İlaç kullanmayan şizofreni hastalarında saldırganlık ve serum kolesterol düzeyi : Kontrollü bir çalışma

Amaç: Şizofrenide saldırganlık önemli bir sorundur. Çeşitli araştırmalarda saldırganlıkla serum kolesterol düzeyi düşüklüğü arasında anlamlı bir ilişki bulunduğu gösterilmiştir. Bu çalışmada şizofreni tanısı ile yatarak tedavi gören hastalardaki saldırganlığın serum kolesterol düzeyleriyle ilişkisinin araştırılması amaçlanmıştır. Yöntem: DSM-IV tanı ölçütlerine göre şizofreni tanısı konulmuş 105 hasta ile 40 normal kontrol çalışmaya alınmıştır. Tüm hastalar sosyodemografik ve klinik özellikleri ölçen bir Bilgi Formu ile değerlendirilmiş, ayrıca psikopatoloji düzeyi Kısa Psikiyatrik Derecelendirme Ölçeği (BPRS), Pozitif Belirtileri Değerlendirme Ölçeği (SAPS) ve Negatif Belirtileri Değerlendirme Ölçeği (SANS) ile, saldırganlık düzeyi Açık Saldırganlık Ölçeği (ASÖ) ile ölçülmüştür. Tüm hasta ve normal kontrollerin kan kolesterol düzeyleri enzimatik yöntemlerle ölçülmüştür. Bulgular: 105 hastadan 56'sının (%53.3) ASÖ'ye göre saldırgan davranış gösterdiği bulunmuştur. BPRS, SAPS ve SANS puanları açısından saldırgan davranış gösteren ve saldırgan davranış göstermeyen şizofreni hastaları arasında anlamlı farklılık saptanmamıştır, iki grup arasında sosyodemografik özellikler yönünden anlamlı farklılık saptanmazken saldırgan davranış gösteren grupta önceden saldırgan davranış gösterme sıklığı daha fazla, geçmişte suç davranışı öyküsü daha sık ve hastanede daha uzun süre yatış gösterdikleri bulunmuştur. Saldırgan davranış gösteren şizofreni hastaları grubunda kan toplam kolesterol (TK) düzeyi ve düşük yoğunluklu lipoprotein (LDL) kolesterol düzeyi saldırgan davranış göstermeyen şizofren hasta grubundan ve normal kontrollerden anlamlı olarak daha düşük bulunmuştur. Sonuç ve Yorum: Düşük kan kolesterol düzeyleri ile şizofrenide görülen saldırganlık arasında anlamlı bir ilişki bulunmaktadır. Kan kolesterol düzeyleri saldırganlığı öngörmede kullanışlı bir araç olabilir, ancak bununla ilgili daha fazla kontrollü çalışmaya gerek vardır.

Aggression and serum cholesterol levels in non-medicated schizophrenic patients: A controlled study

Objective: Aggression in schizophrenia is a serious problem. Various studies have shown that there is a significant relationship between low serum cholesterol levels and aggression. in this study, we examined the relationship between aggression and serum cholesterol levels among in-patients with schizophrenia Method: One hundred and five DSM-IV schizophrenic patients and 40 control subjects were studied. The sociodemographic and clinical variables were assessed with a questionnaire developed for this purpose. The degree of psychopathology was rated by the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS). Aggression was rated by the Overt Aggression Scale (OAS). Cholesterol levels were measured by the enzymatic method. Results: Fifty six (53.3%) of the 105 patients with schizophrenia showed aggression according to the OAS. There were no significant differences between aggressive and non-aggressive schizophrenic patients with respect to BPRS, SAPS and SANS scores. Sociodemographic factors showed no differences between the two groups, whereas the aggressive group showed more common previous aggressive behaviour and a history of criminal behaviour and had spent more days in hospital than the non-aggressive group. Serum total cholesterol (TC) and low-density lipoprotein (LDL) cholesterol levels in the aggressive group were found to be significantly lower than those in the non-aggressive group and the control subjects. There were no significant differences between the non-aggressive group and the control subjects with respect to cholesterol levels. Conclusions: There is a significant relationship between low serum cholesterol levels and aggression in schizophrenia. Serum cholesterol levels might be a useful tool for predicting aggressiveness; however, more controlled studies are needed to confirm this.

