Neuroleptic - waa maxay? Waa maxay hab ay of tallaabo daroogada ee waallida dajiya?

daroogada psychotropic, taas oo ujeedada - daaweynta xanuunada waallida, ee waallida dajiya loo yaqaan (sida waallida dajiya ama neuroleptic). Waa maxay iyo sida uu u shaqeeyo? Aynu u wajihi.

Neuroleptic. Waa maxay? Taariikhda iyo sifooyinka

daawo dajiyaasha muuqday xad dhawaan. Ilaa ay daahfurka ee daaweynta ee psychosis inta badan la isticmaalo diyaarinta ka soo jeedo cuntada (sida henbane, Belladonna, opiates), maamulka xididka ah calcium, bromide, iyo sidoo kale hurdo maandooriyaha.

In ka '50s hore ee qarnigii 20-ujeeddooyinkan qaatay xasaasiyadda ama cusbo lithium.

Mid ka mid ah chlorpromazine ugu horeysay ee waallida dajiya ayaa noqday (ama chlorpromazine), kaas oo ilaa markaas waxaa loo tixgeliyaa a xasaasiyadda caadiga ah. Si balaadhan looga dalban u bilaabay 1953, inta badan sida kabuubiso ama neuroleptic (ee schizophrenia).

neuroleptic Ka dib markii ay ahayd reserpine ee dhimirka, laakiin waxaa ugu dhaqsaha badan bedelay, daawooyinka kale ee wax ku ool ah, sida shiidaa saameyn ah kuma laha.

Horraantii 1958 waxaa jiray nooca daawooyinka kale ee jiilka kowaad: trifluoperazine (triftazin), haloperidol, thioproperazine iyo kuwa kale.

Ereyga "waallida dajiya" waxaa la soo jeediyey in 1967 (markuu abuuray soocidda ee daawooyinka psychotropic qarnigan ugu horeysay), iyo waxa loola dhaqmo si daroogada ayaa wax ku ool waallida dajiya ma aha oo kaliya, laakiin sidoo kale wuxuu keeni karaa xanuunada maskaxda ah (akataziyu, parkinsonism neuroleptic, reactions dystonic kala duwan, iwm). Sida caadiga ah, xanuunadan waxay keeni walxaha sida chlorpromazine, haloperidol iyo triftazin. Waxaa intaa dheer, daaweynta ay had iyo jeer la socdaan saamaynta xun dhinacayga, murugada, walaaca, xanuun aad u daran, warheynta dareen.

jirada dhimirka Horaantii waxaa kaloo loo yaqaan "dajiye weyn", si jirada dhimirka iyo dajiye - waa mid ka mid ah oo la mid ah. Waa maxay sababta? Maxaa yeelay, iyagu waxay sidoo kale keeni ku dejinaysaa, trankviliziruyusche-saamaynta hypnotic iyo walaaca, iyo sidoo kale ilaa xad gobolka gaar ah warheynta (Ataraxia). Haddaba title this marka la eego neuroleptics ma khuseeyo.

Dhammaan daawooyinka ee waallida dajiya waxa loo qaybin karaa caadiga ah iyo atypical. nooca daawooyinka caadiga ah waxaan qayb ahaan ku tilmaamay, hadda ka fiirsan waallida dajiya ah atypical. Waa maxay? Kooxdani waxa ay ka badan tahay daroogo "jilicsan". Iyagu ma ay samayn fal aad u badan oo jidhka ah, sida caadiga ah. Waxay ka tirsan tahay jiil cusub oo nooca daawooyinka. Faa'iidada oo ka mid ah nooca daawooyinka atypical waa in ay leeyihiin saamayn yar ku receptors dopamine ah.

Dajiyaasha: maragga

All jirada dhimirka hantidaan mid hantida aasaasiga ah - saamayn wax ku ool ah oo ku saabsan calaamadaha wax soo saar (muuqaal dhalanteedka, dhibaatooyinkooda, pseudohallucinations, saarneyn, disorder dhaqanka, waaxaan Dhagar ahayn, colaad iyo excitation). Ka sokow, neuroleptics (badanaa atypical) u yeelaan karaa in lagu daaweeyo niyad ama calaamado u dhaca (autism, fidsanaan shucuureed, iyo P. desotsializatsii m.). Si kastaba ha ahaatee, waxtarkooda la xiriira daaweynta ee astaamaha u dhaca waa su'aal weyn. Khubarada ayaa soo jeedinaya in daawooyinka ee waallida dajiya waxay awoodaan inay tirtiraan calaamadaha sare oo keliya.

jirada dhimirka Atypical, taas oo farsamo garoomada waa ka nugul yihiin caadiga ah, waxaa sidoo kale loo isticmaalaa in lagu daaweeyo cudurka laba-cirifoodka.

