Neuroleptic - ndichiyani? ndi limagwirira cha zochita za mankhwala antipsychotic chiyani?

Psychotropic mankhwala, zomwe cholinga - mankhwala a matenda psychotic, antipsychotic otchedwa (monga antipsychotic kapena neuroleptic). Kodi ndi motani ntchito? Dziwani izi.

Neuroleptic. Ndi chiyani icho? History ndi makhalidwe

Antipsychotics mankhwala anaonekera ndi posachedwapa. Mpaka anatulukira mankhwalawa psychosis zambiri ntchito yokonzekera chiyambi masamba (monga henbane, ndi belladonna, opiates), utsogoleli mtsempha wa calcium, bromide, komanso chomwa mankhwalawa tulo.

Kumayambiriro '50s kwa zaka za m'ma 20 zolinga izi ayamba mankhwala kapena lifiyamu mchere.

Munthu woyamba antipsychotic chlorpromazine wakhala (kapena chlorpromazine), zomwe mpaka ndiye ankaona mankhwala ochiritsira. Chimagwiritsidwa ntchito izo zinayamba ndi 1953, makamaka ngati ndi sedative kapena neuroleptic (mu akuchita misala).

Zotsatirazi neuroleptic anali alkaloid reserpine, koma posakhalitsa kuimirira ndi ena, mankhwala aluso, kukhala wopanda ntchito.

Kumayambiriro a 1958, panali ena m'badwo woyamba antipsychotics: trifluoperazine (triftazin), haloperidol, thioproperazine ndi ena.

Mawu akuti "antipsychotic" anali akufuna mu 1967 (pamene analenga gulu la mankhwala psychotropic m'badwo woyamba) ndipo kucitila mankhwala si zotsatira antipsychotic, komanso amatha kuchititsa matenda a ubongo (akataziyu, neuroleptic parkinsonism, dystonic zochita zosiyanasiyana, etc.). Childs, matenda amenewa chifukwa zinthu monga chlorpromazine, haloperidol ndi triftazin. Komanso, mankhwala ali pafupifupi nthawi zonse limodzi ndi zotsatira zosasangalatsa mbali: maganizo, nkhawa, ululu, maganizo zokhazokha.

antipsychotics kale amathanso adzatchedwa "asamakhale ndi nkhawa yaikulu", kotero kuti antipsychotics ndi asamakhale ndi nkhawa - ali m'modzi ndipo olingana. Chifukwa chiyani? Chifukwa iwo kuyambitsa sedative, zachinyengo ndi antianxiety trankviliziruyusche-zotsatira, komanso ndithu boma enieni osalabadira (Ataraxia). Tsopano udindo ndi ulemu kwa neuroleptics sizikhudza.

mankhwala onse antipsychotic akhoza kugawidwa mu lililonse ndi atypical. antipsychotics Chitsanzo ife pang'ono anafotokoza, tsopano tikambirane antipsychotic atypical. Ndi chiyani icho? gulu Izi ndi "zofewa" mankhwala. Iwo sachita kwambiri pa thupi, monga mmene. Iwo ali m'badwo watsopano wa antipsychotics. Ubwino wa antipsychotics atypical n'chakuti zochepa chikoka pa maselo a dopamine.

Antipsychotics: umboni

antipsychotics Pamoyo zoyambirira katundu - chikoka othandiza pa zizindikiro lapansi (zideruderu, zinyengo, pseudohallucinations, Musanyengedwe, khalidwe matenda, zinyengo, ndewu ndi malemeredwe). Komanso, neuroleptics (makamaka atypical) Kodi perekani kuchitira maganizo kapena zizindikiro kuchepekedwa (satha kulankhula bwinobwino, flattening maganizo, ndi desotsializatsii m. P.). Komabe, mogwira awo, poyerekezera ndi mankhwala a zizindikiro za kuchepekedwa ndi funso lofunika. Akatswiri amati mankhwala antipsychotic ali okhoza kuthetsa okha zizindikiro za sekondale.

antipsychotics atypical, lomwe limagwirira kanthu ndi yochepa kuposa mmene amenenso ntchito pofuna kuchiza matendaŵa.