Kaynakça

Amerikan Psikiyatri Birliği (1994) Mental Bozuklukların Tanısal ve Sayımsal El Kitabı, dördüncü baskı (DSM-IV) (Çev. Ed.: E Köroğlu) Hekimler Yayın Birliği, Ankara, 1995.

Andreasen NC (1982) Negative symptoms in schizophrenia definition and reliability, negative and positive schizophrenia definition and validation. Arch Gen Psychiatry, 39:784-794.

Arango C, Barba AC, Salvador TG ve ark. (1999) Violence in inpatients with schizophrenia: A prospective study. Schizophr Bull, 25:493-503.

Asnis GM, Kaplan ML, Hundorfean G ve ark. (1997) Violence and homicidal behaviors in psychiatric disorders. Psychiatr Clin North Am, 20(2):40-58.

Bech P, Kastrup M, Rafaelsen OJ ve ark. (1986) Brief Psychiatric Rating Scale. Acta Psychiatr Scand, 73 (Suppl 326): 10

Bond JA (1993) Serum cholesterol, triglycerides, and aggression in the general population. Br J Psychiatry, 163:666-668.

Boston PF, Dursun SM, Reveley AM ve ark. (1996a) Cholesterol and mental disorder. Br J Psychiatry, 169:682-689.

Boston PF, Dursun SM, Zafer R ve ark. (1996b) Serum cholesterol and treatment-resistance in schizophrenia. Biol Psychiatry, 40:542-543.

Cantwell R, Brewin J, Glazebrook ve ark. (1999) Prevalence of substance misuse in first episode psychosis. Br J Psychiatry, 174:150-153.

Carlson GA, Rapport M (1991) Serum cholesterol and aggressive behavior in psychiatrically hospitalized children. Acta Psychiatr Scand, 83:77-78.

Ceylan ME (1993) Araştırma ve Klinik Uygulamada Biyolojik Psikiyatri. 1. Baskı, İstanbul, cilt 1, s. 155-159.

Çetin M, Çilden Ş, Başoğlu C ve ark. (1996) Saldırganlık davranışının biyokimyasal ve nöroendokrinolojik göstergelerinin araştırılması: Kontrollü bir çalışma. Klinik Psikofarmakoloji Bülteni, 6:66-76.

Çetin M, Başoğlu C, Ağargün MY ve ark. (1999) Antisosyal kişilik bozukluklu hastalarda düşük kolesterol düzeyinin homisidal davranışla birlikteliği. Klinik Psikofarmakoloji Bülteni, 9:185-188.

Deutsch L, Bylsma F, Rovner B ve ark. (1991) Psychosis and physical aggression in probable Alzheimer’s disease. Am J Psychiatry, 148:1159-1163.

Diebold K, Michel G, Schweizer J ve ark. (1998) Are psychoactive-drug-induced changes in plasma lipid and lipoprotein levels of significance for clinical remission in psychiatric disorders? Pharmacopsychiatry, 31:60-67.

Dursun SM, Szemis A, Andrews H ve ark. (1999) The effects of clozapine on levels of total cholesterol and related lipids in serum of patients with schizophrenia: a prospective study. J Psychiatry Neuroscience, 24(5):453-455.

Engelberg H (1992) Low serum cholesterol and suicide. The Lancet, 339: 727-729.

Erkoç Ş, Arkonaç O, Ataklı C ve ark. (1991a) Pozitif semptomları değerlendirme ölçeğinin güvenilirliği ve geçerliliği. Düşünen Adam, 4:16-20.

Erkoç Ş, Arkonaç O, Ataklı C ve ark. (1991b) Negatif semptomları değerlendirme ölçeğinin güvenilirliği ve geçerliliği. Düşünen Adam, 4:12-15.