Ururka Psychiatric American wuxuu mamnuucay isticmaalka jirada dhimirka si loo daaweeyo calaamadaha dabeecadda iyo maskaxeed ee waallida. Sidoo kale, waa in aan la isticmaalaa hurdo la'aan.

Waxa aan la aqbali karin in loola dhaqmo si laba ama in ka badan nooca daawooyinka isku waqti. Oo waa inaad xusuusataa neuroleptics ah loo isticmaalo daweynta cudurada halista, sababtoo ah ma ay talinayaa in ay qaataan.

saamaynta iyo farsamooyinka of tallaabo Main

daawooyinka ee waallida dajiya Modern wadaagaan hab caadi ah garoomada waallida dajiya, maxaa yeelay, waxay yarayn kartaa gudbinta falalkooda dareemayaasha oo kaliya in nidaamka maskaxda diraa digir ah dopamine kuwa. Bal aynu eegno dhow at nidaamyadan iyo saamaynta daawooyinka ee waallida dajiya iyaga on.

• dariiqa Mesolimbic. Yaraynta gudbinta falalkooda dareemayaasha sidan dhacdaa marka la helo waallida dajiya kasta oo tan iyo ka saarista hoose waxa looga jeedaa calaamadaha wax soo saar (tus, dhalanteed, khayaaliga iyo d sida..)
• Jidka Mesocortical. Waxaa hoos u kala iibsiga garaaca wadnaha keenaysaa in muuqaalka kore ee calaamadaha schizophrenia (xanuunada xun u muuqdaan sida arxandarro, desocialization, saboolnimada hadalka, fidsanaan ee saamayn, anhedonia) iyo cudura garashada (Ootiisam, function xusuusta oo yaraada, iyo D. sidaas on.). Isticmaalka nooca daawooyinka caadiga ah, gaar ahaan muddada-dheer, waxay keenaysaa in kordhay cudurada xun, iyo sidoo kale xadgudubyo halis ah ee hawlaha maskaxda. Cancel neuroleptics ay dhacdo in this aanay ku caawin.
• dariiqa Nigrostriatal. Dopamine Go'doominta receptor kiiskan sida caadiga ah u keenaysaa in a waxyeelo waallida dajiya caadiga ah (akathisia, parkinsonism, dystonia, dhareerka, Tardive, daaman iyo D. t.). Kuwani waxay waxyeelo lagu arkay in 60% ka mid ah xaaladaha.
• dariiqa Tuberoinfundibular (gudbinta garaaca u dhexeeya nidaamka limbic iyo qanjirka pituitary ee). Joojinta receptor ka keenaysaa in kordhay hormone prolactin. Ku saabsan asalka this sameeyay tirada badan ee saameynta kale ee kooxda sida gynecomastia, galactorrhea, cillad xagga galmada, dhalmo la'aan iyo xataa buro pituitary cudurada.

nooca daawooyinka caadiga ah sii kordheysa saamayn receptors dopamine, atypical isla saamayn on neurotransmitters kale serotonin (walxaha in gudbiyaan falalkooda dareemayaasha). Taas darteed jirada dhimirka atypical keeni hyperprolactinemia yar, disorder extrapyramidal, murugada neuroleptic iyo yarida neurocognitive iyo calaamadaha xun.

Calaamadaha α ₁ -adrenoceptor Go'doominta waxaa hoos u cadaadiska dhiigga, hypotension orthostatic, horumarinta wareer, dhacdo ee hurdo.

Marka Go'doominta H ₁ receptors histamine muuqan hypotension, baahida loo qabo in a sii kordhaya ee carbohydrates iyo miisaanka oo kordha, iyo suuxin.

Haddii go'doomin ee receptors acetylcholine, waxaa jira dhibaatooyinka soo socda: caloosha oo, afka oo qalala, tachycardia, haynta kaadida, kor u rabshooyin cadaadis iyo hoy intraocular. Waxa kale oo suuragal ah ee wareerka xagga maskaxda ah iyo hurdo.

Cilmi-Western waxay muujiyeen in inta u dhaxaysa jirada dhimirka (neuroleptics, cusub ama jir ah, oo caadi ah ama atypical - ma laha) iyo dhimashada wadnaha lama filaan ah, waxaa jira xiriir.

