Şizofreni Hastalarında Kilo Alımı, Ruhsal Belirtiler ve Benlik Saygısı

Yıl 2022, Cilt: 14 Sayı: Ek 1, 100 - 109, 29.12.2022

Havva Gezgin Yazıcı , İsmail Volkan Şahiner , Müşerref Didin , Sevde Öner

https://doi.org/10.18863/pgy.1113719

Öz

Bu çalışmanın amacı, bir toplum ruh sağlığı merkezinde (TRSM) tedavi gören şizofreni hastalarında kilo alımını, ruhsal belirtileri ve benlik saygısını incelemektir. 103 şizofreni hastası ile 01.08.2021-01.02.2022 tarihleri arasında yürütülmüştür. Veriler, Kişisel Bilgi Formu, Rosenberg Benlik Saygısı ölçeği ve Pozitif ve Negatif Sendrom Ölçeği (PANSS) ile toplanmıştır. Hastaların %35’i kadın, %43,7’si bekar, %48,5’i 45-64 yaş aralığındadır. Hastaların ilk ayda kilo ölçüm değeri (x̄=81,185) ile altı ayın sonundaki ölçüm değeri arasında (x̄=81,320) artış anlamlı bulunmamıştır. İlk aydaki benlik saygısı ölçeği puan ortalamasına (x̄=1,452) göre altı ay sonundaki benlik saygısı ölçeği puan ortalamasındaki (x̄=1,317) düşüş anlamlı bulunmamıştır. PANSS Genel Psikopatoloji alt ölçeği puan ortalaması altı aylık takip sonunda (x̄=26,418), ilk ay puan ortalamasına (x̄=27,136) göre istatistiksel olarak anlamlı derecede düşük bulunmuştur. TRSM’ye kayıtlı olan şizofreni hastalarının altı aylık takibinde kilo alma durumu ile benlik saygısı ve PANSS pozitif/negatif belirtileri arasında anlamlı bir farklılık bulunmamıştır. PANSS genel psikopatoloji belirtilerinde birinci ve altıncı ay ölçümleri arasında anlamlı bir farklılık saptanmıştır. Cinsiyet, gelir getiren işte çalışma durumu, atipik ve karma antipsikotik kullanımı, sigara kullanma durumu ve gündüz uyuma alışkanlığındaki değişikliklerin ruhsal belirtileri etkilediği saptanmıştır.

Anahtar Kelimeler

Şizofreni, Antipsikotik, Kilo alımı, Benlik saygısı, Ruhsal belirti.

Weight Gain, Mental Symptoms and Self-Esteem in Patients with Schizophrenia

Öz

The aim of this study is to examine the weight gain, mental symptoms and self-esteem in patients with schizophrenia undergoing treatment at a community mental health center (CMHC). The study is conducted with 103 schizophrenic patients between 01.08.2021 – 01.02.2022. The data was collected with Personal Information Form, Rosenberg Self-esteem Scale, and Positive and Negative Syndrome Scale (PANSS). 35% of the patients are women, 43.7% are single, and 48.5% are between the ages of 45-64. There was no significant increase between the patients’ weigh measurement value in the first month (x̄=81.185) and the measurement value at the end of six months (x̄=81.320). The decrease in the self-esteem scale mean score at the end of six months (x̄=1.317) was not found significant, when compared to the self-esteem scale mean score in the first month (x̄=1452). The PANSS General Psychopathology subscale mean score was found to be statistically lower at the end of the six-month follow-up (x̄=26.418), compared to the first month mean score (x̄=27.136). There was no significant difference between weight gain, self-esteem, and PANSS positive/negative symptoms in the six-month follow-up of patients with schizophrenia enrolled in CMHC. A significant difference was discovered between the first and sixth-month measurements in PANSS general psychopathology symptoms. It is detected that gender, working status, atypical and mixed antipsychotics use, smoking status, and changes in daytime sleeping habits affect mental symptoms.

