Şizofreni ve Özkıyım

Özkıyım, şizofreni hastalarında erken ölüm nedenleri arasındadır. İzlem çalışmaları bu hastalarda ölümle sonuçlanan özkıyım girişimlerinin %4-5 oranında görüldüğünü bildirmektedir. Şizofrenideki yüksek özkıyım oranlarının azaltılması, büyük ölçüde öngörücü risk etmenlerinin anlaşılması ile mümkündür. Önceki özkıyım girişimi, eşlik eden depresyon, umutsuzluk, içgörünün korunması ve madde kullanımı şizofreni hastalarında özkıyım riskini arttıran etmenlerdir. Yüksek zeka düzeyi ve yüksek hastalık öncesi işlevsellik gibi biyopsikososyal faktörler de aynı zamanda artmış özkıyım riskiyle ilişkili bulunmuştur. Hastalığın başlangıç dönemi özkıyım riskinin en yüksek olduğu dönemdir. Antipsikotik ilaçların, özellikle klozapininve antidepresanların özkıyım riskini azaltabileceği öngörülmektedir.

Anahtar Kelimeler:

özkıyım, şizofreni, risk faktörleri

Schizophrenia and Suicide

Suicide is one of the major causes of premature death among patients with schizophrenia. Follow-up studies have estimated that 4-5% of these patients die by suicide. Reducing the high rates of suicide in schizophrenia is possible with understanding of predictive risk factors. Various studies have identified risk factors for suicide in schizophrenia patients. Clinical risk factors include previous suicide attempts, comorbid depression, feelings of hopelessness, concept of insight and substance abuse. Biopsychosocial factors, such as a high intelligence quotient and high level of premorbid functioning, have also been associated with an increased risk of suicide in patients with schizophrenia. The risk of suicide is considered to be highest in the early course of illness. Antipsychotic drugs, in particular clozapine and antidepressants may be helpful in reducing the risk of suicide in schizophrenia.

Keywords:

suicide, schizophrenia, risk factors,

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Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. World Report on Violence and Health. Geneva, WHO, 2002.
Carlborg A, Winnerback K, Jönsson EG, Jokinen J, Nordström P. Suicide in schizophrenia. Expert Rev Neurother 2010; 10:1153-1164.
Bleuler E. Dementia Praecox or the Group Schizophrenias. New York, International University Press, 1950.
Ösby U, Correia N, Brandt L, Ekbom A, Sparen P. Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res 2000; 45:21-28.
Baxter D, Appleby L. Case register study of suicide risk in mental disorders. Br J Psychiatry 1999; 175:322-326.
Palmer BA, Pankratz VS, Bostwick JM. The lifetime risk of suicide in schizophrenia: A reexamination. Arch Gen Psychiatry 2005; 62:247-253.
Siris SG. Suicide and schizophrenia. J Psychopharmacol 2001; 15:127-135.
Nordentoft M, Laursen TM, Agerbo E, Qin P, Hoyer EH, Mortensen PB. Change in suicide rates for patients with schizophrenia in Denmark, 1981–1997: Nested case– control study. BMJ 2004; 329(7460):261.
Brown S. Excess mortality of schizophrenia: A meta-analysis. Br J Psychiatry 1997; 171:502-508.
Alaräisänen A, Miettunen J, Rasanen P, Fenton W, Koivumaa-Honkanen HT, Isohanni M. Suicide rate in schizophrenia in the Northern Finland 1966 Birth Cohort. Soc Psychiatry Psychiatr Epidemiol 2009; 44:1107-1110.
Gupta S, Black DW, Arndt S, Hubbard WC, Andreasen NC. Factors associated with suicide attempts among patients with schizophrenia. Psychiatr Serv 1998; 49:1353- 1355.
Müller DJ, Barkow K, Kovalenko S, Ohlraun S, Fangerau H, Kölsch H, et al. Suicide attempts in schizophrenia and affective disorders with relation to some specific demographical and clinical characteristics. Eur Psychiatry 2005; 20:65-69.
Özcüler T. Şizofrenik bozukluğu olan hastalarda özkıyım girişimi ve düşüncelerinin değerlendirilmesi (Uzmanlık tezi). Adana, Çukurova Üniversitesi, 2004.
Kuo CJ, Tsai SY, Lo CH, Wang YP, Chen CC. Risk factors for completed suicide in schizophrenia. J Clin Psychiatry 2005; 66:579-585.
Reutfors J, Brandt L, Jönsson EG, Ekbom A, Sparen P, Ösby U. Risk factors for suicide in schizophrenia: findings from a Swedish population-based case–control study. Schizophr Res 2009; 108:231-237.
Kim SJ, Mun JW, Bae KY, Kim JM, Kim SY, Yang SJ et al. Psychosocial factors contributing to suicidal ideation in hospitalized schizophrenia patients in Korea. Psychiatry Investig 2010; 7:79-85.
Tidemalm D, Langström N, Lichtenstein P, Runeson B. Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long term follow-up. BMJ 2008; 337:a2205.
Carlborg A, Jokinen J, Nordström AL, Jönsson EG, Nordström P. Attempted suicide predicts suicide risk in schizophrenia spectrum psychosis. Nord J Psychiatry 2009; 64:68-72.
Uzun Ö. Şizofreni ve intihar. In Şizofreni, 4. Baskı (Eds. ME Ceylan, M Çe- tin):1231-1240. İstanbul, İncekara Ltd., 2009.
Haw C, Hawton K, Sutton L, Sinclair J, Deeks J. Schizophrenia and deliberate self- harm: A systematic review of risk factors. Suicide Life Threat Behav 2005; 35:50-62.
Pompili M, Amador XF, Girardi P, Harkavy-Friedman J, Harrow M, Kaplan K et al. Suicide risk in schizophrenia: learning from the past to change the future. Ann Gen Psychiatry 2007; 6:10.
Hawton K, Sutton L, Haw C, Sinclair J, Deeks JJ. Schizophrenia and suicide: Systematic review of risk factors. Br J Psychiatry 2005; 187:9-20.
Nordentoft M, Jeppesen P, Abel M, Kassow P, Petersen L, Thorup A et al. OPUS study: suicidal behaviour, suicidal ideation and hopelessness among patients with first-episode psychosis. One-year follow-up of a randomised controlled trial. Br J Psychiatry Suppl 2002; 43:s98-s106.
