Kemal SAYAR, Ömer YANARTAŞ, Serhat ERGÜN, Erdoğdu AKÇA, Nurşin HİCRİ, Süha Can GÜRSOY

Schneider belirtileri ve DSM 5: ilişkili iki olgu sunumu

Geçmişte psikotik bozukluklarda daha yaygın olduğu düşü-nülen Schneider tarafından tanımlanan belirtiler (STTB)son dönemde yapılan çalışmalarda dissosiyatif bozuklukve bipolar afektif bozukluk gibi diğer bazı psikiyatrikbozukluklarda da gösterilmiştir. Bunun sonucu olarak daDSM 5'te STTB'e şizofreni tanısındaki özellikli atıf tanısisteminden kaldırılmıştır. Biz bu çalışmada STTB'i olaniki vakayı sunmayı amaçlıyoruz. Sunulan olgularda STTB'eilave olarak amnezi ve füg belirtilerinin varlığı ve bu belirtilerinstresli yaşam olayları ile ilişkili olması nedeniyle dissosiyatifbozukluk tanısını da akla getirmekteydi. Bundandolayı antipsikotik tedavi yerine uygulanan psikoterapötikmüdahale ve psikolojik stresörden uzaklaşma yaklaşımlarınınSTTB açısından da fayda sağladığı gözlemlendi.STTB'in DSM 5'te psikoza özellikli atıfın çıkarılması diğerbozukluklarda da STTB'in klinisyenlerin dikkatini çekmesineneden olacaktır. Böylece bu değişiklik dissosiyatif bozuklukve bazı bipolar afektif bozukluk olgularının daha iyi tanınmasınısağlayabilir ve hastaların gereksiz yere yüksek dozantipsikotik tedavi almasının önüne geçebilir.

Schneiderian symptoms and DSM 5: related to two cases

Thought to be more common in psychotic disorders in the past, Schneiderian symptoms (SS) were also observed in other disorders such as dissociative disorders and bipolar disorders. As a result of this, specific attribution of Schneiderian first rank symptoms was eliminated from diagnostic criteria of schizophrenia in DSM-5. In this article, we aim to present two cases having schneiderian symptoms. Since these cases had additional symptoms such as amnesia, fugue, and Schneiderian symptoms related to psychosocial stressors, we also suggested that these patients might have dissociative disorders. In terms of Schneiderian symptoms; instead of antipsychotic treatments, psychotherapeutic interventions and removal from psychogenic stressors can be considered in management of these cases. In DSM-5 the elimination of specific attribution of SS in psychosis results in clinician's drawn attention to this issue in other disorders. Therefore, this alteration may provide better diagnosis of dissociative disorders and bipolar disorders and prevent these patients' from taking high dose antipsychotic treatments unnecessarily.

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