Eronen M, Tiihonen J, Hakolo P ve ark. (1996) Schizophrenia and homicidal behavior. Schizophr Bull, 22(1):86-88.

Fowkes FG, Leng GC, Donnan PT ve ark. (1992) Serum cholesterol, triglycerides, and aggression in the general population. The Lancet, 340:995-998.

Gidiş D, Kaya N, Şahinoğlu U ve ark. (2000) İntihar girişiminde bulunan olgularda serum kolesterol ve trigliserid düzeyleri. Düşünen Adam, 13:92-95.

Golier JA, Marzuk PM, Leon AC ve ark. (1995) Low serum cholesterol level and attempted suicide. Am J Psychiatry, 152:419-423.

Goodman J, Davidson KW, McGrath PJ ve ark. (1997) Cholesterol and aggression. J Am Acad Child Adolesc Psychiatry, 36(3):303-304.

Hawton K, Cowen P, Owens D ve ark. (1993) Low serum cholesterol and suicide. Br J Psychiatry, 162:818-825.

Hillbrand M, Spitz RT, VandenBos GR ve ark. (1997) Investigating the role of lipids in mood, aggression and schizophrenia. Psychiatr Serv, 48:875-876,882

Hoge SK, Appelbaum PS, Lawlor T ve ark. (1990) A prospective, multicenter study of patients’ refusal of antipsychotic medication. Arch Gen Psychiatry, 47:949-956.

Kırkpınar İ, Özer H, Coşkun İ ve ark. (1995) Yatan psikiyatri hastalarında saldırganlık: Erzurum’da psikiyatri kliniklerinde görülen saldırgan davranışlar üzerine bir çalışma. Türk Psikiyatri Dergisi, 6:285-296.

Krakowski M, Czobor P, Chou JC ve ark. (1999) Course of violence in patients with schizophrenia: relationship to clinical symptoms. Schizophr Bull, 25(3):505-517.

Kültür S, Mete L (1997) Şizofreni Psikiyatri Temel Kitabı, cilt 1, Güleç C, Köroğlu E (Ed), Hekimler Yayın Birliği, Ankara, s.321-353.

Lam JN, McNiel DE, Binder RL ve ark. (2000) The relationship between patients’ gender and violence leading to staff injuries. Psychiatr Serv, 51(9):1167-1170.

Lapierre D, Braun C, Hodgins S ve ark. (1995) Neuropsychological corellates of violence in schizophrenia. Schizophr Bull, 21(2):253-262.

McNiel DE, Binder RL, Greenfield TK ve ark. (1988) Perdictors of violence in civilly committed acute psychiatric patients. Am J Psychiatry, 145:965-970.

Marzuk PM (1996) Violence, crime, and mental illness. Arch Gen Psychiatry, 53:481-486.

Meltzer HY, Okayli G (1995) Reduction of suicidality during clozapine treatment of neuroleptic-resistant schizophrenia: Impact of risk benefit assessment. Am J Psychiatry, 152:183-189.

Miller RJ, Zadolinnyj K, Hafner RJ ve ark. (1993) Profiles and predictors of assaultiveness for different psychiatric ward populations. Am J Psychiatry, 150:1368-1373.

Modestin J, Ammann R (1996) Mental disorder and criminality: Male schizophrenia. Schizophr Bull, 22(1): 69-82.

Muldoon MF, Manuck SB, Matthews KA ve ark. (1990) Lowering cholesterol concentrations and mortality: a quantitative rewiev of primary prevention trials. BMJ, 301:309-314.

Muldoon MF, Kaplan JR, Manuck SB ve ark. (1992) Effects of a low fat diet on brain serotonergic responsivity in cynomolgus monkeys. Biol Psychiatry, 31:739-742.

Noble P, Rodger S (1989) Violence by psychiatric in patients. Br J Psychiatry, 155: 384-390.