Evren EC, Evren B, Erkıran M. Şizofrenili hastalarda özkıyım düşüncesi: pozitif, negatif belirtiler, depresyon ve içgörü ile ilişkisi. Turk Psikiyatri Derg 2002; 13:255- 264.
Özsan H, Tuğcu H. Şizofrenik hastalarda intihar olasılığının çeşitli faktörlere göre incelenmesi. Kriz Dergisi 1999; 6(1):33-39.
Aydemir Ö, Danacı EA, Pırıldar Ş. Şizofrenide depresyonu olan ve olmayan hastaların belirti yönünden ayrımı. Turk Psikiyatri Derg 2002; 13:173-178.
Kim CH, Jayathilake K, Meltzer HY. Hopelessness, neurocognitive function, and insight in schizophrenia: Relation to suicidal behavior. Schizophr Res 2003; 60:71- 80.
Bourgeois M, Swendsen J, Young F, Amador X, Pini S, Cassano GB et al. Awareness of disorder and suicide risk in the treatment of schizophrenia: results of the international suicide prevention trial. Am J Psychiatry 2004; 161:1494-1496.
Novick D, Haro JM, Suarez D, Perez V, Dittmann RW, Haddad PM. Predictors and clinical consequences of non-adherence with antipsychotic medication in the outpatient treatment of schizophrenia. Psychiatry Res 2010; 176:109-113.
Uzun Ö, Tamam L, Özcüler T, Doruk A, Ünal M. Specific characteristics of suicide attempts in patients with schizophrenia in Turkey. Isr J Psychiatry Relat Sci 2009; 46:189-194.
Heila H, Isometsa ET, Henriksson MM, Heikkinen ME, Marttunen MJ, Lonnqvist JK. Suicide and schizophrenia: a nationwide psychological autopsy study on age- and sex-specific clinical characteristics of 92 suicide victims with schizophrenia. Am J Psychiatry 1997; 154:1235-1242.
Limosin F, Loze JY, Philippe A, Casadebaig F, Rouillon F. Ten-year prospective follow-up study of the mortality by suicide in schizophrenic patients. Schizophr Res 2007; 94:23-28.
Miller R, Ream G, McCormack J, Gunduz-Bruce H, Sevy S, Robinson D. A prospective study of cannabis use as a risk factor for non-adherence and treatment dropout in first-episode schizophrenia. Schizophr Res 2009; 113:138-144.
Cantwell R. Substance use and schizophrenia: Effects on symptoms, social functioning and service use. Br J Psychiatry 2003; 182:324-329.
Zisook S, Byrd D, Kuck J, Jeste DV. Command hallucinations in outpatients with schizophrenia. J Clin Psychiatry 1995; 56:462-465.
Rudnick A. Relation between command hallucinations and dangerous behavior. J Am Acad Psychiatry Law 1999; 27:253-257.
Kelly DL, Shim JC, Feldman SM, Yu Y, Conley RR. Lifetime psychiatric symptoms in persons with schizophrenia who died by suicide compared to other means of death. J Psychiatr Res 2004; 38:531-536.
Tekin Z. Bir psikiyatri hastanesinde tedavi gören şizofrenili hastalarda intihar düşün- cesi: pozitif, negatif belirtiler ve depresyon ile ilişkisi (Yüksek lisans tezi). Trabzon, Karadeniz Teknik Üniversitesi, 2007.
Acosta FJ, Aguilar EJ, Cejas MR, Gracia R, Caballero- Hidalgo A, Siris SG. Are there subtypes of suicidal schizophrenia? A prospective study. Schizophr Res 2006; 86:215- 220.
Alaräisänen A, Miettunen J, Lauronen E, Rasanen P, Isohanni M. Good school performance is a risk factor of suicide in psychoses: A 35-year follow up of the Northern Finland 1966 Birth Cohort. Acta Psychiatr Scand 2006; 114:357-362.
Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 1999; 156:181-189.
Canetto SS. Women and suicidal behavior: A cultural analysis. Am J Orthopsychiatry 2008; 78:259-266.
Karvonen K, Sammela HL, Rahikkala H, Hakko H, Särkioja T, Meyer-Rochow VB et al. Sex, timing, and depression among suicide victims with schizophrenia. Compr Psychiatry 2007; 48:319-322.
