Şizofrenide Görülen Tıbbi Durumlar

Şizofreni genç yaşlarda başlayarak kronik bir gidişle kişiyi ömür boyu etkileyen bir hastalıktır. Yaşam kalitesinde, sosyal hayatta, genel hijyende ve daha birçok alanda ciddi gerileme yaşanmakta ve hasta eski haline tekrar kavuşamamaktadır. Bu kronik ve yıkıcı seyir sırasında hastalarda mortalite riski artmaktadır ve yaşam süresi 10 yıla kadar kısalmaktadır. Ölüm sebepleri arasında özkıyım gibi doğal olmayan sebepler kadar genel tıbbi durumu ilgilendiren hastalıkların da önemli yeri vardır. Bu derlemede şizofreni hastalarında görülen tıbbi hastalık ve durumlar gözden geçirilmiştir.

Comorbid Medical Conditions in Schizophrenia

Schizophrenia is an early onset disorder that impacts the individuals deeply for their lifetimes. The disorder causes setbacks in quality of life, social interactions, general hygiene and a number of other aspects without full recovery. Increase in mortality and lifetime reductions of up to 10 years are observed during this chronic and destructive process. Possible causes of death include medical conditions that affect general health as well as suicide. This paper reviews comorbid medical disorders and conditions in patients with schizophrenia.

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  • Abraham G, Friedman RH, Verghese C, De Leon J (1995) Osteoporosis and schizophrenia: can we limit known risk factors? Biol Psychiatry, 38:131-132.
  • Akpınar A, Tanrıtanır B, Yaman AR, Ersoy İ (2014) Şizofreni ve Wolff Parkinson White sendromu birlikteliğinde antipsikotik kullanımı: bir olgu sunumu. SDÜ Sağlık Bilimleri Enstitüsü Dergisi, 5:23-25.
  • Alpay N, Ulaşoğlu C, Ağargün Y, Saygılı S (1991) The effect of long-term neuroleptic treatment on liver function tests. Dusunen Adam, 4(3): 59-60.
  • Altındağ A, Demirbaş R, Saraçoğlu G (2008) Metabolik sendromda yaşam kalitesi: komorbid psikiyatrik bozuklukların etkisi. Türkiye'de Psikiyatri, 10:29-33.
  • Barnes RF, Mason JC, Greer C, Ray FT (1983) Medical illness in chronic psychiatric outpatients. Gen Hosp Psychiatry, 5:191-193.
  • Basoglu C, Oner O, Ates AM, Algul A, Semiz UB, Ebrinc S et al. (2010) Association between symptom improvement and change of body mass index, lipid profile, and leptin, ghrelin, and cholecystokinin levels during 6-week olanzapine treatment in patients with first-episode psychosis. J Clin Psychopharmacol, 30:636-638.
  • Basson BR, Kinon BJ, Taylor CC, Szymanski KA, Gilmore JA, Tollefson GD (2001) Factors influencing acute weight change in patients with schizophrenia treated with olanzapine, haloperidol, or risperidone. J Clin Psychiatry, 62:231-238.
  • Bennett N, Dodd T, Flatley J, Freeth S, Bolling K (1995) Health Survey for England 1993. London, HMSO Series.
  • Bilici M, Kavakçı Ö, Çetin İ, Karahan SC, Bekaroglu M, Uluutku N (2000) Pozitif ve negatif belirtili şizofrenide hipotalamo-pituiter-tiroid eksen bulgularının sağlıklı bireylerle karşılaştırılması. Klinik Psikofarmakol Bulteni, 10:81-89.
  • Bo QJ, Wang ZM, Li XB, Ma X, Wang CY, de Leon J (2016) Adjunctive metformin for antipsychotic-induced hyperprolactinemia: a systematic review. Psychiatry Res, 237:257-263.
  • Böke O, Aker S, Sarısoy G, Saricicek EB, Sahin AR (2008) Prevalence of metabolic syndrome among inpatients with schizophrenia. Int J Psychiatry Med, 38:103-112.
  • Bulut SD, Bulut S, Alataş E (2015) Antipsikotiklere bağlı hiperprolaktinemi. Psikiyatride Güncel Yaklasimlar, 7:109-124.