Anahtar Kelimeler

schizophrenia, antipsychotic, weight gain, self-esteem, mental symptom

Kaynakça

• Annamalai A, Kosir U & Tek C (2017) Prevalence of obesity and diabetes in patients with schizophrenia. World journal of diabetes, 8(8), 390–396. https://doi.org/10.4239/wjd.v8.i8.390
• Çetin M (2015) Şizofreni tedavisi: geçmişi, bugünü ve geleceği. Bulletin of Clinical Psychopharmacology, 25(2), 95-9.
• Mermi O (2018) Obezite ve psikiyatri. Fırat Tıp Dergisi, 23, 54-60.
• Wang J, Zhang Y, Liu Z. et al. (2020) Schizophrenia patients with a metabolically abnormal obese phenotype have milder negative symptoms. BMC Psychiatry 20, 410. https://doi.org/10.1186/s12888-020-02809-4
• Rosenberg M (1965) Society and the Adolescent SelfImage. Princeton, New Jersey, Princeton University Press, p.12-32.
• Çuhadaroğlu F (1986) Adolesanlarda Benlik Saygısı. Yayımlanmamış Uzmanlık Tezi. Hacettepe Üniversitesi Tıp Fakültesi, Ankara.
• Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull;13:261-76.
• Kostakoğlu E, Batur S, Tiryaki A, Göğüş A (1999) Pozitif ve negatif sendrom ölçeğinin (PANSS) Türkçe uyarlamasının geçerlilik ve güvenilirliği. Türk Psikoloji Dergisi;14:23-32.
• Seeman M V (2016) Obesity in schizophrenia. Journal of Obesity Management - 1(1):10-24.
• Meltzer HY & Gadaleta E (2021) contrasting typical and atypical antipsychotic drugs. Focus (American Psychiatric Publishing), 19(1), 3–13. https://doi.org/10.1176/appi.focus.20200051
• Holt RIG (2019) The Management of obesity in people with severe mental ıllness: an unresolved conundrum. Psychother Psychosom;88:327-332. doi: 10.1159/000503835 Laursen TM, Nordentoft M, Mortensen PB (2014) Excess early mortality in schizophrenia. Annu Rev Clin Psychol;10(1):425–48.
• Annamalai A, Tek C (2015) An overview of diabetes management in schizophrenia patients: office based strategies for primary care practitioners and endocrinologists. Int J Endocrinol:969182.
• Aguilar M C, Gurpegui M, Diaz F J & de Leon J (2005) Nicotine dependence and symptoms in schizophrenia: naturalistic study of complex interactions. The British journal of psychiatry: the journal of mental science, 186, 215–221. https://doi.org/10.1192/bjp.186.3.215
• Cerit C, Yıldız M, Candan S (2006) Psikotik bozukluğu olan ve antipsikotik ilaç kullanan hastalarda obezite sıklığı ve bir yılın sonunda kilo değişimi. Klinik Psikofarmakoloji Bülteni, 16:233-238.
• Eraslan D, Öztürk Ö, Kayahan B, Zorlu N & Veznedaroğlu B (2006) Şizofreni, atipik antipsikotikler ve obezite. Anadolu Psikiyatri Dergisi, 7(3), 167-172.
• Every-Palmer S, Huthwaite MA, Elmslie J L, Grant E & Romans SE (2018) Long-term psychiatric inpatients' perspectives on weight gain, body satisfaction, diet and physical activity: a mixed methods study. BMC psychiatry, 18(1), 300. https://doi.org/10.1186/s12888-018-1878-5
• Kaskie RE, Graziano B & Ferrarelli F (2017) Schizophrenia and sleep disorders: links, risks, and management challenges. Nature and science of sleep, 9, 227.
• Krishnadas R, Jauhar S, Telfer S, Shivashankar S & McCreadie RG (2012) Nicotine dependence and illness severity in schizophrenia. The British journal of psychiatry : the journal of mental science, 201(4), 306–312. https://doi.org/10.1192/bjp.bp.111.107953
• Kurzthaler I & Fleischhacker WW (2001) The clinical implications of weight gain in schizophrenia. The Journal of clinical psychiatry, 62 Suppl 7, 32–37
• Meltzer HY, Perry E, Jayathilake K (2003) Clozapine-induced weight gain predicts improvement in psychopathology. Schizophr. Res; 59:19–27.
• Robertson I, Cheung A & Fan X (2019) Insomnia in patients with schizophrenia: current understanding and treatment options. Progress in neuro-psychopharmacology & biological psychiatry, 92, 235–242. https://doi.org/10.1016/j.pnpbp.2019.01.016
• Reeve S, Sheaves B & Freeman D (2019) Sleep disorders in early psychosis: incidence, severity, and association with clinical symptoms. Schizophrenia bulletin, 45(2), 287-295.
• Schwartz T L, Nihalani N, Jindal S, Virk S & Jones N (2004) Psychiatric medication-induced obesity: a review. Obesity reviews : an official journal of the International Association for the Study of Obesity, 5(2), 115–121. https://doi.org/10.1111/j.1467-789X.2004.00139.x.
• Vergi İ (2020) Şizofreni hastalarında benlik saygısı obezite ve ilaç uyumunun belirlenmesi, Yüksek Lisans Tezi, Cumhuriyet Üniversitesi, Sivas.
• Wei C W, Chen Y Q, Ma M, Xiu MH & Zhang X Y (2020) Sex differences in the association of body mass index with symptoms and cognitive deficits in Chinese patients with chronic schizophrenia. Translational psychiatry, 10(1), 18. https://doi.org/10.1038/s41398-020-0717-x
• Zhang X Y, Chen D C, Xiu MH, Haile C N, Sun H, Lu L, Kosten TA & Kosten T R (2012) Cigarette smoking and cognitive function in Chinese male schizophrenia: a case-control study. PloS one, 7(5), e36563. https://doi.org/10.1371/journal.pone.0036563
• De Hert M, Peuskens B, van Winkel R, Kalnicka D, Hanssens L, Van Eyck D& Peuskens J (2006) Body weight and self-esteem in patients with schizophrenia evaluated with B-WISE®. Schizophrenia research, 88(1-3), 222-226.
• Oh E, Song E & Shin J (2017) Individual factors affecting self-esteem, and relationships among self-esteem, body mass index, and body image in patients with schizophrenia. Archives of psychiatric nursing, 31(6), 588-595.
• Agid O, Siu CO, Pappadopulos E, Vanderburg D, Remington G (2013) Şizofrenide klinik ve fonksiyonel sonucun erken tahmini . Eur Nöropsikofarmakol. 23 :842–51. 10.1016/j.euroneuro.2012.10.005
• Garcia-Rizo C (2020) Antipsychotic-ınduced weight gain and clinical ımprovement: a psychiatric paradox. Frontiers in psychiatry, 11, 560006. https://doi.org/10.3389/fpsyt.2020.560006