Neuroleptic - ntoni na? Yintoni na indlela amanyathelo iziyobisi antipsychotic?

Isiyobisi se-Psychotropic, enenjongo - unyango lweengxaki zengqondo, kuthiwa yi-antipsychotic (kunye ne-antipsychotic okanye neuroleptic). Yintoni na kwaye isebenza njani? Masibhale phantsi.

Neuroleptic. Yintoni na? Imbali kunye neempawu

I-neuroleptics kumayeza yabonakala ngokutsha nje. Ngaphambi kokufumanisa kwabo, unyango lweengqondo, izidakamizwa ezazisetyenziswa ngokuqhelekileyo zivela kwimveliso (umzekelo, i-bleach, i-belladonna, i-opiates), i-calcium ene-intravenous, i-bromide ne-sleeping narcotic.

Kwiminyaka eyi-50-yokuqala yekhulu lama-20, i-antihistamines okanye i-lithium salts yayisetyenziselwa ezi njongo.

Enye ye-antipsychotics yakuqala yayiyi-chlorpromazine (okanye i-aminazine), eyayiyicingwa njenge-antihistamine eqhelekileyo. Ukusetyenziswa ngokubanzi kwaqala ngo-1953, ngokuyinhloko njengento yokuguqula okanye njenge-neuroleptic (kwi-schizophrenia).

I-neuroleptic elandelayo yayiyi-alkaloid reserpine, kodwa kungekudala yadlulisela kwezinye izidakamizwa ezisebenzayo, njengoko kwakungasebenzi.

Ekuqaleni kuka-1958, ezinye i-antipsychotics zesizukulwana sokuqala yabonakala: trifluoperazine (triftazine), haloperidol, thiopperazine, nabanye.

I-term "neuroleptic" yahlongozwa ngo-1967 (xa kuhlonywa izidakamizwa zengqondo ze-psychotropic kwisizukulwana sokuqala) kwaye wayiphatha iziyobisi kungekhona nje ngezenzo zokulwa ne-antipsychotic, kodwa nazo zinokubangela ukuphazamiseka kweengxaki zegazi (i-acacia, i-neuroleptic Parkinsonism, iimpendulo ezahlukeneyo ze-dystonic kunye nabanye). Ngokuqhelekileyo ezi ntlupheko zabangela izinto ezifana ne-aminazine, i-haloperidol kunye ne-trifazin. Ngaphezu koko, unyango kunye nabo luhlala luhamba kunye nemiphumo engathandekiyo: ukudandatheka, ukuxhalaba, ukwesaba, ukungahloneli kwemvakalelo.

Ngaphambili ama-neuroleptics angabizwa nangokuthi "amaxhala amakhulu", ngoko i-neuroleptics kunye ne-tranquilizers ifanayo. Kutheni? Kungenxa yokuba nazo zibangelwa ukuzondla, ukuchithwa kunye nokuxilisa-iziphumo zokuxhalabisa, kunye neemeko ezingabandakanyiyo (i-ataraxia). Ngoku eli gama alisetyenzisiwe kuma-neuroleptics.

Zonke i-antipsychotics zinokuhlulwa kwiindawo eziqhelekileyo kunye nezobuhlobo. I-antipsychotics ekhethekileyo esiyichazile ngokucacileyo, ngoku qwalasela i-antipychotic. Yintoni na? Eli liqela lezilwanyana ezininzi "ezithambileyo". Abenzi nto emzimbeni njengoko benzayo. Bayiyo ye-neuroleptics yesizukulwana esitsha. Inzuzo ye-antipsychotics ye-atypical kukuba ayinomphumo omncinci kwi-dopamine receptors.