Seeman MV. Suicide among women with schizophrenia spectrum disorders. J Psychiatr Pract 2009; 15:235-242.
Nordström P, Samuelsson M, Åsberg M, Träskman-Bendz L, Aberg-Wistedt A, Nordin C et al. CSF 5-HIAA predicts suicide risk after attempted suicide. Suicide Li- fe Threat Behav 1994; 24:1-9.
Lester D. The concentration of neurotransmitter metabolites in the cerebrospinal fluid of suicidal individuals: A meta-analysis. Pharmacopsychiatry 1995; 28:45-50.
Jokinen J, Nordström AL, Nordström P. The relationship between CSF HVA/5- HIAA ratio and suicide intent in suicide attempters. Arch Suicide Res 2007; 11:187- 192.
Mann JJ, Malone KM, Psych MR, Sweeney JA, Brown RP, Linnoila M et al. Attempted suicide characteristics and cerebrospinal fluid amine metabolites in depressed inpatients. Neuropsychopharmacology 1996; 15:576-586.
Träskman-Bendz L, Alling C, Oreland L, Regnell G, Vinge E, Öhman R. Prediction of suicidal behavior from biologic tests. J Clin Psychopharmacol 1992; 12:21-26.
Cooper SJ, Kelly CB, King DJ. 5-Hydroxyindoleacetic acid in cerebrospinal fluid and prediction of suicidal behaviour in schizophrenia. Lancet 1992; 340(8825):940-941.
Carlborg A, Jokinen J, Nordström AL, Jönsson EG, Nordström P. CSF 5-HIAA, attempted suicide and suicide risk in schizophrenia spectrum psychosis. Schizophr Res 2009; 112:80-85.
Marcinko D, Pivac N, Martinac M, Jakovljevic M, Mihaljevic-Peles A, Muck-Seler D. Platelet serotonin and serum cholesterol concentrations in suicidal and non- suicidal male patients with a first episode of psychosis. Psychiatry Res 2007; 150:105- 108.
Jokinen J, Carlborg A, Mårtensson B, Forslund K, Nordström AL, Nordström P. DST non-suppression predicts suicide after attempted suicide. Psychiatry Res 2007; 150:297-303.
Plocka-Lewandowska M, Araszkiewicz A, Rybakowski JK. Dexamethasone suppression test and suicide attempts in schizophrenic patients. Eur Psychiatry 2001; 16:428-431.
Lewis CF, Tandon R, Shipley JE, DeQuardo JR, Jibson M, Taylor SF et al. Biological predictors of suicidality in schizophrenia. Acta Psychiatr Scand 1996; 94:416-420.
Courtet P, Jollant F, Castelnau D, Buresi C, Malafosse A. Suicidal behavior: relationship between phenotype and serotonergic genotype. Am J Med Genet C Se- min Med Genet 2005; 133C(1):25-33.
Li D, He L. Meta-analysis supports association between serotonin transporter (5- HTT) and suicidal behavior. Mol Psychiatry 2007; 12:47-54.
Saetre P, Lundmark P, Wang A, Hansen T, Rasmussen HB, Djurovic S et al. The tryptophan hydroxylase 1 (TPH1) gene, schizophrenia susceptibility, and suicidal behavior: A multi-centre case–control study and meta-analysis. Am J Med Genet B Neuropsychiatr Genet 2010; 153B(2):387-396.
Li D, Duan Y, He L. Association study of serotonin 2A receptor (5-HT2A) gene with schizophrenia and suicidal behavior using systematic meta-analysis. Biochem Biophys Res Commun 2006; 340:1006-1015.
Fanous AH, Chen X, Wang X, Amdur R, O'Neill FA, Walsh D et al. Genetic variation in the serotonin 2A receptor and suicidal ideation in a sample of 270 Irish high-density schizophrenia families. Am J Med Genet B Neuropsychiatr Genet 2009; 150B(3):411-417.
De Luca V, Tharmalingam S, Zai C, Potapova N, Strauss J, Vincent J et al. Association of HPA axis genes with suicidal behaviour in schizophrenia. J Psychopharmacol 2010; 24:677-682.
Feldcamp LA, Souza RP, Romano-Silva M, Kennedy JL, Wong AH. Reduced prefrontal cortex DARPP-32 mRNA in completed suicide victims with schizophrenia. Schizophr Res 2008; 103: 192-200.