Sidoo kale ee daaweynta ee neuroleptic-stroke iyo halista wadne si weyn u kordhiyaa. Tan waxa u sabab xaqiiqada ah in daawooyinka waallida saamayn ku-shiid la egyahay. neuroleptics Admission sidoo kale keeni laga yaabaa in nooca 2aad ee sonkorowga. The fursadahaaga helidda dhibaatooyin daran oo la kordhiyo daawaynta la isu geeyey oo la nooca daawooyinka caadiga ah iyo atypical.

nooca daawooyinka lagu dayan karo waxaa laga yaabaa in ka cadhaysiinina suuxdintu, ayaa hoos baxayay marinkii qalalka.

jirada dhimirka intooda badan (badanaa neuroleptics phenothiazine) waxay leeyihiin saameyn weyn hepatotoxic iyo xataa waxay keeni kartaa in horumarka joonis cholestatic.

daaweynta ee waallida dajiya ee dadka waayeelka ah kordhi kara khatarta ah ee pneumonia by 60%.

Saamaynta fahamka ee neuroleptics

QABASHADA waxbarasho furan muujisay in nooca daawooyinka atypical caadi ahaan wax yar wax ku ool ah ee daaweynta ee deficiency neurocognitive. Si kastaba ha ahaatee, caddaymo ku saabsan iyaga ugu yaraan qaar ka mid ah saamaynta on ma xanuunada neurocognitive. neuroleptics Atypical, hab ay of tallaabo taas oo wax yar ka duwan caadiga ah, imtixaanka inta badan ku filan.

Hal daraasad caafimaad oo barbar saamaynta risperidone caafimaad, iyo haloperidol ee qaadasho yar yahay. In daraasadda, ma farqi weyn oo la helay muujinaya. Waxa kale oo la tusay in qaadasho yar yahay ee haloperidol in saamayn togan ku waxqabadka neurocognitive.

Sidaas darteed, saamaynta neuroleptics koowaad ama jiilka labaad ee garaadka weli waa lagu muransan yahay.

dirka jirada dhimirka

Waxaan hore u soo sheegnay in nooca daawooyinka kala qaybsan yihiin caadiga ah iyo atypical.

Ka mid ah nooca daawooyinka caadiga ah waxay noqon kartaa distinguished:

1. Qabojinta, jirada dhimirka (bixinta saamayn braked ka dib codsiga): promazine, levomepromazine, chlorpromazine, alimemazine, chlorprothixene, iyo kuwa kale periciazine.
2. jirada dhimirka go'an (leeyihiin saamayn waallida dajiya caalamka awood): fluphenazine, trifluoperazine, thioproperazine, pipotiazine, zuclopenthixol iyo haloperidol.
3. Dezingibiruyuschie (leeyihiin kaakicin ah, tallaabada sii daayo): karbidin, sulpiride iyo kuwa kale.

By jirada dhimirka atypical ka mid ah walxaha ay ka midka yihiin aripiprazole, sertindole, ziprasidone, amisulpride, quetiapine, risperidone, olanzapine iyo clozapine.

Waxaa jira kala soocidda kale oo neuroleptics, kuwaas oo loo qoondeeyey si waafaqsan:

1. Phenothiazines, tricyclic iyo taagayo kale. waxaa jira noocyo iyaga ka mid ah:
   
   ● neuroleptics la a bond aliphatic fudud (Levomepromazine, alimemazin, promazine, chlorpromazine), si adag hor joogsada receptors acetylcholine iyo receptors adrenergic leeyihiin saamayn ku dejinaysaa fahmayaan oo waxay keeni karaan xanuunada extrapyramidal;
   ● neuroleptics la xuduntii piperidine (thioridazine, pipotiazine, periciazine) saamayn waallida dajiya fudud iyo neydokrinnymi khafiif ah iyo saameynta dhinaca extrapyramidal;
   ● neuroleptics la xuduntii a piperazine (fluphenazine, prochlorperazine, perphenazine, thioproperazine, frenolon, trifluoperazine), awood u xanibeen receptors dopamine, iyo saamaynta daciif on acetylcholine iyo receptors adrenergic.
   
   
2. taagayo All thioxanthene (chlorprothixene, flupentixol, zuclopenthixol), kuwaas tallaabo la mid tahay tallaabo ah ee phenothiazines.
3. benzamides bedelay (tiapride, sultopride, sulpiride, amisulpride), kuwaas oo ficil sidoo kale waa la mid ah neuroleptics phenothiazine.
4. All taagayo butyrophenone (trifluperidol, droperidol, galoperiodol, Benperidol).
5. Dibenzodiazapin iyo taagayo ay (olanzapine, clozapine, quetiapine).
6. Benzisoxazole iyo taagayo ay (risperidone).
7. Benzizotiazolilpiperazin iyo taagayo ay (ziprasidone).
8. Indole iyo taagayo ay (dikarbin sertindole).
9. Piperazinilhinolinon (aripiprazole).