Neuroleptics: ubungqina

Zonke i-neuroleptics zinepropati enye esisisiseko-isiphumo esiphumeleleyo kwimpawu ezivelisayo (i-hallucinations, i-delusion, i-hallucinations, i-illusions, iziphazamiso zokuziphatha, i-mania, i-aggressive and agitation). Ukongezelela, i-neuroleptics (i-atypical) inokumiselwa ukonyango lweempawu ezixinezelekileyo okanye ezingenzileyo (i-autism, ukuphazamiseka kwengqondo, i-desocialisation, njl.). Nangona kunjalo, ukuphumelela kwabo malunga nokunyanga kweempawu zephutha ngumbuzo omkhulu. Iingcali zibonisa ukuba i-antipsychotics inokuphelisa kuphela iimpawu zesibini.

I-antipyychotics ye-Atypical, eyindlela yokuthatha isenzo ibuthakathaka kunezona zinto eziqhelekileyo, isetyenziselwa ukuphatha ingxaki ye-bipolar.

Umbutho we-American Psychiatric Umthetho uvimbela ukusebenzisa i-neuroleptics ukunyanga iimpawu zesifo sengqondo nokuziphatha komqondo. Kwakhona, akufanele kusetyenziswe ukulala.

Akuvunyelwanga ukuphathwa ngamachiza amabini okanye amaninzi okulwa ne-antipsychotic ngexesha elifanayo. Yaye ukhumbule ukuba i-antipsychotics isetyenziselwa ukuphatha izifo ezinzulu, akukhuthazeki ukuba uwathathe.

Imiphumo ephambili kunye neendlela zokusebenza

I-neuroleptics zanamhlanje zinendlela eqhelekileyo yesenzo sokulwa ne-antipsychotic, kuba sinokunciphisa ukuhanjiswa kweentshukumo zentsholongwane kuphela kwezo zixhobo zengqondo apho iimpembelelo zihambisa i-dopamine. Masiqwalasele ngokuthe kratya kwezi nkqubo kunye nemiphumo ye-neuroleptics kubo.

• Mesolimbic path. Ukunciphisa ukuhanjiswa kweempembelelo zesibindi ngale ndlela kwenzeka ngokulawulwa kwezidakamizwa ze-antipsychotic, kuba kuthetha ukuthathwa kweempawu zokuvelisa (umzekelo, ukucoca, ukukhohlisa, njl)
• Indlela ye-mesocortical. Apha, ukunciphisa ukuhanjiswa kweempembelelo kubangela ukubonakaliswa kweempawu ze-schizophrenia (iziphazamiso ezimbi ezifana nokunganakwa, ukuhlaziywa kwemfundo, ukuphazamiseka kwentetho, ukuphazamiseka kokunciphisa, i-anedonia) kunye nokuphazamiseka kwengqondo (ukunqongophala komnxeba, ukusebenza kwememori engafanelekanga, njl njl). Ukusetyenziswa kwe-antipsychotics eqhelekileyo, ngokukodwa ixesha elide, kubangela ukwanda kweengxaki ezimbi, kunye nokuphazamiseka okukhulu kwemisebenzi yengqondo. Ukupheliswa kwe-neuroleptics kule meko akuyi kunceda.
• Inkqubo yeNigrostriar. Ukunqandwa kwe-dopamine receptors kulo mzekelo kukhokelela ekubonakaleni kwemiphumo emibi efana ne-neuroleptics (akathisia, ipasinsonism, i-dystonia, i-salivation, i-dyskinesia, i- dicamine yemihlathi , njl.). Ezi ziphumo zecala zigcinwa kwi-60% yamatyala.
• I-Tuberoinfundibular path (ukudluliselwa kweempembelelo phakathi kwenkqubo ye-limbic kunye ne-pituitary). Ukukhusela i-receptors kubangela ukwanda kwe-hormone prolactin. Ngokuchasene nale mvelaphi, ininzi enkulu yeminye imiphumo emibi, efana ne-gynecomastia, i-galactorrhea, ukungasebenzi kwezesondo, ukukhubazeka kokungabikho komzimba kunye ne-tumor pituitary.