Rusch N, Spoletini I, Wilke M, Martinotti G, Bria P, Trequattrini A et al. Inferior frontal white matter volume and suicidality in schizophrenia. Psychiatry Res 2008; 164:206-214.
Aguilar EJ, Garcia-Marti G, Marti-Bonmati L, Lull JJ, Moratal D, Escartí MJ et al. Left orbitofrontal and superior temporal gyrus structural changes associated to suicidal behavior in patients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1673-1676.
Caldwell CB, Gottesman II. Schizophrenics kill themselves too: A review of risk factors for suicide. Schizophr Bull 1990; 16:571-589.
Roy A, Pompili M. Management of schizophrenia with suicide risk. Psychiatr Clin North Am 2009; 32:863-883.
Leucht S, Heres S. Epidemiology, clinical consequences, and psychosocial treatment of nonadherence in schizophrenia. J Clin Psychiatry 2006; 67(Suppl. 5):3-8.
Nordentoft M. Prevention of suicide and attempted suicide in Denmark: Epidemiological studies of suicide and intervention studies in selected risk groups. Dan Med Bull 2007; 54: 306-369.
Melle I, Johannesen JO, Friis S, Haahr U, Joa I, Larsen TK et al. Early detection of the first episode of schizophrenia and suicidal behavior. Am J Psychiatry 2006; 163:800-804.
Tiihonen J, Lönnqvist J, Wahlbeck K, Klaukka T, Niskanen L, Tanskanen A et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009; 374(9690): 620-627.
Uzun Ö, Zincir N, Cansever A, Özşahin A. İlk atak şizofrenide depresif belirtiler: altı aylık izlem çalışması. Klinik Psikofarmakoloji Bülteni 2002; 12:64-67.
Baskak B, Yarpuz AY, Özgüven HD, Atbaşoğlu C. Antipsikotik kullanan hastalarda akatizinin psikiyatrik belirtiler, intihar eğilimi ve diğer hareket bozuklukları ile ilişkisi. Nöropsikiyatri Arşivi 2010; 47:307-313.
Meltzer HY, Okayli G. Reduction of suicidality during clozapine treatment of neuroleptic-resistant schizophrenia: impact on risk-benefit assessment. Am J Psychiatry 1995; 152:183-190.
Gündüz MM. Klozapin tedavisi ile ayaktan takibi yapılan şizofreni hastalarında klinik tablonun ve klozapin tedavisi öncesi ve sonrasında, hastane yatış sayısı, intihar girişi- mi, alkol ve/veya madde kullanımı ve agresyon açısından değerlendirilmesi (Uzmanlık tezi). İstanbul, Bakırköy Prof.Dr.Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, 2010.
Cipriani A, Pretty H, Hawton K, Geddes JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry 2005; 162:1805-1819.
De Hert M, Mckenzie K, Peuskens J. Risk factors for suicide in young patients suffering from schizophrenia. Schizophr Res 2001; 47:127-134.
Haukka J, Tiihonen J, Härkänen T, Lönnqvist J. Association between medication and risk of suicide, attempted suicide and death in nationwide cohort of suicidal patients with schizophrenia. Pharmacoepidemiol Drug Saf 2008; 17:686-696.
Kayahan B, Veznedaroğlu B. Şizofrenide depresif belirtilerin önemi ve psikofarmokolojik sağaltımı. Klinik Psikofarmakoloji Bülteni 2006; 16:52-56.
Alaräisänen A, Heikkinen J, Kianickova Z, Miettunen J, Räsänen P, Isohanni M. Pathways leading to suicide in schizophrenia. Curr Psychiatry Rev 2007; 3:233-242.
Bateman K, Hansen L, Turkington D, Kingdon D. Cognitive behavioral therapy reduces suicidal ideation in schizophrenia: Results from a randomized controlled trial. Suicide Life Threat Behav 2007; 37:284-290.
Deveci A, Esen-Danacı A, Yurtsever F, Deniz F, Gürlek-Yüksel E. Şizofrenide psikososyal beceri eğitiminin belirti örüntüsü, içgörü, yaşam kalitesi ve intihar olasılığı üzerine etkisi. Turk Psikiyatri Derg 2008; 19:266-273.

ISSN: 1309-0658
Yayın Aralığı: Yılda 4 Sayı
Başlangıç: 2009
Yayıncı: Psikiyatride Güncel Yaklaşımlar

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