Neuroleptic - chii? Chii mashandiro chiito pamusoro antipsychotic zvinodhaka?

Psychotropic mushonga, izvo chinangwa - pakurapa pfungwa zvirwere, antipsychotic rinonzi (sezvo antipsychotic kana neuroleptic). Chii uye sei kushanda? Ngatimbotaurei zvazviri.

Neuroleptic. Chii? History uye unhu

Antipsychotics mushonga akazviratidza nekaupenyu achangobva. Kusvikira yawanikwa yavo pakurapa psychosis zvinowanzoshandiswa kugadzirirwa miriwo mavambo (akadai henbane, belladonna, opiates), intravenous kwokubatsira calcium, bromide, uyewo marwadzo hope.

Mukutanga '50s remakore rechi20 kuti zvinangwa izvi zvinoona antihistamines kana lithium munyu.

Mumwe wokutanga antipsychotic chlorpromazine razova (kana chlorpromazine), iyo kusvikira panguva iyoyo ainzi kwakajairika antihistamines. Zvikuru yoashandisa akatanga 1953, kunyanya sezvo ari kunyaradza kana neuroleptic (mu schizophrenia).

Zvichitevera neuroleptic aiva alkaloid reserpine, asi nokukurumidza ndakanga kwaidarika nevamwe, zvinodhaka hubudirire, sezvo anenge asina maturo.

Mukutanga 1958 kwaiva nevamwe chizvarwa vokutanga antipsychotics: trifluoperazine (triftazin), haloperidol, thioproperazine uye nevamwe.

Shoko rokuti "antipsychotic" akanga aronga muna 1967 (paakasika kupatsanura pakati psychotropic zvinodhaka vezera wokutanga), uye kubatwa nayo mishonga kwete chete ane antipsychotic mugumisiro, asi kugonawo kukonzera chetsinga zvirwere (akataziyu, neuroleptic parkinsonism, siyana dystonic siyana, etc.). Kazhinji, zvirwere izvi zvinokonzera zvinhu zvakadai chlorpromazine, haloperidol uye triftazin. Uyezve, marapirwo Vari dzinenge nguva dzose achiperekedzwa kusingafadzi nemishonga: mwoyo, kufunganya, irwadziwe kwazvo, mupfungwa vasingakendengi.

Kwekutanga antipsychotics zvinogona kunzi "mapiritsi huru", saka kuti antipsychotics uye mapiritsi - tiri dzakangofanana. Sei? Nokuti anokonzerawo kunyaradza, hypnotic uye antianxiety trankviliziruyusche-zvinokonzerwa, uyewo yakati dzakananga ezvinhu hanya (Ataraxia). Zvino zita ichi panyaya neuroleptics haushandi.

zvinodhaka All antipsychotic inogona rakakamurwa zvemo uye atypical. Typical antipsychotics isu kurondedzerwa zvishomanana, funga zvino atypical antipsychotic. Chii? boka iri zvikuru zvinodhaka "nyoro". Vanoita zvisiri chiito zvikuru pamusoro muviri, sezvo zvemo. Vanopinda chizvarwa chitsva antipsychotics. The mukana atypical antipsychotics ndechokuti vane zvishoma simba pamusoro dopamine receptors.

Antipsychotics: uchapupu

antipsychotics All nhaka imwe inokosha pfuma - abudirire rokuchinja inobereka zviratidzo (kuvhumuka, zvinovadadira, pseudohallucinations, neunyengedzi, mufambiro wenyonganyonga, zvinovadadira, utsinye uye excitation). Kunze, neuroleptics (kazhinji atypical) anogona basa kurapa mwoyo kana dhefisiti zviratidzo (autism, mupfungwa flattening, uye desotsializatsii m. P.). Zvisinei, kubudirira kwavo toreva pakurapa zviratidzo dhefisiti mubvunzo guru. Nyanzvi dzinoti zvinodhaka antipsychotic vanokwanisa kubvisa chete dzisiri zviratidzo.

Atypical antipsychotics, izvo mashandiro chiito riri simba kupfuura kwese, rinoshandiswawo kurapa rebipolar.