The American Psychiatric Association loletsa kugwiritsa ntchito antipsychotics kuchitira zizindikiro khalidwe ndi maganizo a maganizo. Komanso, iwo sayenera kugwiritsidwa ntchito chifukwa tulo.

Ndi zosavomerezeka kuchitiridwa ndi antipsychotics awiri kapena kuposa nthawi yomweyo. Ndipo kumbukirani kuti neuroleptics ntchito zochizira matenda aakulu, chabe chifukwa choti osavomerezeka kutenga.

Zotsatira Main ndi njira ya kanthu

Modern mankhwala antipsychotic kugawana limagwirira wamba kanthu antipsychotic, chifukwa akhoza kuchepetsa kufala kwa zikhumbo za mitsempha okha amene machitidwe ubongo amatumiza nyemba za dopamine. Tiyeni tione pa kachitidwe aka ndi zotsatira za mankhwala antipsychotic pa iwo.

• Mesolimbic njira. Kuchepetsa kufala kwa zikhumbo za mitsempha motere kumachitika pamene kulandira antipsychotic iliyonse kuyambira pansi amatanthauza kuchotsa zizindikiro zipatso (mwachitsanzo, kuyerekezera zinthu m'maganizo, zinyengo ndi zina zotero. D.)
• Mesocortical njira. Pali kuchepetsa zimachitika kutengerapo kumabweretsa maonekedwe a zizindikiro za akuchita misala (matenda oipa kuoneka monga mphwayi, desocialization, umphawi wa kulankhula, flattening wa bwanji, anhedonia) ndi matenda chidziwitso (tcheru kuchepekedwa, mkhutu kukumbukira ntchito, ndi zina zotero. D.). Ntchito antipsychotics lililonse, makamaka yaitali, kumabweretsa kuchuluka matenda oipa, komanso kuswa ntchito ubongo. Kuletsa neuroleptics mu nkhani iyi si kuthandiza.
• Nigrostriatal njira. Dopamine cholandilira anatseka misewu mu nkhani iyi kawirikawiri zimabweretsa ndi zotsatira lililonse antipsychotic mbali (akathisia, parkinsonism, dystonia, salivation, dyskinesia, lockjaw ndi T. D.). zotsatirapo zimenezi ndi anamuona pa 60% ya milandu.
• Tuberoinfundibular njira (zimachitika HIV pakati pa dongosolo limbic ndi pituitary England). Kutsekereza cholandilira kumabweretsa kuchuluka prolactin timadzi. Pa maziko awa anapanga nambala yaikulu zotsatira mbali inayo monga gynecomastia, galactorrhea, kukanika kugonana, osabereka ndipo ngakhale kudwala pituitary chotupa.

antipsychotics Chitsanzo kunadetsa bwanji dopamine zolandilira; atypical chomwecho bwanji pa timene ena serotonin (zinthu zimafalitsa zikhumbo mitsempha). Chifukwa cha antipsychotics izi atypical chifukwa ochepa hyperprolactinemia, matenda extrapyramidal, neuroleptic maganizo ndi kuwononga neurocognitive ndi zizindikiro negative.

Zizindikiro za α ₁ -adrenoceptor anatseka misewu ndi kutsitsa magazi, orthostatic hypotension, chizungulire chitukuko, pakutchulidwa kugonagona.

Pamene anatseka misewu H ₁ histamine zolandilira kuoneka hypotension, kusowa kukula kwa chakudya ndi kunenepa kwambiri, ndi sedation.

Ngati anatseka misewu ya maselo acetylcholine, pali zotsatira zotsatirazi mbali: kudzimbidwa, pakamwa youma, tachycardia, posungira mkodzo, kuchuluka intraocular kuthamanga ndipo malawi chisokonezo. N'zothekanso zikamera wa chisokonezo maganizo ndi tulo.

Akatswiri Western asonyeza kuti pakati antipsychotics (neuroleptics, latsopano kapena akale, lililonse kapena atypical - zilibe kanthu) ndipo mwadzidzidzi imfa mtima, pali kugwirizana.

