Hasan BELLİ, Cenk URAL, Melek Kanarya VARDAR, Bahar TEZCAN

Şizofrenide şiddet ve cinayet eylemi: Risklerin değerlendirilmesi, önleyici tedbirler ve tedavide klozapinin yeri

Amaç: Bu gözden geçirme yazısı, şizofreni tanılı bireylerde cinayet işleme davranışının ortaya çıkmasında rol oynayabilecek risk faktörlerini, önleyici tedbirleri analiz etmeyi ve bu şiddet davranışlarını önlemede klozapinin etkinliğini tartışmayı ve sonuçlarını değerlendirmeyi amaçlamaktadır. Yöntem: Bu amaca yönelik olarak, psikiyatri yazını kapsamlı şekilde incelenmiştir. Uluslararası ve ulusal veri tabanlarında 1979-2010 yılları arasında bulunan makaleler taranmıştır. Bu alana katkılar sağlamış araştırmalardan yararlanılmıştır. Bulgular: Şizofrenili bireylerde cinayet davranışlarının görülme riski, genel popülasyona göre daha yüksek olmasına rağmen, şizofrenili suçlularda bu şiddet eylemlerini tetikleyen durumlar hakkında çok az şey bilinmektedir. Mevcut bulgular; bazı sosyodemografik özellikler, erkek cinsiyet, genç yaş, alkolizm, madde kötüye kullanımı, tedaviye uyumsuzluk, antisosyal kişilik bozukluğu ve paranoid alt tip ölçütlerini karşılama, intihar düşüncesi ve intihar girişimi öyküsü ve hastaneye sık yatış öyküsünü içeren faktörlerin şiddet epizotlarının ortaya çıkma olasılığını arttırdığını ileri sürmektedir. Sonuç: Klinik pratikte, cinayet işleme riski taşıyan hastalar tespit edilmeli, yakın ve sık takibe alınmalıdırlar. Eldeki mevcut veriler, şizofrenlerde şiddet davranışlarını önlemede klozapinin akla en uygun tedavi seçeneği olduğunu göstermektedir.

Schizophrenia, violence and homicidal act: Assessing the risks, preventive measures and place of clozapine in the treatment

Objective: This review is designed to analyze the potential risk factors and preventive measures involved in homicidal behaviors in schizophrenic individuals and investigate the efficacy of clozapine in preventing these violence behaviors and evaluate the results. Method: For this purpose, the psychiatry literature was comprehensively reviewed. A screening of the articles in the international and national databases, covering the period between 1979 and 2010 was performed. Trials that have contributed to this field were also utilized. Results: Although the risk of homicidal behaviors is higher in the schizophrenic individuals compared to the overall population, little is known about the relevant conditions triggering this act of violence among criminals. The available results suggest that certain factors, including some sociodemographic characteristics, male gender, young age, alcoholism, substance abuse, incompliance with the treatment, fulfillment of the criteria for antisocial personality disorder and paranoid subtype, history of suicidal ideation and attempts, history of frequent hospitalization increase the potential for occurrence for violence episodes. Conclusion: In the clinical practice, the patients with a risk of committing homicide should be detected and monitored closely. The available data show clozapine to be the most rational therapeutical choice in preventing the acts of violence in schizophrenics.

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