Iingxaki ze-neuroleptics ezinomdla zinomthelela omkhulu kwi-dopamine receptors; I-Atypical efanayo ichaphazela i-serotonin ngamanye ama-neurotransmitters (izinto ezithumela impembelelo zesisindo). Ngenxa yoko, i-neuroleptics ye-atypical ayibangakho ibangele i-hyperprolactinaemia, i- extrapyramidal disorders, ukuxinezeleka kwe-neuroleptic, kunye neengxaki ze-neurocognitive kunye neempawu ezimbi.

Iimpawu zokukhusela i-α ₁ -adrenoreceptors zinciphisa uxinzelelo lwe-arterial, hypotension, orthostatic hypotension, ukuphuhliswa kwesisu, nokubonakala kokulala.

Xa i-H ₁ -gistamine receptors ivaliwe, i-hypotension ibonakala, isidingo sama-carbohydrates sanda kunye nokwanda komzimba, kunye nokuhlaliswa.

Ukuba ukukhutshwa kwe-acetylcholine receptors kwenzeka, iziphumo ezilandelayo zenzeke: ukumbanjwa, umlomo owomileyo, i-tachycardia, ukugcinwa kwamanzi, ukunyanzeliswa kwe-intraocular, kunye neengxaki zokuhlala. Kukho kwakhona ukudideka nokulala.

Abaphandi baseNtshona baphengile ukuba phakathi kwama-antipsychotics (amatsha amachiza omzimba okanye adala, aqhelekileyo okanye atypical - akunandaba) kunye nokufa ngokukhawuleza kwegazi kukunxibelelana.

Kwakhona, unyango nge-neuroleptics lwandisa kakhulu umngcipheko we-stroke kunye ne-myocardial infarction. Oku kungenxa yokuba iziyobisi zengqondo zichaphazela i-lipid imetabolism. Ukwamkelwa kwe-neuroleptics kungabangela uhlobo lwesifo sikashukela se-2. Amathuba okufumana iingxaki ezinzulu zanda kunye neyeza ezidibeneyo kunye ne-antipsychotics eziqhelekileyo kunye neengcali.

I-antipsychotics ephawulekayo inokubangela ukuxhamla, ngenxa yokunciphisa umda wokulungelelanisa.

Uninzi lwe-antipsychotics (ikakhulukazi i-phenothiazine antipsychotics) lunempembelelo enkulu ye-hepatotoxic, kwaye ingakhokelela ekuphuhliseni i-jaundice ye-cholestatic.

Unyango lwama-antipsychotics asebekhulile lunokwandisa umngcipheko we-pneumonia nge-60%.

Impembelelo yengqondo ye-antipsychotics

Izifundo ezivulekileyo ezibonisiweyo zibonise ukuba i-neuroleptics ye-atypical iphumelela ngakumbi kunezo ziqhelekileyo ekunyanga kwe-insufficiency ye-neurocognitive. Nangona kunjalo, akukho bungqina obukholisayo bokuba ubuncinane kwimpembelelo enokukhubazeka kwe-neurocognitive. Ama-antipsychotics ase-Atypical, asebenza ngayo amanyathelo ahlukeneyo nakwimifuziselo, idlalwa rhoqo.

Kwesinye sezifundo zekliniki, oogqirha bafanisa nemiphumo ye-risperidone kunye ne-haloperidol kumanani aphantsi. Ngethuba lokufunda, akukho mvelaphi ephawulekayo kwiimpawu ezifunyenweyo. Kwakuboniswe kwakhona ukuba i-haloperidol kwizilwanyana ezisezantsi zichaphazela ngokuchanekileyo iingongoma ze-neurocognitive.

Ngaloo ndlela, umbuzo weempembelelo ze-neuroleptics zesizukulwana sokuqala okanye sesibini kwisizukulwana sogcino-nkqubela sisasazo.

Ulwahlulo lwe-antipsychotics

Sekukhankanywe ngentla apha ukuba ama-neuroleptics ahlulwe ngohlobo oluqhelekileyo kunye neengcali.

