Şizofreni Tedavisinde Benzodiazepinler
Özet
Şizofreni tedavisinde benzodiazepinlerin (BDZ) yeri, etkinliği ve riskleri üzerine yapılan güncel çalışmaları derleyen bu yazıya göre, şizofreninin uzun dönem yönetiminde antipsikotik monoterapi birinci basamak ilaç olarak önerilse de birçok hasta tam remisyona ulaşamadığı için BDZ gibi güçlendirme tedavilerine başvurulmaktadır. GABA-A reseptörleri üzerinden postsinaptik iletide hızlı bir inhibisyon yaratarak çalışan benzodiazepinler, özellikle akut hecmelerde ajitasyonun yatıştırılması, anksiyete, uyku bozuklukları ve antipsikotik yan etkilerinin yönetimi amacıyla klinisyenler tarafından yaygın şekilde tercih edilmektedir. Dünya genelinde ve Türkiye'de %31 ile %63 arasında değişen yüksek kullanım oranlarına sahip olmasına rağmen, BDZ'lerin şizofreni semptomları üzerinde uzun vadeli ve süreğen bir terapötik etkisi olmadığı gösterilmiştir. Özellikle uzun süreli kullanımları; bilişsel işlevlerde kötüleşme, bağımlılık, motor hızda yavaşlama, kaudat çekirdek hacminde azalma, pnömoni ve intiharla ilişkili ya da ilişkisiz mortalite riskinde artış gibi ciddi olumsuz sonuçlarla ilişkilendirilmektedir. Buna karşın, Türkiye'de yapılan güncel bir çalışma, 6 aydan kısa süreli BDZ kullanımının daha az hastaneye yatış süresi ve sayısı, daha düşük ilaç bırakma ve intihar oranları gibi olumlu klinik gidişat özellikleri ile ilişkili olduğunu ortaya koymuştur. Sonuç olarak, psikiyatristlerin BDZ kullanımından tamamen kaçınmak yerine, risk ve fayda dengesini gözeterek kullanım süresini ve dozunu mümkün olduğunca düşük tutmaları, bu doğrultuda günlük pratiğe yönelik sistematik tedavi kılavuzlarının geliştirilmesi önerilmektedir.
According to this text, which reviews recent studies on the role, efficacy, and risks of benzodiazepines (BDZs) in schizophrenia treatment, antipsychotic monotherapy is recommended as the first-line medication for the long-term management of schizophrenia, but since many patients do not achieve full remission, augmentation strategies like BDZs are utilized. Working through GABA-A receptors to cause rapid inhibition in postsynaptic transmission, benzodiazepines are widely preferred by clinicians, especially during acute exacerbations, for alleviating agitation, managing anxiety, sleep disorders, and antipsychotic side effects. Despite high utilization rates ranging between 31% and 63% globally and in Turkey, BDZs have been shown to lack a sustained therapeutic effect on schizophrenia symptoms. Particularly, their long-term use is associated with severe negative outcomes such as cognitive decline, dependence, psychomotor slowing, reduction in caudate nucleus volume, pneumonia, and an increased risk of suicide-related or unrelated mortality. Conversely, a recent study conducted in Turkey revealed that short-term BDZ use (less than 6 months) was linked to favorable clinical course characteristics, including fewer psychiatric hospitalizations, shorter hospital stays, and lower rates of treatment discontinuation and suicide. Consequently, rather than avoiding BDZs entirely, psychiatrists are advised to balance benefits against potential side effects by keeping the duration and dose as low as possible, and it is recommended to develop systematic treatment guidelines for daily practice in this regard.
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