  • Bulut SD, Bulut S, Tüzer V, Ak M, Ak E, Kısa C et al. (2014) Şizofreni tanılı hastalarda prolaktini yükselten ve az etkileyen antipsikotiklerin prolaktin seviyesi ve kemik mineral yoğunluğu üzerine etkileri. Noro Psikiyatri Ars, 51:205-210
  • Casadebaig F, Philippe A, Guillaud-Bataille JM, Gausset MF, Quemada N, Terra JL (1997) Schizophrenic patients: physical health and access to somatic care. Eur Psychiatry, 12:289-293.
  • Casey DE (2000) Prevalence of diabetes during extended clozapine and olanzapine threatment. Poster Presented at the American College of Neuropsychopharmacology Annual Meeting, San Juan, Puerto Rico, December, 10-14.
  • Casey DE (2005) Metabolic issues and cardiovascular disease in patients with psychiatric disorders. Am J Med, 118:15-22.
  • Castelli WP (1996) Lipids, risk factors and ischemic heart disease. Atherosclerosis, 124:1-9.
  • Cerit C, Özten E, Yıldız M (2008) Şizofreni hastalarında metabolik sendrom sıklığı ve ilişkili etmenler. Turk Psikiyatri Derg, 19:124-132.
  • Cetin M (2010) A comparative study of atypical antipsychotics on sexual dysfunction. Int J Neuropsychopharmacol, 13:89.
  • Chafetz L, White MC, Collins-Bride G, Nickens J (2005) The poor general health of the severely mentally ill: impact of schizophrenic diagnosis. commun. Ment Health, 41:169-184.
  • Chang A, Krygier D, Chatur N, Yoshida EM (2009) Clozapine- induced fatal fulminant hepatic failure. Can J Gastroenterol, 23:376-378.
  • Chen YL, Chen YH, Mak FL (2000) Soft neurological signs in schizophrenic patients and their nonpsychotic siblings. J Nerv Ment Dis, 188:84-89.
  • Corey-Lisle PK, Kolotkin RL, Crosby RD (2005) Schizophrenia: relationship between body mass index and quality of life. Abstract presented at the Annual Meeting of the American Psychiatric Association, Atlanta, GA.
  • Correl CU, Frederickson AM, Kane JM, Manu P (2006) Metabolic syndrome and the risk of coronary heart disease in 367 patients treated with second-generation antipsychotic drugs. J Clin Psychiatry, 67:575-583.
  • Correl CU, Fredericson AM, Kane JM, Manu P (2007) Does antipsychotic poly- pharmacy increase the risk for metabolic syndrome?. Schizophr Res, 89:91-100.
  • Correll CU, Detraux J, De Lepeleire J, De Hert M (2015) Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry, 14:119-136.
  • Correll CU, Joffe BI, Rosen LM, Sullivan TB, Joffe RT (2015) Cardiovascular and cerebrovascular risk factors and events associated with second-generation antipsychotic compared to antidepressant use in a non-elderly adult sample: results from a claims-based inception cohort study. World Psychiatry, 14:56-63.
  • Coulter D (2003) Atypical antipsychotics may cause hypertension. Prescriber Update, 24(1):4.
  • Çetin M (2015) Şizofreni tedavisi: geçmişi, bugünü, geleceği. Klinik Psikofarmakol Bulteni, 25:95-99.
  • Çiftçi TU (2012) Türk Toraks Derneği obstrüktif uyku apne sendromu tanı ve tedavi uzlaşı raporu (2012). Türk Toraks Dergisi, 13 (Suppl 1):1-66
  • Dalton SO, Mellemkjaer L, Thomassen L, Mortensen PB, Johansen C (2005) Risk for cancer in a cohort of patients hospitalized for schizophrenia in Denmark, 1969-1993. Schizophr Res, 75:315-324.
  • Davidson M (2002) Risk of cardiovascular disease and sudden death in schizophrenia. J Clin Psychiatry, 63 (Suppl 9):5-11.
  • Davidson S, Judd F, Jolley D, Hocking B, Thompson S, Hyland B (2001) Cardiovascular risk factors for people with mental illness. Aust N Z J Psychiatry, 25:196-202.
  • De Hert M, Mittoux A, He Y, Peuskens J (2011) Metabolic parameters in the short- and long-term treatment of schizophrenia with sertindole or risperidone. Eur Arch Psychiatry Clin Neurosci, 261:231-239.