The American Psychiatric Association unorambidza kushandiswa antipsychotics kurapa zvounhu uye mafungiro zviratidzo dementia. Uyewo, irege kushandiswa hope.

Hazvina kunaka kubatwa maviri kana kupfuura antipsychotics panguva imwe chete. Uye yeuka kuti neuroleptics akashandiswa kurapwa zvirwere zvakakomba nokungoti havana ndakarumbidzwa kutora.

Main migumisiro zvigadziriswe kuita

Modern zvinodhaka antipsychotic vane mashandiro pamusoro antipsychotic chiito, nokuti kunogona kuderedza kupararira tsinga nomunhu chete idzodzo uropi hurongwa unoendesa pulses ose dopamine. Ngatitorei kunyatsoongorora izvi hurongwa nokuitika antipsychotic zvinodhaka pamusoro pavo.

• Mesolimbic gwara. Kuderedza kupararira etsinga nomunhu munzira iyi kunoitika apo achitora antipsychotic mishonga ipi, sezvo chinofanira kureva kubviswa zvakanaka zviratidzo (semuenzaniso, aone zvinhu zvisipo, zvinovadadira, uye zvichingodaro. D.)
• Mesocortical nzira. Pane kupomba kuchinjirwa rutapudzo inotungamirira chimiro zviratidzo schizophrenia (kunaka zvinetso kuonekwa akadai vasingakendengi, desocialization, urombo pakutaura, flattening pamusoro kukanganisa, anhedonia) zvishande zvirwere (kutarisirwa dhefisiti, havachanyatsogoni kuyeuka basa, uye zvichingodaro. D.). Kushandiswa nezvekumwe antipsychotics, kunyanya refu-refu, kunoita kuti vawedzere kunaka kwepfungwa, uyewo zvakakomba kutyorwa uropi mashandiro. Kukanzura neuroleptics iyi nyaya hazvirevi kubatsira.
• Nigrostriatal gwara. Dopamine Kanotokonya blockade iyi nyaya kazhinji kunotungamirira kune randinenge antipsychotic nemishonga (akathisia, parkinsonism, dystonia, salivation, dyskinesia, lockjaw uye t. D.). Izvi marwadzo vari kuchengetwa 60% nyaya.
• Tuberoinfundibular gwara (kupomba Kupfuudzwa pakati chikamu ichocho ndicho chinoita maitiro uye pituitary gland). Rakavhara Kanotokonya kunotungamirira vawedzere prolactin kemikari. On ichi kumashure vakaumba kuwanda mhiri anokonzerwa akadai gynecomastia, galactorrhea, pabonde dysfunction, kushaya mbereko uye kunyange zvokurwara pituitary bundu.

Typical antipsychotics kuramba kukanganisa dopamine receptors; atypical chete sei pane dzimwe neurotransmitters kweserotonin (zvinhu kuti zvinoparadzira tsinga mafungiro). Nemhaka iyi atypical antipsychotics kukonzera hyperprolactinemia zvishoma, extrapyramidal wenyonganyonga, neuroleptic mwoyo uye neurocognitive deficits uye akaipa zviratidzo.

Zviratidzo α ₁ -adrenoceptor blockade vari BP, orthostatic hypotension, dzungu kukura, panowanikwa nehope.

Kana blockade H ₁ histamine receptors kuoneka hypotension, kukura kudiwa makabhohaidhiretsi uye uremu, uye nyaradzo.

Kana blockade pamusoro acetylcholine receptors, pane zvinotevera nemishonga: kupatira, muromo yakaoma, tachycardia, Urinary chengetedzo, vakawedzera intraocular kumanikidzwa uye pokugara nenyonganiso. Zvinogonekawo kuti chidzoke kuvhiringika kwepfungwa uye nehope.

Vatsvakurudzi Western kwakaratidza kuti pakati antipsychotics (neuroleptics, zvitsva kana mutana, kwese kana atypical - hazvina basa) uye kungoerekana cardiac rufu, pane kubatana.