Komanso mankhwalawa neuroleptic-sitiroko ndi chiopsezo cha matenda a mtima kumawonjezera kwambiri. Ichi ndi chifukwa chakuti mankhwala psychotic bwanji zamadzimadzi kagayidwe. Chikuonetseratu neuroleptics kungachititsenso mtundu shuga 2. The mwayi chotenga mavuto aakulu kuonjezera ndi mankhwala kuphatikiza ndi antipsychotics lililonse ndi atypical.

antipsychotics Chitsanzo imfayo khunyu khunyu akhala adatchithisira kulanda pakhomo.

antipsychotics ambiri (makamaka phenothiazine neuroleptics) ndi zotsatira kwambiri hepatotoxic, ngakhale kupangitsa kuti chitukuko cha matenda a chikasu ndiyo cholestatic.

antipsychotic chithandizo anthu okalamba mwina azitaya chibayo ndi 60%.

Zotsatira chidziwitso cha neuroleptics

Anyamula kuphunzira lotseguka anasonyeza kuti atypical antipsychotics ambiri pang'ono aluso pa matenda a akusowa neurocognitive. Komabe, umboni wokwanira za iwo ena mphamvu pa matenda neurocognitive ayi. Atypical neuroleptics, limagwirira cha zochita zosiyana pang'ono kuchokera lililonse mayeso zambiri zokwanira.

Kafukufuku wina matenda kuyerekeza zotsatira za risperidone zachipatala, ndipo haloperidol pa mlingo wochepa. Mu phunziro, palibe kusiyana kwambiri anapezeka zizindikiro. Zikuonekanso wasonyeza kuti Mlingo otsika haloperidol mu ubwino ntchito neurocognitive.

Choncho, mmene neuroleptics woyamba kapena m'badwo wachiwiri pa cognition akadali maganizo.

gulu la antipsychotics

Tanena kale kuti antipsychotics anawagawa lililonse ndi atypical.

Pakati antipsychotics lililonse akhoza kukhala wolemekezeka:

1. Mitsempha, antipsychotics (kupereka braked zotsatira pambuyo ntchito): promazine, levomepromazine, chlorpromazine, alimemazine, chlorprothixene, ndi ena periciazine.
2. antipsychotics Incisive (ndi amphamvu padziko lonse antipsychotic zochitika): fluphenazine, trifluoperazine, thioproperazine, pipotiazine, zuclopenthixol ndi haloperidol.
3. Dezingibiruyuschie (ndi mphamvu, kanthu kumasuka): karbidin, sulpiride ndi ena.

Ndi antipsychotics atypical monga zinthu monga aripiprazole, sertindole, ziprasidone, amisulpride, quetiapine, risperidone, olanzapine ndi clozapine.

Pali gulu lina la neuroleptics, amene allocated malinga:

1. Phenothiazines, tricyclic ndi ena ofanana ena. pali mitundu pakati pawo:
   
   ● neuroleptics ndi aliphatic chomangira chosavuta (Levomepromazine, alimemazin, promazine, chlorpromazine), mwamphamvu ziletsa acetylcholine zolandilira ndi maselo adrenergic ndi kutchulidwa sedative zotsatira ndipo angachititse matenda extrapyramidal;
   ● neuroleptics ndi piperidine phata (thioridazine, pipotiazine, periciazine) ndi wofatsa zotsatira antipsychotic ndi neydokrinnymi wofatsa ndi zotsatira extrapyramidal mbali;
   ● neuroleptics ndi Piperazine phata (fluphenazine, prochlorperazine, perphenazine, thioproperazine, frenolon, trifluoperazine), angathe kutsekereza dopamine zolandilira, ndipo zotsatira ofooka pa acetylcholine ndi maselo adrenergic.
   
   
2. opangidwa kuchokera onse thioxanthene (chlorprothixene, flupentixol, zuclopenthixol), amene kanthu ndi ofanana ndi zochita za phenothiazines.
3. benzamides mmalo (tiapride, sultopride, sulpiride, amisulpride), amene kanthu ndi chimodzimodzi phenothiazine neuroleptics.
4. opangidwa kuchokera onse butyrophenone (trifluperidol, droperidol, galoperiodol, Benperidol).
5. Dibenzodiazapin ndi ena ofanana (olanzapine, clozapine, quetiapine).
6. Benzisoxazole ndi ena ofanana (risperidone).
7. Benzizotiazolilpiperazin ndi ena ofanana (ziprasidone).
8. Indole ndi ena ofanana (sertindole dikarbin).
9. Piperazinilhinolinon (aripiprazole).