Phakathi kwezinto eziqhelekileyo ze-neuroleptics zingabonwa:

1. I-antipsychotics ezithandwayo (enefuthe lokulinda emva kwesicelo): promazine, levomepromazine, chlorpromazine, alimamazine, chlorprotixen, pericyazin kunye nabanye.
2. I-antipsychotics ye-Induction (ibe nefuthe elinamandla lomhlaba jikelele): i-fluphenazine, i-trifluoperazine, i-thioproperazine, i-pipotiazine, i-zuclopentixol kunye ne-haloperidol.
3. I-Disinhibitory (yenza isenzo esisebenzayo, sokukhubaza): i-carbidine, i-sulpiride kunye nabanye.

Ama-antipsychotics atypical afaka izinto ezifana ne-aripiprazole, i-sertindole, i-ziprasidone, i-amulpride, i-quetiapine, i-risperidone, i-olanzapine ne-clozapine.

Kukho olunye uluhlu lweeuroleptics, ngokwemiqathango elandelayo eyaziwayo:

1. Iiphenothiazines, kunye nezinye izixhobo ezivela kwi-tricyclic. Phakathi kwazo kukho iintlobo ezinjalo:
   
   ● Ama-neuroleptics anesibophelelo esilula esilula (i-levomepromazine, alimamazine, promazine, i-chlorpromazine), ikhusela ngamandla i-acetylcholine receptors kunye ne-adrenoreceptors, ibe nefuthe elikhusayo kwaye liyakwazi ukubangela izifo ezingaphezulu kwe-extrapyramidal;
   ● I-neuroleptics ene-piperidine nucleus (thioridazine, pipotiazine, pericyazin), eneempembelelo ezicwangcisiweyo zokulwa ne-antipsychotic kwaye ingabonakali kakuhle i-neutocrine kunye ne-extrapyramidal effects effects;
   ● i-neuroleptics ene-piperazine yangundoqo (i-fluphenazine, i-prochlorperazine, i-perphenazine, i-thioproperazine, i-frenolone, i-trifluoperazine), iyakwazi ukuvimba i-dopamine receptors, kwaye ayinakuchaphazeleka kakhulu kwi-acetylcholine kunye ne-adrenoreceptors.
   
   
2. Zonke ezivela kwi-thioxanthene (i-chlorprotixen, i-flupentixol, i-zuclopentixol), isenzo saso sifana neso-phenothiazines.
3. I-benzamide esekelwe (i-tiaprid, i-sultopride, i-sulpiride, i-amisulpride), isenzo saso sifana ne-phenothiazine neuroleptics.
4. Zonke iziphumo ze-butyrophenone (trifluperidol, droperidol, haloperiodol, benperidol).
5. I-Dibenzodiazapine kunye neziphumo zayo (olanzapine, clozapine, quetiapine).
6. I-Benzisoxazole kunye neziphumo zayo (risperidone).
7. I-Benzisothiazolylpiperazine kunye neziphumo zayo (ziprasidone).
8. I-Indole kunye neziphumo zayo (i-sertindole, i-dicarbine).
9. I-Piperazinylquinolinone (aripiprazole).

Kukho konke oku ngasentla, kunokwenzeka ukufumanisa i-neuroleptics ekhoyo-iziyobisi, ngaphandle kwemigqaliselo ethengiswa kuma-pharmacy, kunye neqela le-antipsychotics ezithengiswa ngokungqongqo ngokwemigqaliselo yonyango.

Ukusebenzisana kwama-antipsychotics kunye nezinye iziyobisi

Njengawo nawaphi na amanye amayeza, iintsholongwane zanamhlanje zisebenzisana nezinye iziyobisi xa zithathwa kanyekanye. Ukunye ukusebenzisana kuyingozi kakhulu kumzimba womntu, ngoko kubalulekile ukwazi ukuba iziphi i-antipsychotics zithatha ingozi. Khumbula ukuba utyhefu lwe-neuroleptic luhlala lwenzeka ngokuchanekileyo ngenxa yokusebenzisana kwazo nezinye iziyobisi.