Uyewo pakurapa neuroleptic-sitiroko uye ngozi chomwoyo kunowedzera yekudyidzana. Izvi imhaka yokuti zvinodhaka pfungwa sei lipid muviri. Rubvumo neuroleptics kunogonawo kukonzera mhando 2 chirwere cheshuga. Mikana yokuenda zvakakomba yematambudziko kuwedzera pamwe yaisanganisa kurapwa pamwe kwese uye atypical antipsychotics.

Wakanaka antipsychotics anogona kutsamwisa zvipusha pfari kunge akatura kufenda pachikumbaridzo.

antipsychotics Most (kunyanya phenothiazine neuroleptics) guru hepatotoxic nemigumisiro uye kungatoita kuti kukura cholestatic jaundice.

antipsychotic kunorapwa vanhu vakwegura kungawedzera njodzi nemabayo kubudikidza 60%.

The zvishande Migumisiro neuroleptics

Wakabata kudzidza rakashama akaratidza kuti atypical antipsychotics yemanyorero zvishoma tibudirire pakurapa neurocognitive kukanganisika. Zvisinei, chokwadi uchapupu pamusoro pavo vamwe sei neurocognitive zvirwere kwete. Atypical neuroleptics, kuti mashandiro chiito chiri siyanei kubva hwokufananidzira, bvunzo kazhinji zvakakwana.

Mune imwe ongororo zvekuchipatara kuenzanisa migumisiro yokurapa risperidone, uye haloperidol zvishoma mishonga. Kudzidza, pasina Misiyano kwakawanikwa zvairatidza. Zvakanzi dzakaratidza kuti pasi mishonga kuti haloperidol mune kunobatsirawo neurocognitive unongotaura.

Saka, matambudziko neuroleptics kutanga kana chizvarwa wechipiri cognition richiri nharo.

kupatsanura pakati antipsychotics

Takatodzidza kutaurwa kuti antipsychotics vari rakakamurwa zvemo uye atypical.

Pakati randinenge antipsychotics kunogona anokudzwa:

1. Sedatives, antipsychotics (kupa braked mugumisiro pashure kushanda): promazine, levomepromazine, chlorpromazine, alimemazine, chlorprothixene, uye vamwe periciazine.
2. Nechido antipsychotics (kuva simba rose antipsychotic mugumisiro): fluphenazine, trifluoperazine, thioproperazine, pipotiazine, zuclopenthixol uye haloperidol.
3. Dezingibiruyuschie (ane simba, kusunungura chiito): karbidin, sulpiride uye nevamwe.

By atypical antipsychotics anosanganisira zvinhu zvakadai aripiprazole, sertindole, ziprasidone, amisulpride, quetiapine, risperidone, olanzapine uye clozapine.

Pane imwe kupatsanura pakati neuroleptics, izvo dzinounzwa maererano:

1. Phenothiazines, tricyclic nezvimwe nomukaka. pane mhando pakati pavo:
   
   ● neuroleptics nokungoti aliphatic chisungo (Levomepromazine, alimemazin, promazine, chlorpromazine), zvakasimba tunodzivisa acetylcholine receptors uye adrenergic receptors vane raidudzwa kunyaradza mugumisiro uye zvinogona kukonzera extrapyramidal zvirwere;
   ● neuroleptics vane piperidine neerekitironi (thioridazine, pipotiazine, periciazine) kuva munyoro antipsychotic kushanda uye munyoro neydokrinnymi uye extrapyramidal nemishonga;
   ● neuroleptics ane piperazine neerekitironi (fluphenazine, prochlorperazine, perphenazine, thioproperazine, frenolon, trifluoperazine), vaikwanisa ichivharira dopamine receptors, uye simba kubatsira acetylcholine uye adrenergic receptors.
   
   
2. thioxanthene nomukaka All (chlorprothixene, flupentixol, zuclopenthixol), uyo chiito zvakafanana zvinoitwa phenothiazines.
3. Kuchiiswa benzamides (tiapride, sultopride, sulpiride, amisulpride), uyo chiito iri saizvozvowo phenothiazine neuroleptics.
4. All nomukaka butyrophenone (trifluperidol, droperidol, galoperiodol, Benperidol).
5. Dibenzodiazapin uye nomukaka ayo (olanzapine, clozapine, quetiapine).
6. Benzisoxazole uye nomukaka ayo (risperidone).
7. Benzizotiazolilpiperazin uye nomukaka ayo (ziprasidone).
8. Indole uye nomukaka ayo (sertindole dikarbin).
9. Piperazinilhinolinon (aripiprazole).