Kuyambira onse pamwamba, mukhoza kuonetsetsa ndi antipsychotics zilipo - mankhwala popanda mankhwala amagulitsidwa pharmacies, ndi gulu la antipsychotics, omwe amagulitsidwa mosamalitsa pa malamulo dokotala.

Mwanjira mankhwala antipsychotic

Monga mankhwala ena aliwonse, antipsychotics ano kucheza ndi mankhwala ena, ngati amwedwa pa nthawi yomweyo. Ena ankachita ndi owopsa kwambiri kwa thupi, kotero ndikofunika kudziwa kutenga mankhwala antipsychotic ndi woopsa. Kumbukirani kuti neuroleptics poyizoni zambiri kumachitika chifukwa cha zimene ankachita ndi mankhwala ena.

Mogwirizana ndi antidepressants kumabweretsa kuchuluka wachita neuroleptics ndi antidepressants okha. kuphatikiza awo kungachititse kuti kudzimbidwa, manjenje ileus, matenda oopsa.

Musamalandire pamodzi:

• Kuphatikiza antipsychotics ndi benzodiazepines kumayambitsa matenda a maganizo kupuma, zotsatira sedation mbali.
• Pamene concomitantly ndi mankhwala lifiyamu angathe hyperglycemia, maonekedwe a chisokonezo, kusinza. kuphatikiza awo atha kupirira, koma moyang'aniridwa ndi achipatala.
• Ntchito ndi agonists (ephedrine, metazonom, noradrenaline, zikuwonjezereka masiku ano) amachepetsa zotsatira za mankhwala onse.
• Antihistamine pa coadministration ndi neuroleptics patsogolo mmene ochepetsera pa chapakati mantha dongosolo.
• Zotsatira chomwecho atengedwa pamodzi ndi mowa antipsychotic, zikutanthauza kuti mankhwala, hypnotics kapena anticonvulsants.
• Chikuonetseratu antipsychotics ndi analgesics ndi dzanzi amatsogolera ndi kuwonjezeka zotsatira zawo. kuphatikiza ndi kumafooketsa pa CNS.
• Antipsychotics anatengedwa ndi insulin ndi mankhwala antidiabetic akutitsogolera kuti kuchepa wogwira awo.
• Pamene kulandira antipsychotics ndi tetracyclines kumaonjezera ngozi ya poizoni chiwindi.

contraindications

Ndi atypical ndi mmene mankhwala antipsychotic ndi mndandanda generic wa contraindications:

• Kukonzekera mbali yapadera;
• pamaso pa chatsekedwa-ngodya khungu, Prostatic adenoma, porphyria, matenda Parkinson, pheochromocytoma;
• thupi lawo siligwirizana ndi neuroleptics m'mbiri ya anthu;
• matenda a chiwindi ndi impso;
• mimba ndi mkaka wa m'mawere;
• matenda a dongosolo mtima;
• pachimake febrile matenda;
• chikomokere.

Zotsatira zoyipa za neuroleptics

Pamene yaitali mankhwala, ngakhale zabwino chionetsero neuroleptic mavuto.

mankhwala onse antipsychotic akhoza azitaya hypersensitivity dopamine, womwe kumabweretsa zizindikiro za psychosis ndi tardive dyskinesia.

Nthawi zambiri, zizindikiro izi zimachitika pamene inu kuletsa munthu neuroleptic (iyi akutchedwa "achire syndrome"). achire matenda ali mitundu angapo: tardive psychosis, dyskinesia anatulukira (kapena kudana dyskinesia), wa syndrome cholinergic "angadzachite" neri Al.

muyenera kutsiriza pang'onopang'ono kuteteza matenda ichi, neuroleptic chithandizo, pang'onopang'ono kuchepetsa mlingo.