Ukusebenzisana neengcinezelo zokhuseleko kubangela ukwanda kwenzeni ye-antipsychotics kunye nezidandlululo. Intsebenziswano yazo inokukhokelela ekumanyeni, ukukhubazeka kwamathumbu emathunjini, isifo sengqondo somzimba.

Akukhuthazwa ukuthatha ndawonye:

• Ukudibanisa i-neuroleptics kunye ne-benzodiazepines kukhokelela ekudakaleni kokuphefumula, kwimiphumo emibi.
• Ngamalungiselelo athile ngexesha elilodwa kunye nokulungiselelwa kwe-lithium, kunokwenzeka ukuhlakulela i-hyperglycemia, ukubonakala kokudideka, ukulala. Intsebenziswano yabo inokunyamezela, kodwa kuphela ngokulawulwa kwezonyango.
• Ukusetyenziswa kwe-adrenomimetics (ephedrine, metazone, norepinephrine, adrenaline) ibangela ukuhla kwefuthe lazo zombini iziyobisi.
• Ama-Antihistamines kunye nolawulo lwentsebenziswano kunye nama-neuroleptics ukwandisa umonakalo owenza uxinzelelo kwinkqubo yesantya.
• Impembelelo efanayo ifakwe kunye ne-antipsychotics, utywala, i-anesthesia, i-hypnotics okanye i-anticonvulsants.
• Ukusetyenziswa kwe-antipsychotics kunye nama-analgesics kunye ne-anesthetics kubangela ukwanda kwempembelelo yabo. Olu lugxininiso lugxininisa inkqubo ye-nervous central.
• I-neuroleptics ezithathwe nge-insulin kunye neyeza-antidiabetic zikhokelela ekunciphiseni ukusebenza kwazo.
• Xa uthatha i-antipsychotics nge-tetracyclines, umngcipheko wokulimala kwesibindi kunye neengxube zanda.

Ukungqinelana

Bobabini abanama-atypical ne-typical neuroleptics banoluhlu olufanayo lweengqinisiso:

• Ukunganyamezelani komntu kumachiza;
• Ubukho be-glaucoma evalwe, i-prostate adenoma, i-porphyria, i-parkinsonism, i-pheochromocytoma;
• Ukuphendulwa kweengxaki eziya kwi-neuroleptics kwi-anamnesis yomntu;
• Ukuphazamiseka kwesibindi kunye neentso;
• Ukukhulelwa kunye nokuhlamba;
• Izifo zesimo senhliziyo;
• Iimeko eziphazamisayo;
• Coma.

Imiphumo emibi ye-Neuroleptics

Ngonyango olude, nokuba neyona ndlela ifanelekileyo ye-neuroleptic imiphumo emibi.

Zonke i-antipsychotics inokunyusa umngcipheko we-dopamine hypersensitivity, ekhokelela ekubangeni iimpawu zengqondo yengqondo kunye ne-dyskinesia ye-tardive.

Ngokuqhelekileyo, ezi zimpawu zivela xa i-neuroleptic ichithwa (le nto ibizwa nangokuthi "i-withdrawal syndrome"). I-withdrawal syndrome ineentlobo ezininzi: i-psychosis ye-hypersensitivity, ikhupha i-dyskinesia (okanye i-dyskinesia ye-recoil), i-cholinergic "recovery" syndrome, njl.

Ukuthintela le syndrome, unyango kunye neuroleptics kufuneka luzaliswe ngokuthe ngcembe, ngokunciphisa ukunciphisa umthamo.

Xa uthatha i-antipsychotics kumanqanaba aphezulu, kukho umphumo wesigxina onjenge-neuroleptic deficiency syndrome. Ngokutsho kwedatha engafanelekanga, esi siphumo senzeke kwi-80% yezigulane ezithatha i-antipsychotics.

