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Şizofreni
Şizofreni, kelime kökeni olarak Yunanca’da şizo (ayrık, bölünmüş) ve frenos (akıl) kelimelerinin birleşiminden doğmuş “bölünmüş zihin” anlamına gelen ciddi bir zihinsel rahatsızlıktır. Kişinin gerçeklikle bağlantısını kopartan sanrılar (yanlış inançlar) ve birtakım garip davranışlarla karakterizedir.
Şizofrenin başlangıç yaşı 15-40 yaş arasındadır. Çoğunlukla 18-25 yaş civarında başlar. Erkeklerde %30 ila 40 oranında daha fazla görülmektedir ve kadınlarda erkeklerden ortalama 10 yıl daha geç ortaya çıkmaktadır. Ülkemizde yaklaşık 700 bin şizofreni hastası vardır. Şizofreninin genetik alt yapısı fazladır. Yalnızca bir ebeveyni şizofren olan bir insanın şizofrene yakalanma olasılığı %12 civarındayken her iki ebeveyni de şizofren olan bir insanın yakalanma olasılığı %50’ye kadar çıkmaktadır. Aynı zamanda beyin kimyasallarının da etkili olduğu şizofreni gelişimine çevresel etkenlerin de katkısı vardır. Şizofreninin belirtilerine bakacak olduğumuzda karşımıza karmaşık bir tablo çıkmaktadır. Bilişsel olarak dikkati ve ilgiyi yoğunlaştırmada güçlük, ilgi azlığından kaynaklı bellek bozukluğu; duyguda düzleşme (ifadesizlik, küntlük) ve uygunsuz duygulanım görülmekle beraber, konuşmada ve düşüncede -düşünme süreci ve içeriği (sanrılar) olarak- bozukluklar vardır.
Sanrı türlerine bakacak olursak bunları bazı başlıklar altında toplayabiliriz:
Grandiyöz (büyüklenmeci) sanrılar: Hastanın çok önemli, değerli, ünlü, güçlü, bilge, üstün ya da kutsal bir insan olduğuna inanmasıdır.
Erotomanik sanrılar: Hastanın kendisine âşık olunduğuna ve kendisinin arzulandığına inanmasıdır. Örneğin çok ünlü bir oyuncunun ya da yıldızın gizlice kendine âşık olduğunu düşünmesi gibi.
Referans sanrıları: Hastanın kendisiyle alakasız durumlarda insanların kendisi hakkında konuştuklarına inanmasıdır. Örneğin bir şarkı dinlerken o şarkıda kendisinden bahsedildiğini düşünebilir ya da yanından geçtiği insanların kendisi hakkında konuştuğuna inanabilir.
Kötülük görme sanrıları: İnsanların kendisine yönelik bir kötülük planı kurduğuna, kendisine ya da sevdiklerine bir zarar vereceklerine inanmasıdır. Örneğin birinin kendisini takip edip telefonlarını dinlediğinden şüphelenebilir.
Kıskançlık sanrıları: Partnerinin kendisini aldattığına ya da ona ihanet ettiğine yönelik bir inancı vardır. Buna yönelik olarak sürekli kanıt aramaya çalışabilir. Partnerini takip edebilir. Öfke problemleri yaşayabilir.
Dinsel sanrılar: Dini olarak absürt düşüncelere sahip olmasıdır. Örneğin dini varlıkların kendisiyle uğraştığını söylemesi. Şeytanın ya da cinlerin kendini takip edip bir şeyler yapmasını istediklerine inanabilir. Kendisini mehdi ya da peygamber gibi dini güçlere sahip bir ruhani lider olarak görebilir.
Somatik (bedensel) sanrılar: İç organlarında ya da bedeninde bir sorun olduğuna inanır. İçinde böceklerin dolaştığını düşünebilir. Kimsenin bilmediği gizli bir hastalığı olduğundan endişelenebilir. Bedeninde organlarını değiştiren bir “gizli gücün” yaşadığına bile inanabilir.
Suçluluk/günahkarlık sanrıları: Geçmişte yaptığı korkunç bir suçun ya da affedilemez bir günahın olduğuna inanır. Başına gelen her şeyin bu günahlarından kaynaklandığını düşünür.
Nihilistik sanrılar: Hastanın her şeyin sonlanmakta ya da sonlandığına inanması. Örneğin malını mülkünü kaybettiğine, sevdiklerinin yok olduğuna, dünyanın sonunun geldiğine inanması gibi.
Kişi birden fazla sanrıya sahip olabilir. Bununla birlikte konuşmasında da bozukluklar görülebilir.
Örneğin araya girilmesi zor olan hızlı ve çok konuşması olabilir. Dağınık ve asıl konunun etrafında dolaşan ya da asıl konuya bir türlü gelemeyen çevresel konuşma görülebilir. Laf salatası denilen, yani mantıksız ve dil kurallarından uzak, birtakım kelimelerin bir araya geldiği şekilde konuşabilir. Hecelerden yeni sözcükler üreterek konuşabilir. Konuşma esnasında birden kendini durdurup susabilir. Karşısında konuşan kişinin sözünü tekrarlayabilir. Hızlıca konudan konuya atlayan bir konuşma yapabilir. Sözlerini sürekli tekrar ederek konuşabilir. İlgisiz olan ancak benzer seste kelimelerle sözünü devam ettirebilir. Bunların yanı sıra konuşmanın ve içeriğinin azalması, konuşmama da görülebilir. Hasta hiç konuşmak istemeyebilir.
Şizofrenide görülen ve belki de halk tarafından en çok bilinen belirtilerden biri de halüsinasyonlardır. Halüsinasyonlar, kişinin aslında var olmayan şeyleri algılamasıdır. Bunlar ses, görsel, koku, tat, dokunsal biçimde yaşanabilir. Kişi olmayan bir şeyi görüp sesler duyabileceği gibi, aslında var olmayan kokuları, tatları da algılayabilir ya da dokunsal olarak bir şeyler hissedebilir.
Şizofreni; hastalık öncesi, sırası ve sonrası olarak üçe ayrılabilir. Belirtiler bu dönemlerde değişiklik gösterir. Bazı evrelerde şizofren bireyde daha aktif belirtiler görülebileceği gibi bazı evrelerde belirtiler daha pasif seyreder. Hastalık ortaya çıkmadan önceki dönemde kişinin genellikle içine kapandığı, sosyal ortamlardan kendini izole ettiği, özbakımını aksattığı, dikkatini toparlayamadığı, depresif ve endişeli hissettiği görülür. Bu dönemde aynı zamanda konuşma da azalmıştır. Duygusal olarak tepkisizleşmiştir. Hastalığın ortaya çıktığı sırada aktif belirtilerin alevlendiği, halüsinasyonların, sanrıların, konuşma bozukluklularının şiddetlendiği görülebilir. Sonrasında bu belirtiler azalarak hastalık sonrası döneme geçilir. Hastalık sonrası dönemde de kişi hastalık öncesi döneme benzer bir düzeyde yaşamına devam eder. Bu belirtiler kişiden kişiye değişkenlik gösterebilmektedir.
Tüm bu anlatılanlardan özetle şizofreni, pek çok sebebin ve belirtinin bir arada görülebileceği kompleks bir rahatsızlıktır. Kişinin işlevselliğini önemli derecede etkileyebileceğinden dolayı mutlaka psikiyatriye başvurulmasını gerektirir. Bu rahatsızlıktan muzdarip kişilerin psikiyatri tedavisine ek olarak aynı zamanda psikoterapiyle de günlük yaşamda daha uyumlu ve işlevsel hale gelmeleri mümkündür.
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