Pamene kulandira mlingo waukulu wa neuroleptics anatchulapo mmene mbali monga neuroleptic chovutika kuchepekedwa syndrome. Malinga ndi kafukufuku zosavomerezeka, mawu amenewa akupezeka 80% odwala kutenga antipsychotics lililonse.

kusintha kandalama ubongo ntchito yaitali

Placebo womwe maphunziro deta rhesus, limene kwa zaka ziwiri anapatsidwa haloperidol kapena olanzapine mu mlingo wabwinobwino, voliyumu ndi kulemera kwa ubongo kulandira neuroleptics yafupika pafupifupi ndi 11,8%. Ichi ndi chifukwa kuchepa mu buku la nkhani woyera ndi imvi. Atachira neuroleptics zosatheka.

Pambuyo buku la zotsatira ofufuza za adandaula kuti zotsatira za neuroleptics sichinayambe anawayesa pinyama makina pa msika mankhwala, ndipo kuti angabweretse ngozi anthu.

Ena ofufuza za, Nancy Andreasen, ankakhulupirira kuti kuchepetsa voliyumu imvi kanthu, ndipo antipsychotics ambiri kungasokoneze pa thupi la munthu ndipo kumayambitsa manja a kotekisi prefrontal. Komano, izo ananenanso kuti antipsychotics ali ndi mankhwala ofunika kuti akhoza kuchiza matenda ambiri, koma iwo ayenera kumwedwa yekha zedi ochepa.

Mu 2010, akatswiri John. Leo ndi Yohane. Moncrieff lofalitsidwa mubwereze kafukufuku pa maziko a zithunzi maginito kumveka ubongo. phunziro zinachitikadi kuyerekeza ubongo kusintha odwala kutenga neuroleptics, ndi odwala amene anali kuwatengera.

14 milandu 26 (odwala mankhwala neuroleptics) anazindikira kuchepa mu Volume ubongo, buku la nkhani imvi ndi woyera.

A milandu 21 (odwala amene sanali kutenga antipsychotics, kapena kuvomereza, koma Mlingo zing'onozing'ono) kaya kusintha palibe anapezeka.

Mu 2011, onse kafukufuku chomwecho Nancy Andreasen zafalitsa zotsatira za kafukufuku amene wapeza kusintha mu ubongo buku odwala 211 ankachitira ndi mankhwala antipsychotic kwa nthawi yaitali (pa 7 zaka). Kwakukulu mlingo mankhwala anali kwambiri, kuchuluka kwa ubongo utachepa.

Papezeke mankhwala atsopano

Panthawi imeneyi tayamba antipsychotics watsopano amene alibe mphamvu pa maselo a. Gulu lina la ofufuza ananena kuti zotsatira antipsychotic ndi cannabidiol cannabis zigawo zikuluzikulu. Choncho n'zotheka kuti posakhalitsa tidzaona zinthu pa maalumali wa pharmacies.

Pomaliza

Tikukhulupirira, palibe munthu akhalabe funso la kodi antipsychotic. N'chiyani chimene zochita zake ndi zotsatira za limagwirira phwando takambirana pamwambapa. Iwo okha mpaka kuwonjezera kuti chilichonse mlingo wa mankhwala ano, palibe chinthu sangakhoze anaphunzira mpaka ku mapeto. Ndipo mochenjera mungayembekezere chilichonse kuli pa mankhwala osiyanasiyana monga antipsychotics.

M'zaka zaposachedwapa, milandu chithandizo antipsychotic maganizo. Chifukwa cha kusadziwa kuopsa kwa mankhwala, anthu eni kuchita zoipitsitsa. Antipsychotics Mulimonsemo sangathe ntchito ina m'malo cholinga chake. Ndipo za zotsatira za mankhwala pa ubongo umabala, kale ngakhale mwa funso.

N'chifukwa chake antipsychotics - mankhwala popanda mankhwala alipo kugula, ayenera kugwiritsidwa ntchito mosamala (ndi pokhapokha ngati muli 100% kuonetsetsa kuti muyenera izo), ndi bwino kuti ntchito popanda mankhwala dokotala.