Utshintsho olusemgangathweni kwingqondo kunye nokusetyenziswa ixesha elide

Ngokwezifundo ezilawulwa yi-placebo ze-macaques, ezenza iminyaka emibili zenziwe i-olanzapine okanye i-haloperidol kwimilinganiselo eqhelekileyo, umthamo kunye nobukhulu beengqondo ekuthathweni kwe-antipsychotics kunciphisa ngokuqhelekileyo ngo-8-11%. Oku kungenxa yokunciphisa umthamo wezinto ezimhlophe kunye negrey. Ukubuyiselwa emva kwe-neuroleptics akunakwenzeka.

Emva kokupapashwa kweziphumo, abaphandi babetyholwa ukuba isenzo se-neuroleptics asivivanywanga kwizilwanyana ngaphambi kokuxothwa kwiimakethe zonyango, kwaye zibeka ingozi kubantu.

Omnye uphando, u-Nancy Andreasen, uyaqiniseka ukuba ukuncipha kwimiba yemigca kunye nokulawulwa kwama-neuroleptics ngokubanzi kuphazamisa umzimba womntu kwaye kukhokelela ekutheni i-corrox ye-prefrontal ifikelele. Ngakolunye uhlangothi, wabuye waqaphela ukuba i-neuroleptics yipilisi ebalulekileyo ekwazi ukuphilisa izifo ezininzi, kodwa kufuneka zifakwe kuphela ezincinane kakhulu.

Ngo-2010, abaphandi uJoe noJ. J. Monricier bapapasha uphando olwenziwe kwizifundo ezisemgangathweni. Uhlolisiso lwenziwe ukuthelekisa ingqondo eguquka kwizigulana ezithatha i-antipsychotics kunye nezigulane ezingazange zithathe.

Kwiimeko ezingama-14 kuma-26 (kwizigulane ezithatha i-antipsychotics), ukuncipha kwimiqulu yengqondo, ubungakanani bemigodi nemhlophe babonwa.

Kuzo zonke iimeko-21 (izigulane zaye ukuba ngubani othatha antipsychotics, okanye wamkele, kodwa ngeedosi ezincinane) nokuba akukho tshintsho wafunyanwa.

Ngo-2011, zonke umphandi efanayo Nancy Andreasen iye yapapashwa iziphumo isifundo ethe wafumana utshintsho umthamo zobuchopho izigulane 211 abanyangwa ngamachiza antipsychotic ixesha elide (ngaphezu iminyaka esi-7). Okuya uba mkhulu umsantsa ithamo ichiza yaba, kokukhona isixa ebuchotsheni yehla.

Uphuhliso lwamachiza amatsha

Ngalo mzuzu siphuhlisa antipsychotics ezintsha zibe nafuthe receptor. Elinye iqela labaphandi wathi umphumela antipsychotic yi amacandelo ntsango cannabidiol. Ngoko ke kusenokwenzeka ukuba siza kubona kungekudala lento ezishelfini of ekhemesti.

isiphelo

Ngethemba, akukho bani uhlala lo mbuzo oko i antipsychotic. Yintoni na, yintoni izenzo zakhe kunye neziphumo mechanism reception sihlole ngasentla. Kuhleli kuphela ukongeza ukuba nantoni na inqanaba amayeza kwihlabathi mihla, akukho nanye into ayikwazi kufundwa kude kube sekupheleni. Kwaye ke iqhinga ubunokukulindela nantoni na, singasathethi kwimveliso ezintsonkothileyo ezifana antipsychotics.

Kwiminyaka yakutshanje, amatyala unyango antipsychotic ndidandatheka. Out of ngokungazi ngeengozi eli chiza, bantu ngokwabo benza okubi. Antipsychotics kuyo nayiphi na imeko alukwazi ukuba lusetyenziselwe enye injongo engeyiyo injongo yawo. Kwaye malunga nefuthe lamachiza kwi ingqondo kuvelisa, sele Balurhole umbuzo.

Kungenxa yoko le nto antipsychotics - iziyobisi ngaphandle nemigqaliselo kuthengwa, kufuneka isetyenziswe zizazi (kwaye kuphela xa uqinisekile 100% ukuba uyayifuna), kwaye ngcono ukuba isetyenziswe ngaphandle kagqirha kagqirha.