  • Demirci H, Kosku N, Çınar Y, İlnem C (2003) Tipik antipsikotiklerle tedavi edilen şizofreni hastalarında koroner kalp hastalığı riskinin değerlendirilmesi. Klinik Psikofarmakol Bulteni, 13:50-56.
  • Demirel A, Demirel ÖF, Uğur M (2015) Atipik antipsikotiklere bağlı metabolik sendrom. Psikiyatride Güncel Yaklaşımlar, 7:81-97.
  • Dickson RA (1998) The aetiology of spinal deformities. Lancet, 1:1151-1155.
  • Elisaf M (2001) The treatment of coronary heart disease: an update. Part 1: an overview of the risk factors for cardiovascular dis- ease. Curr Med Res Opin, 17:18-26.
  • Emul M, Kalelioglu T (2015) Etiology of cardiovascular disease in patients with schizophrenia: current perspectives. Neuropsychiatr Dis Treat, 11:2493-2503.
  • Filik R, Sipos A, Kehoe PG, Burns T, Cooper SJ, Stevens H et al. (2006) The cardiovascular and respiratory health of people with schizophrenia. Acta Psychiatr Scand, 113:298-305.
  • Gerasimov G, Chernova T, Goncharov N (1992) Monoamine regulation of prolactin and TSH secretion in hypothyroidism. Acta Med Austriaca, 19(Suppl 1):86-88.
  • Glaser DL, Kaplan FS (1997) Osteoporosis: definition and clinical presentation. Spine, 22(Suppl 24):12-16.
  • Goldman LS (1999) Medical illness in patients with schizophrenia. J Clin Psychiatry, 60(Suppl 21):10-15.
  • Gotto MA, Pownall HJ (1999) Manual of Lipid Disorders: Reducing the Risk for Coronary Heart Disease, 2nd ed. Baltimore, Williams & Wilkins.
  • Gough SCL, O’Donovan MC (2005) Clustering of metabolic comorbidity in schizophrenia: a genetic contribution? J Psychopharmacol, 19:47-55.
  • Halbreich U, Palter S (1996). Accelerated osteoporosis in psychiatric patients: possible pathophysiological processes. Schizophr Bull, 22:447-454.
  • Halbreich U, Rojansky N, Palter S, Hreshchyshyn M, Kreeger J, Bakhai Y et al. (1995) Decreased bone mineral density in medicated psychiatric patients. Psychosom Med, 57:485-491.
  • Hatemi H, Yumuk VD, Turan N, Arik N (2003) Prevalence of overweight and obesity in Turkey. Metab Syndr Relat Disord, 1:285-290.
  • Helleberg M, Pedersen MG, Pedersen CB, Mortensen PB, Obel N (2015) Associations between HIV and schizophrenia and their effect on HIV treatment outcomes: a nationwide population-based cohort study in Denmark. Lancet HIV, 2:e344-e350.
  • Henderson DC, Cagliero E, Gray C, Nasrallah RA, Hayden DL, Schoenfeld DA et al. (2000) Clozapine, diabetes mellitus, weight gain and lipid abnormalities: a five-year naturalistic study. Am J Psychiatry, 157:975-981.
  • Hennekens CH, Hennekens AR, Hollar D, Casey DE (2005) Schizophrenia and increased risks of cardiovascular disease. Am Heart J, 150:1115-1121.
  • Hennessy S, Bilker WB, Knauss JS, Margolis DJ, Kimmel SE, Reynolds RF et al. (2002) Cardiac arrest and ventricular arrhythmia in patients taking antipsychotic drugs: cohort study using administrative data. BMJ, 325:1070.
  • Hinterhuber H, Lochenegg L (1975) Gastric ulcers stress and schizophrenia: incidence of gastric ulcers in male schizophrenic patient. Arch Psychiatr Nervenkr (1970), 220:335-345.
  • Hofer A, Kemmler G, Eder U, Edlinger M, Edlinger M, Hummer M, Fleischhacker WW (2004) Quality of life in schizophrenia: the impact of psychopathology, attitude toward medication, and side effects. J Clin Psychiatry, 65:932-939.
  • Hsu Y, Cheng, J Ouyang W, Lin CL, Huang CT, Hsu CC (2015) Lower incidence of end-stage renal disease but suboptimal pre-dialysis renal care in schizophrenia: a 14-year nationwide cohort study. PLoS One, 10:e0140510.
