Psihijatrijske dileme: terapija shizofrenije - prikaz slučaja Psychiatric dilemmas: schizophrenia therapy - Case report

saŽetaK . Cilj: Izbor antipsihotika u lijecenju shizofrenije važan je zbog potencijalnih nuspoja va, a dobre rezultate u lijecenju mogu dati pravilan odabir i kombinacija psihijatrijskih metoda lijecenja. Prikaz slucaja: Studentica prve godine fakulteta oboljela je od shizofrenije, te je u akutnoj fazi bolesti hospitalizirana. Pozitivni simptomi shizofrenije (fenomen nametanja misli, slusne halucinacije) uz strah i smetnje sna i alimentacije bili su indikacija za hospitalizaciju. U bolnickim uvjetima uveden je atipicni antipsihotik kvetiapin koji je titriran do dnevne doze od 600 mg koja je dovela do remisije simptoma. Nuspojava lijeka bila je znacajan porast tjelesne težine od 30 kg, sto je bio razlog uvođenja drugog atipicnog antipsihotika olanzapina (10 mg na dan). Po olanzapinu su simptomi ostali u remisiji, a zabilježen je pad tjelesne težine od 10 kg. Bolesnica je radno i socijalno zadovoljavajuce funkcionirala. Za citavo vrijeme lijecenja nala zila se u psihoterapijskom tretmanu (grupnom i individualnom). Rasprava: Iako postoji izbor u lijecenju shizofrenije, s obzirom na cinjenicu da uzrok bolesti jos uvijek nije poznat, nema univerzalne terapije koja bi bila ucinkovita kod svih bolesnika. Kombinacija razlicitih oblika lijecenja može dovesti do remisije bolesti i potpunog oporavka. Zakljucak: Kombinacija terapija (psihofarmaka i psihoterapije) daje bolje rezultate u lijecenju shizofrenije nego svaka od navedenih terapija pojedinacno. Cilj lijecenja je postici sto dulju remisiju bolesti. Kljucne rijeci: atipicni antipsihotici, psihoterapija, remisija, shizofrenija aBstRa Ct. Aim: The choice of antypsychotics in schizophrenia treatment is very important due to the potential side-effects, and yet, some good treatment outcomes are achieveable if an adequate choice is made and a combination of psychiatric methods is applied. Case report: A 1st year degree student became ill with schizophrenia and ended up hospitalized in the acute phase of the illness. The reason for hospitalization were the positive symptoms she manifested (obtrusive thoughts phenomenon, auditory hallucinations) as well as fright, sleep disturbances and disordered alimentation. The inpatient treatment commenced with a titration of quetiapine, an atypical antipsychotic, with a daily dose of 600 mg, which lead to remission of the illness. Very soon a side effect became evident; a significant weight gain of 30 kilos which was the main reason of introducing a new atypical antipsychotic – olanzap ine, with a 10 mg daily dose. This new atypical antipsychotic kept the illness in remission and a weight loss of 10 kilos was achieved, while the patient retained her working ability and social functioning. Throughout her therapy, the patient was actively participating in a psychotherapy treatment (individual and group). Discussion: Despite the accessability of choices of treatment methods for treating schizophrenia, while considering the fact that an exact cause of the illness is yet to be determined, the availability of an universal therapy adequate for all schizophrenia patients, is still not available,. A combination of different treat ment methods can lead to remission of the illness and a complete recovery, relating to the working ability as well as social functioning. Conclusion: A combination therapy (psychop harmacs and psychotherapy) is more effective as a treatment for schizophrenia than any of the therapies mentioned, when applied independently. The aim of the treatment is achieve ing the longest possible remission of the illness.