Kubva ose pamusoro, unogona govera nyika iripo antipsychotics - zvinodhaka pasina nachiremba inotengeswa Pharmacies, uye boka antipsychotics, izvo anotengeswa kunoparirwa yachiremba kurayira.

antipsychotic mushonga kwavatori

Kungofanana neimwe mishonga, antipsychotics ano kushamwaridzana nevamwe mishonga, kana kutorwa panguva imwecheteyo. Vamwe kwavatori vane ngozi chaizvo nokuti munhu muviri, saka zvakakosha kuziva chii kutora zvinodhaka antipsychotic iri ngozi. Yeuka kuti neuroleptics chepfu rinowanzoberekera nokuda kubata kwavo zvimwe zvinodhaka.

Kudyidzana pamwe antidepressants kunotungamirira vawedzere zviito sezvo neuroleptics uye antidepressants pachavo. mubatanidzwa wavo kunogona kupatira, akafa mitezo ileus, BP.

Musatora pamwe:

• Tikafunga antipsychotics uye benzodiazepines kunotungamirira kufema mwoyo, nyaradzo nemishonga.
• Kana concomitantly chete lithium kurapa zvingamuka hyperglycemia, chitarisiko kuvhiringika, hope. mubatanidzwa wavo zvinogona akashivirira, asi chete pasi zvokurapa achitarisirwa.
• Nokushanda agonists (ephedrine, metazonom, noradrenaline, adrenaline) akazoita nokuitika zvose zvinodhaka.
• Antihistamines panguva coadministration pamwe neuroleptics kuvandudza zvavo inhibitory zvainoita nechepakati tsinga.
• Zvimwechetezvo vanotorwa pamwe antipsychotic doro, zvinoreva kuti yokutindivadza, hypnotics kana anticonvulsants.
• Rubvumo antipsychotics vane analgesics uye dzokutindivadza kunotungamirira kuwedzera zvazvinoita. mubatanidzwa uyu mwoyo zvainoita CNS.
• Antipsychotics kubatwa jekiseni uye zvinodhaka antidiabetic kunotungamirira vasanyanye zvinobudirira yavo.
• Kana kugamuchira antipsychotics pamwe tetracyclines kunowedzera ngozi yokubatwa chiropa muchetura.

Contraindications

Zvino atypical uye mifananidzo zvinodhaka antipsychotic vane Generic mazita contraindications:

• idiosyncrasy gadziriro;
• kuvapo namahwindo-angled yemaziso, prostatic adenoma, porphyria, chirwere chinonzi Parkinson, pheochromocytoma;
• neutachiona kuti neuroleptics munhoroondo yevanhu;
• kusagadzikana chiropa uye itsvo;
• pamuviri uye lactation;
• zvirwere kumwoyo;
• chenjera febrile kurwara;
• pakoma.

Side anokonzerwa neuroleptics

Kana mushonga kwenguva refu, kunyange zvakanakisisa zviratidzwa neuroleptic nemishonga.

zvinodhaka All antipsychotic anogona kuwedzera ngozi hypersensitivity dopamine, izvo zvinozoita kunotungamirira zviratidzo psychosis uye tardive dyskinesia.

Kakawanda, zviratidzo izvi zvichiitika paunenge kudzima mumwe neuroleptic (ichi anonzi "kushaya chirwere"). WIthdrawal chirwere ane dzakawanda mhando: tardive psychosis, dyskinesia akafumura (kana hazviiti dyskinesia), kuti cholinergic chirwere "hazviiti" and said.

unofanira kupedzisa zvishoma nezvishoma kudzivirira chirwere ichi, neuroleptic kurapwa, zvishoma nezvishoma achidzikisa dose.

Kana muchigamuchira yakakwirira mishonga ine neuroleptics yakati rutivi mugumisiro akadai neuroleptic Kutemeswa dhefisiti syndrome. Maererano ndibatsireiwo data, izvi rinowanikwa muna 80% wevarwere kutora zvemo antipsychotics.