  • Hui SL, Slemenda CW, Johnston CC (1988) Age and bone mass as predictors of fracture in a prospective study. J Clin Invest, 81:1804-1809.
  • Hummer M, Malik P, Gasser RW, Hofer A, Kemmler G, Moncayo Naveda RC et al. (2005) Osteoporosis in patients with schizophrenia. Am J Psychiatry, 162:162-167.
  • Hussar AE (1968) Peptic ulcer in long-term ınstituonalized schizophrenic patients. Psychosom Med, 30:374-377.
  • Hwang MY, Bermanzohn PC (2001) Şizofreni ve Eş Tanılı Durumlar (Çeviri Ed. A Üçok). İstanbul,Yelkovan Yayıncılık.
  • Işık E (2006) Güncel Şizofreni. Ankara, Format Matbaacılık.
  • Jeste DV, Gladsjo JA, Lindamer LA, Lacro JP (1996) Medical comorbidity in schizophrenia. Schizophr Bull, 22:413-443.
  • Karşıdağ Ç, Aksoy UM, Yüksel G, Alpay N, Uysal A (2013) Yataklı tedavi hizmeti sunan psikiyatri kliniklerinde ektanılar. Klinik Psikiyatri Dergisi, 16:47-52.
  • Kaya MC, Vırıt O, Altındağ A, Selek S, Bülbül F, Bulut M et al. (2009) Şizofrenide metabolik sendrom sıklığı, metabolik sendromun özellikleri, ve kullanılan antipsikotiklerle ilişkisi. Noro Psikiyatr Ars, 46:13-18.
  • Khamker N, Moola NM, Moola JL, Rheeder P (2010) Profile of mortality of patients admitted to Weskoppies Psychiatric Hospital in South Africa over a 5-year period (2001-2005). Afr J Psychiatry (Johannesbg), 13:211-217.
  • Kinon BJ, Gilmore JA, Liu H, Halbreich UM (2003) Prevalence of hyperprolactinemia in schizophrenic patients treated with conventional antipsychotic medications or risperidone. Psychoneuroendocrinology, 28(Suppl 2):55-68.
  • Koçer E, Yazıcı S, Canan F (2011) Genç-erişkin şizofreni hastalarında kemik mineral yoğunluğu düzeyinin sağlıklı kontrollerle karşılaştırılması. Dusunen Adam, 24:314-320.
  • Kuloğlu M, Albayrak Y, Ekinci O, Önen S, Çayköylü A (2010) Tipik ve atipik antipsikotiklerin serum lipid ve karaciğer enzimleri üzerine etkilerinin karşılaştırılması. Yeni Symposium, 48:192-197.
  • Lawrence D, Holman CD, Jablensky AV, Threlfall TJ, Fuller SA (2000) Excess cancer mortality in Western Australian psychiatric patients due to higher case fatality rates. Acta Psychiatr Scand, 101:382-388.
  • Leuch S, Burkard T, Henderson JH, Maj M, Sartorius N (2008) Fiziksel Hastalık ve Şizofreni (Çeviri Ed. A Üçok). İstanbul, Sigma Yayıncılık.
  • Levinson DF, Simpson GM (1987) Antipsychotic drug side effects. Psychiatry Update: APA Annual Review, Vol 6. Washington, DC: American Psychiatric Association, 704-723.
  • Levy RP, Jensen JB, Laus VG, Agle DP, Engel IM (1981) Serum thyroid hormone abnormalities in psychiatric disease. Metabolism, 30:1060-1064.
  • Lindenmayer JP, Czobor P, Volavka J, Citrome L, Sheitman B, McEvoy JP et al. (2003) Changes in glucose and cholesterol levels in patients with schizophrenia treated with typical or atypical antipsychotics. Am J Psychiatry, 160:290-296.
  • Lovett Doust JW (1980) Sinus tachycardia and abnormal cardiac rate variation in schizophrenia. Neuropsychobiology, 6:305–312.
  • Macfarlane B, Davies S, Mannan K, Sarsam R, Pariente D, Dooley J (1997) Fatal acute fulminant liver failure due to clozapine: a case report and review of clozapine-induced hepatotoxicity. Gastroenterology, 112:1707-1709.
  • Malik P, Kemmler G, Hummer MJ, Riecher-Roessler A, Kahn RS, Fleischhacker WW et al. (2011) Sexual dysfunction in first-episode schizophrenia patients: results from European First Episode Schizophrenia Trial. Clin Psychopharmacol, 31:274-280.
