Agresivnost i hostilnost u strukturi i lečenju shizofrenih poremećaja

Abstract

Cilj: U istraživanju je posmatrana učestalost agresivnosti i hostilnosti kod osoba sa shizofrenim poremećajem, zatim povezanost težine kliniĉke slike shizofrenog poremećaja sa pojavom i stepenom agresivnosti i hostilnosti, povezanost doze ordiniranih antipsihotika sa stepenom agresivnosti i hostilnosti, kao i razlika u specifiĉnoj antiagresivnoj i antihostilnoj efikasnosti između risperidona i klozapina. Materijal i metode: Ova opservaciona studija je uključila 110 hospitalno lečenih bolesnika sa dijagnozom shizofrenog poremećaja koji su na prijemu u bolnicu imali vrednost ajtema P7 (hostilnost) skale PANSS ≥ 3 i vrednost skale MOAS ≥ 3. Bolesnici su procenjivani skalama PANSS i MOAS svakih sedam dana tokom njihovog bolničkog lečenja. Rezultati: Hostilnost i agresivnost su kao simptomi prisutni kod jedne trećine bolesnika sa dijagnozom shizofrenog poremećaja, a intenziteti hostilnosti i agresivnosti nisu povezani sa težinom kliničke slike poremećaja. Visine doza inicijalno ordiniranih antipsihotika su upravo srazmerne stepenu hostilnosti i agresivnosti bolesnika. Utvrđeno je da postoji specifično antiagresivno i antihostilno dejstvo i klozapina i risperidona, koje je nezavisno od njihovog antipsihotičnog dejstva, a klozapin je tokom posmatranog perioda imao bolju antihostilnu efikasnost. Zaključak: Agresivnost i hostilnost predstavljaju često prisutnu, značajnu, ali nezavisnu dimenziju shizofrenog poremećaja, a izbor antipsihotika se pored antipsihotične efikasnosti mora zasnivati i na njihovoj specifičnoj antiagresivnoj efikasnosti.

Objective: Frequency of aggression and hostility was observed in patients with schizophrenia, as well as the connection of symptom’s severity with the appearance and level of aggression and hostility. The connection between the applied doses of antipsychotics with the level of aggression and hostility was observed, as well as differences in the specific antiagressive and antihostile efficacy of risperidone and clozapine. Materials and Methods: This observational study involved 110 hospitalized patients diagnosed with schizophrenia who had scores ≥ 3 on item P7 (hostility) of PANSS scale and score ≥ 3 on MOAS scale. Patients were evaluated every seven days during their hospitalization. Results: Hostility and aggression were present in one-third of schizophrenic patients on their hospital admission and their intensity was not related to the severity of the symptoms of schizophrenia. The dose of initially administered antipsychotics was proportional to the level of patient’s hostility and aggression. It has been found that there is a specific antiaggressive and antihostile efficacy of clozapine and risperidone, which is independent of their antipsychotic efficacy, and that clozapine has a better antihostile efficacy during the observed period. Conclusion: Aggression and hostility are often present, important, but an independent dimension of schizophrenia, and the selection of antipsychotic must be based on it’s specific antiaggressive efficacy, in addition to it’s antipsychotic efficacy.