Osser DN, Najarian DM, Dufresne RL ve ark. (1999) Olanzapine increases weight and serum triglyceride levels. J Clin Psychiatry, 60:767-770.

Overall JE, Gorham DR (1962) The Brief Psychiatric Rating Scale. Psychol Rep, 10:799-812.

Rosenbaum M, Bennett B (1986) Homicide and depression. Am J Psychiatry, 143:367-370.

Rybakowski J, Ainiyet J, Szajnerman Z ve ark. (1996) The study of the relationship beetween cholesterol and lipid concentration and suicidal behavior in patients with schizophrenia affective illness. Psychiatr Pol, 30(5):699-712.

Ryman A (1994) Cholesterol, violent death, and mental disorder. BMJ, 309:421-422.

Scott H, Johnson S, Menezes P ve ark. (1998) Substance misuse and risk of agression and offending among the severely mentally ill. Br J Psychiatry, 172:345-350.

Soyka M (2000) Substance misuse, psychiatric disorder and violent and disturbed behaviour. Br J Psychiatry, 176:345-350.

Soykan Ç (1990) Institutional differences and case typicality as diagnosis system severity, prognosis and treatment. Master Tezi. Orta Doğu Teknik Üniversitesi.

Soysal H, Uygur N (1993) Psikotik hastaların öldürme davranışında hedef kitle. Nöropsikiyatri Arşivi, 30(2): 342-346.

Spivak B, Lamschtein C, Talmon Y ve ark. (1999) The impact of clozapine treatment on serum lipids in chronic schizophrenic patients. Clin Neuropharmacol, 22(2): 98-101.

Steadman HJ, Mulvey EP, Monahan J ve ark. (1998) Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psychiatry, 55:393-404.

Steinert T, Woelfle M, Gebhard RP ve ark. (1999) No correlation of serum cholesterol levels with measures of violence in patients with schizophrenia and non-psychotic disorders. Eur Psychiatry, 14: 346-348.

Tanke ED, Yesavage JA (1985) Characteristics of assaultive patients who do and do not provide visible cues of potential violence. Am J Psychiatry, 142: 1409-1413.

Turan M, Telcioğlu M, Özkan İ ve ark. (1998) Ayaktan takip edilen psikiyatri hastalarının uyguladıkları şiddet, 34. Ulusal Psikiyatri Kongresi Bilimsel Çalışmalar Özet Kitabı, İzmir, Güne Ofset Matbaacılık s. 304.

Uygur N, Işıklı M, Ögel K ve ark. (1992) Suç işlemiş şizofrenlerin demografik özellikleri ve suç profili. Düşünen Adam, 5:5-9.

Virkkunnen M (1983a) Insulin secretion during the glucose tolerance test in antisocial personality. Br J Psychiatry, 142:598-604.

Virkkunen M (1983b) Serum cholesterol levels in homicidal offenders: a low cholesterol levels is connected with a habitually violent tendency under the influence alcohol. Neuropsychobiology, 10:65-69.

Virkkunen M, Penttinen H (1984) Serum cholesterol in aggressive conduct disorder: A preliminary study. Biol Psychiatry, 19: 435-439.

Virkkunen ME, Horrobin DF, Jenkins DK ve ark. (1987) Plasma phospholipid essential fatty acids and prostaglandins in alcoholic, habitually violent, and impulsive offenders. Biol Psychiatry, 22: 1087-1096.

Walker NP, Fox HC, Whalley LJ ve ark. (1999) Lipids and schizophrenia. Br J Psychiatry, 174:101-104.

Wessely S (1997) The epidemiology of crime, violence and schizophrenia. Br J Psychiatry, 170 (suppl. 32): 8-11.

Yudofsky SC, Silver JM, Jackson W ve ark. (1986) The overt aggression scale for the objective rating of verbal and physical aggression. Am J Psychiatry, 143 (1):35-39.

Zureik M, Courbon D, Ducimetiere P ve ark. (1996) Serum cholesterol concentration and death from suicide in men: Paris prospective study I. BMJ, 313:649-650.

Kaynak Göster