  • Martinos A, Rinieris P, Papachristou DN, Souvatzoglou A, Koutras DA, Stefanis C (1986) Effects of six weeks' neuroleptic treatment on the pituitary-thyroid axis in schizophrenic patients. Neuropsychobiology, 16:72-77.
  • Mashimo K, Kanaya M, Yamauchi T (1995) Electroconvulsive therapy for a schizophrenic patient in catatonic stupor with joint contracture. Convuls Ther, 11:216-9.
  • Melkersson K, Dahl ML (2004) Adverse metabolic effects associated with atypical antipsychotics: literature review and clinical implications. Drugs, 64:701-723.
  • Meyer JM, Nasrallah HA (2003) Medical Illness and Schizophrenia. Washington DC, American Psychiatric Publishing.
  • Milano W, De Rosa M, Capasso A (2013) Antipsychotic drugs opposite to metabolic risk: neurotransmitters, neurohormonal and pharmacogenetic mechanisms underlying with weight gain and metabolic syndrome. Open Neurol J, 7:23-31
  • Mortensen PB (1989) The incidence of cancer in schizophrenic patients. J Epidemiol Community Health, 43:43–47.
  • Mortensen PB (1992) Neuroleptic medication and reduced risk of prostate cancer in schizophrenic patients. Acta Psychiatr Scand, 85:390-393.
  • Mortensen PB (1994) The occurrence of cancer in first-admitted schizophrenic patients. Schizophr Res, 12:185–194.
  • Nasrallah HA, Meyer JM, Goff DC, McEvoy JP, Davis SM, Stroup TS et al. (2006) Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophr Res, 86:15-22.
  • Newcomer JW (2005) Second generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs, 19(Suppl 1):S1-S93.
  • Osby U, Correia N, Brandt L, Ekbom A, Sparén P (2000) Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res, 45:21-28.
  • Ozan E, Deveci E, Oral M et al. (2010) Male genital self-mutilation as a psychotic solution. Isr J Psychiatry Relat Sci., 47(4):297-303.
  • Öyekçin DG (2009) Bir grup şizofreni ve şizoaffektif bozukluk hastasında metabolik sendrom sıklığı. Anadolu Psikiyatri Derg, 10:26-33.
  • Özbakkaloğlu B, Sivrel Arısoy A, Yegane Tosun S, Esen A, Akçalı S, Kurutepe S (1999) Kronik şizofreni tanılı hastalarda hepatit B ve hepatit C prevalansı. Viral Hepatit Derg, 2:88-90.
  • Papaioannou A, Kennedy CC, Cranney A, Hawker G, Brown JP, Kaiser SM et al. (2009) Risk factors for low BMD in healthy men age 50 years or older: a systematic review. Osteoporos Int, 20:507-518.
  • Pappa S, Dazzan P (2009) Spontaneous movement disorders in antipsychotic- naive patients with first-episode psychoses: a systematic review. Psychol Med, 39:1065-1076.
  • Rinieris P, Christodoulou GN, Souvatzoglou A, Koutras DA, Stefanis C (1980) Free-throxine index in schizophrenic patients before and after neuroleptic treatment. Neuropsychobiology, 6:29-33.
  • Ristić DI, Petrović D, Cirić Z (2008) Penile self-mutilation-two cases in one family. Psychiatr Danub, 20:332-336.
  • Rosack IJ (2003) New-generation antipsychotic effective for treating mania. Psychiatric News, 38(19):31.
  • Sayar GH, Özden E, Eryılmaz G, Göğcegöz I, Ceylan ME (2014) Elektrokonvuzif tedavi üzerine güncel bir gözden geçirme. Psikiyatride Güncel Yaklaşımlar, 6:107-125.
  • Schoepf D, Potluri R, Uppal H, Natalwala A, Narendran P, Heun R (2012) Type-2 diabetes mellitus in schizophrenia: increased prevalence and major risk factor of excess mortality in a naturalistic 7-year follow- up. Eur Psychiatry, 27:33–42.
  • Seeman MV (2011) Antipsychotic-induced amenorrhea. J Ment Health, 20:484-491.
  • Smith SM, O’Keane V, Murray R (2002) Sexual dysfunction in patients taking conventional antipsychotic medication. Br J Psychiatry, 181:49-55.