Structural kuchinja muuropi kushandiswa kwenguva refu

Zvidzidzo kurapa kunonyaradza pfungwa raitungamirirwa pamusoro rhesus data, izvo kwemakore maviri vakapiwa haloperidol kana olanzapine chaiye chipimo chemushonga, Vhoriyamu uye kurema uropi kugamuchira neuroleptics kwakaderedza Paavhareji nokuda 11.8%. Izvi imhaka vasanyanye bhuku chena uye pfumbu nyaya. Achakavhiringidzika neuroleptics zvisingabviri.

Pashure racho migumisiro vaongorori vakapomera kuti migumisiro neuroleptics haina akaedzwa mhuka vasati pakudhinda pamusoro mishonga pamusika, uye kuti ivo kukuisa pangozi kuvanhu.

Mumwe vaongorori, Nancy Andreasen, achivimba kuti zvinoderedza wachena nyaya vhoriyamu, uye nokugamuchira antipsychotics zvavo inokanganisa pamusoro womunhu muviri uye inotungamirira atrophy pamusoro prefrontal cortex. Ukuwo, izvozvo yakataurawo kuti antipsychotics vari rinokosha mushonga kuti anogona kurapa zvirwere zvakawanda, asi vanofanira kubatwa chete chaizvo diki zvakawanda.

Muna 2010, vatsvakurudzi John. Leo naJohani. Moncrieff akabudisa kudzokorora tsvakurudzo maererano rinobva resonance mifananidzo uropi. Kudzidza akanga akatakurwa achiburitswa kunze kuenzanisa kuuropi wevarwere kuchinja achitora neuroleptics, uye varwere vakanga vasina kutora kwavari.

Muna 14 26 nyaya (varwere kubatwa neuroleptics) akanga akacherechedza imwe kudzikisa inzwi uropi, bhuku vachena uye chena nyaya.

Pakati 21 nyaya (varwere vakanga tisingaomereri antipsychotics, kana kugamuchira, asi mishonga diki) mu kana havashanduki kuwanikwa.

Muna 2011, zvose zvakafanana mutsvakurudzi Nancy Andreasen akabudisa migumisiro kudzidza iyo yakawanikwa kuchinja pfungwa vhoriyamu muna 211 varwere kubatwa antipsychotic zvinodhaka kwenguva refu (anopfuura 7 years). The mukuru zvinodhaka dose rakanga, chikuru uwandu shoma uropi.

Pokumuka zvinodhaka itsva

Panguva ino tiri kuva antipsychotics itsva vasina zvainoita receptors. Rimwe boka Vatsvakurudzi vakati kuti antipsychotic nezvinozoitika cannabidiol Cannabis zvinoriumba. Saka zvinoita kuti isu nokukurumidza kuona zvinhu izvi pamusoro echiShinto ose Pharmacies.

mhedziso

Tinovimba hapana chinoramba mubvunzo kuti chii chiri antipsychotic. Chii, chii maitiro ake uye migumisiro kugamuchirwa mashandiro takurukura kumusoro. It chete unoramba kuwedzera kuti chero padanho zvokurapa munyika yanhasi, hapana pfuma hazvigoni kudzidza kusvikira pakuguma. Uye wemanomano here zvawaizotarisira kubva chinhu, ndoda pamusoro zvinhu zvakadai kunzwisisa sezvo antipsychotics.

Mumakore achangopfuura, zviitiko antipsychotic kurapwa mwoyo. Nokusaziva nezvengozi zvinodhaka ichi, vanhu pachavo vanoita zvakaipa. Antipsychotics chero zvazvingava haigoni kushandisirwa chero chinangwa kunze chinangwa chahwo. Uye pamusoro matambudziko kuti zvinodhaka izvi pave uropi, nechekare kunyange kubva mubvunzo.

Ndokusaka antipsychotics - zvinodhaka pasina nachiremba dziripo kutenga, inofanira kushandiswa nokungwaririra (uye chete kana uri 100% nechokwadi chokuti wava), uye kunyange nani kwete kushandiswa pasina chiremba mushonga.