Kullanılan Ölçekler

Öz

Şizofreni hem sosyal hem de mesleki açıdan yaşam boyu süren işlevsellik kayıplarına yol açan kronik bir hastalıktır. Hastalık için özgün olmayan belirtilerin ve defisitlerin ortaya çıkmasından belirgin ve devam edegelen şizofrenik belirtilerin görülmesine dek süren zamanı tanımlayan prodromal evre çoğu şizofreni hastasında görülmektedir. Hastalıktaki kötü premorbid uyumun daha kötü prognoza yol açması, hastalık öncesi prodromal evrede hastalığın erken tanı ve müdahalesinin yapılması gerekliliğini doğurmuştur. Bu amaçla son 10 yılda şizofreni ve psikozlar için risk faktörleri başlığı altında sınıflandırma ve riski belirleyen ölçekler kullanılmaya başlanmıştır. Bu ölçeklerden en sık kullanılanlar; Bonn Temel Semptomların Değerlendirilmesi Ölçeği (BSABS), Riskli Mental Durumların Kapsayıcı Değerlendirmesi (CAARMS), Prodromal Belirtiler için Yapılandırılmış Görüşme (SIPS)’dır. Bu gelişmeler ışığında yakın zamanda yayınlanan Amerikan Psikiyatri Birliğinin Ruhsal Bozuklukların Tanısal ve Sayımsal El Kitabı 5. Baskı (DSM-5)’de Psikoz Risk Sendromu veya Hafif Psikoz Sendromu adları altında psikoza çevrilme riski olan durumlar eklenmiştir. Bu yaklaşımların ortaya çıkardığı sonuç, ölçütleri karşılayan hastalarda psikoz gelişme riskinden çok ölçütleri karşılamayanlarda psikoz gelişmeyeceği olasılığını daha yüksek güvenilirlikte ortaya koymaları olmuştur. Premorbid özelliklerin ve prodromal belirtilerin birlikte psikoz ve şizofreni gelişme olasılığını normal populasyona göre belirgin oranda artırdığı açıktır. Ancak risk ölçütlerinin daha özgül hale getirilmesi ve ayrıntılandırılması riskin belirlenmesinde güvenilirliği artıracaktır.

Anahtar Kelimeler

Psikotik bozukluklar, şizofreni, prodrom, risk sendromları

Kaynakça

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