  • Spelman LM, Walsh PI, Sharifi N, Collins P, Thakore JH (2007) Impaired glucose tolerance in first-episode drug-naive patients with schizophrenia. Diabet Med, 24:481-485.
  • Stubbs B, Vancampfort D, Veronese N, Solmi M, Gaughran F, Manu P et al. (2016) The prevalence and predictors of obstructive sleep apnea in major depressive disorder, bipolar disorder and schizophrenia: a systematic review and meta-analysis. J Affect Disord, 197:259-267.
  • Subramaniam M, Chong SA, Pek E (2003) Diabetes mellitus and impaired glucose tolerance in patients with schizophrenia. Can J Psychiatry, 48:345-347.
  • Szaulińska K, Pływaczewski R, Sikorska O, Holka-Pokorska J, Wierzbicka A, Wichniak A et al. (2015) Obstructive sleep apnea in severe mental disorders.Psychiatr Pol, 49:883-895.
  • TEMD Hipofiz Çalışma Grubu (2009) Hipofiz Hastalıkları Tanı, Tedavi ve İzlem Kılavuzu. Ankara, Türkiye Endokrinoloji ve Metabolizma Derneği.
  • TEMD Metabolik Sendrom Çalışma Grubu (2009) Metabolik Sendrom Kılavuzu. Ankara, Türkiye Endokrinoloji ve Metabolizma Derneği.
  • Thomas P, Raymondet P, Charbonnel B, Vaiva G (2005) Are the specific care requirements for patients with schizoprenia and diabetes or with a risk of diabetes? Eur Psychiatry, 20:358-363.
  • Tiihonen J, Lönnqvist J, Wahlbeck K, Klaukka T, Niskanen L, Tanskanen A et al. (2009) 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet, 374:620-627.
  • Tzeng NS, Hsu YH, Ho SY, Kuo YC, Lee HC, Yin YJ et al. (2015) Is schizophrenia associated with an increased risk of chronic kidney disease? a nationwide matched-cohort study. BMJ Open, 5:e006777.
  • Usta E, Metin O, Birsöz S (2007) Şizofreni ve diyabet: yeni kuşak antipsikotiklerin yol açtığı diyabet veya metabolik sendrom. Klinik Psikofarmakol Bulteni, 17:207-216.
  • Üstündağ MF, Yücel A, İbiş EÖ, Özcan H (2015) Bir şizofreni hastasında katatoni belirtileri nedeniyle maskelenen kalça kemiği kırığı. Yeni Symposium, 53:33-34.
  • Van der Auwera S, Teumer A, Hertel J, Homuth G, Völker U, Lucht MJ et al. (2016) The inverse link between genetic risk for schizophrenia and migraine through NMDA (N-methyl-D-aspartate) receptor activation via D-serine. Eur Neuropsychopharmacol, 26:1507-1515.
  • Van Gaal LF (2006) Long-term health considerations in schizophrenia: metabolic effects and the role of abdominal adiposity. Eur Neuropsychopharmacol, 16 (Suppl 3):142-148.
  • Warner JP, Barnes TR, Henry JA (1996) Electrocardiographic changes in patients receiving neuroleptic medication. Acta Psychiatr Scand, 93:311-313.
  • Wetterling T (2001) Bodyweight gain with atypical antipsychotics: a comparative review. Drug Saf, 24:59-73.
  • Winkelman JW (2001) Schizophrenia, obesity, and obstructive sleep apnea. J Clin Psychiatry, 62:8-11.
  • Woo YS, Kim W, Chae CH, Yoon BH, Bahk W (2009) Blood pressure changes during clozapine or olanzapine treatment in Korean schizophrenic patients. World J Biol Psychiatry, 10:420-425.
  • Yılmaz G, Badur S, Tüz C, Çetin ET (1991) Uzun süredir hospitalize kronik psikiyatri hastalarında Hepatit B infeksiyonu prevalansı, Türk Mikrobiyoloji Cemiyeti Dergisi, 2:328-330.
  • Yücel Y (2008) Migren baş ağrısında tanı ve tedavi yaklaşımları. Dicle Tıp Dergisi, 35:281-286.
  • Yüksel N (2010) Temel Psikofarmakoloji. Ankara, Türkiye Psikiyatri Derneği.