Prediktori depresivnosti i suicidnog rizika kod pacijenata obolelih od shizofrenije

Abstract

Uvod : Shizofrenija kao mentalno oboljenje nosi povišen suicidalni rizik. Depresija u shizofreniji daje poseban aspekt u proučavanju suicidalnih faktora. Cilj: Istraživanje karakteristika emocionalnog profila i kliničke forme shizofrenije kao prediktora depresivnosti i mogućeg suicidalnog rizika u shizofreniji. Metod : Studija je dizajnirana kao slučaj-kontrola studija preseka koja uključuje pacijenate sa dijagnozom shizofrenije F20 po ICD-10 kriterijumima, u fazi inicijalne remisije ( CGI-I skor 2 ili 1), starosne dobi od 18 do 60 godina, na lečenju u Klinici za psihijatrijske bolesti “ Dr Laza Lazarević“. Grupu slučaj čine N = 53 pacijeta sa depresijom i suicidalnim rizikom u shizofreniji, a grupu kontrola N = 159 pacijenta sa shizofrenijom bez depresije i suicidalnog rizika.Instrumenti istraživanja su: CDSS za potvrdu depresije i suicidalnog rizika u shizofreniji, PANSS, PIE –JRS za utvđivanje emoconalnog profila i semistrukturisani intervju za prikupljanje dodatnih podataka. Rezultati :1. Intenzitet negativnih simptoma shizofrenije je značajno veći kod pacijenata koji ispoljavaju depresivnost i suicidalni rizik u fazi inicijalne remisije. 2.Emocionalni profil ličnosti pacijenata sa depresijom i suicidalnim rizikom u shizofreniji ima povišen skor na dimenzijama lišenost, agresivnost, odbacivanje, a niske skorove na dimenzijama zaštita, inkorporacija i reprodukcija. 3. Rad na boljoj psihofarmakoterapijskoj komplijansi i psihoedukaciji pacijenata obolelih od shizofrenije i njihove porodice umanjuje rizik od razvoja depresije u shizofreniji i smanjuje suicidalni rizik. Zaključak : Multiplim logističkim modelom kao prediktori depresivnosti i suicidalnog rizika izdvojeni su : dominacija negativnog sindroma i loša psihofarmakoterapijska kompijansa. Konstelacija dokazanog povišenog depresivnog potencijala i suicidalni rizika nameće potrebu primene preventivnih mera.

Introduction : As a mental illness, schizophrenia carries an increased suicide risk. The depression in schizophrenia presents a special aspect of the study of suicidal factors. Aim : The study of the characteristics of the emotional profile and clinical form of schizophrenia as a predictor of the depression and possible suicidal risk in schizophrenia. Method : The study was designed as a case-control and cross-section study, involving patients with a diagnosis of schizophrenia F20, according to ICD-10 criteria, in the initial stage of remission (CGI-I score of 2 or 1), aged 18 to 60 and treated at the Clinic for psychiatric diseases, "Dr Laza Lazarević". The case group was consisted of N = 53 patients with the depression and suicidal risk in schizoprenia and the control group of N = 159 patients with schizophrenia without the depression and suicidal risk. Survey instruments were: CDSS to confirm the depression and suicidal risk in schizophrenia, PANSS, PIE-JRS to determine the emotional profile and semi-structured interviews to gather additional data. Results : 1) The intensity of the negative symptoms of schizophrenia is significantly higher in patients who exhibit the depression and suicide risk in the stage of initial remission. 2) Emotional profile of the patients’ personality with the depression and suicidal risk in schizophrenia has increased scores in the dimensions of deprivation, aggression, rejection, and low scores in the dimensions of protection, incorporation and reproduction. 3) Work on better psychopharmacotherapy compliance and psychoeducation of patients with schizophrenia and their families reduces the risk of depression in schizophrenia and the suicide risk. Conclusion : In multiple logistic model the following was singled out as predictors of depression and suicidal risk: predominance of the negative syndrome and poor compliance with psychopharmacotherapy. The constellation of the proven increased depressive potential and suicidal risk necessitates the application of preventive measures.