Laga soo bilaabo kor ku xusan oo dhan, aad qoondeeyo kartaa nooca daawooyinka la heli karo - maandooriyaha adiga oo aan qoro iibiyaa farmasiyada, iyo koox ka mid ah nooca daawooyinka, kuwaas oo si adag u iibin on dhakhtarka amarada.

isdhexgalka daawada waallida dajiya

Like wixii daawooyin kale ah, nooca daawooyinka casriga ah ula falgalaan daawooyin kale, haddii aad qaadato waqti isku mid ah. isdhexgalka Qaar ka mid ah ay yihiin kuwo aad halis u ah jidhka bini'aadamka, sidaa darteed waxaa muhiim ah in la ogaado waxa ay qaataan daawooyinka ee waallida dajiya waa khatar. Xusuusnow in neuroleptics sumowga waxay badanaa ka dhacdaa sababtoo ah isdhexgalka ay daawooyin kale.

Dhexgalka murugada keenaysaa in kordhay falalka sida neuroleptics iyo naftooda murugada. Waxay isku dhafan waxay keeni kartaa in calooshu, ileus ninkii curyaanka ahaa, hypertension.

Ha qaadan oo ay la socdaan:

• Isku darka of nooca daawooyinka iyo benzodiazepines keenaysaa in murugada neefsashada, waxyeelo suuxin.
• Marka concomitantly la therapy lithium laga yaabaa in hyperglycemia, muuqaalka wareer, dawakhsanaan. Waxay isku darka loo dulqaadan karo, laakiin waa keliya ka yar kormeer caafimaad.
• Codsiga la agonister (ephedrine, metazonom, noradrenaliin, adrenaline) yaraynaysaa saamaynta labada daroogada.
• Antihistamines inta lagu guda jiro coadministration la neuroleptics xoojiyo saamayn inhibitory on habka dhexe ee neerfayaasha.
• Saamaynta isku soo wada qaaday aalkolo waallida dajiya, waxay ka dhigan tahay, waayo, suuxinta, hypnotics ama anticonvulsants.
• jirada dhimirka Admission-jebin iyo suuxinta keenta in la kordhiyo in ay saamayn. isku darka Tani waa saamayn nixiyay on yimaada habdhiska dhimirka.
• Dajiyaasha la insulin iyo daawooyinka antidiabetic keenaysaa in hoos u dhac in waxtarkooda.
• Marka la helo nooca daawooyinka la tetracycline'nada kordhiyaa halista ah ee sunta beerka.

sababo

Iyo daawooyinka ee waallida dajiya atypical oo caadiga ah waxay leeyihiin liiska generic ah sababo:

• diyaarinta idiosyncrasy;
• joogitaanka glaucoma xiran-xagal, adenoma Prostatic, porfyri, cudurka Parkinson, pheochromocytoma;
• cadaanyo in neuroleptics ee taariikhda aadanaha;
• xanuunada beerka iyo kelyaha,
• uurka iyo nuujinta,
• cudurada nidaamka wadnaha iyo,
• xanuun xummada ba'an;
• kooma.

Dhibaatooyinka ay keento neuroleptics

Marka therapy muddo dheer, xataa bandhig fiican waxyeelo neuroleptic.

Dhammaan daawooyinka ee waallida dajiya kordhin kartaa halista ah dopamine diidmo, taas oo keenta in calaamadaha psychosis iyo tardive dyskinesia.

Inta badan, calaamadaha dhacaan marka aad baajiso neuroleptic ah (tani waxaa la yiraahdaa "syndrome bixitaanka"). bixitaanka syndrome uu leeyahay noocyo dhowr ah: psychosis dyskinesia, Tardive in waligiis (ama Tardive recoil), ee cholinergic syndrome "recoil" et al.

aad u baahan tahay in si tartiib tartiib ah ku dhameysan si looga hortago in this syndrome, daaweynta neuroleptic, daawada loo yareeyo.

Marka la helo qaadasho sare ee neuroleptics xusay saamaynta dhinaca sida neuroleptic-laaluusheen deficit syndrome. Sida laga soo xigtay xogta aan rasmi ahayn, saamayn ay taasi dhacdo in 80% ka mid ah bukaanka qaadanaya nooca daawooyinka caadiga ah.

isbadal leh qaabka maskaxda loo isticmaalo daba dheeraaday

waxbarashada jaallaha ay gacanta xogta rhesus, oo muddo laba sano ah la siiyey haloperidol ama olanzapine in qiyaasta caadiga ah, mugga iyo miisaanka maskaxda ka helaya neuroleptics hoos u celcelis ahaan by 11.8%. Tan waxa u sabab ah hoos u dhac in mugga of arrin cad oo cawl. Uu ka soo kabsaday neuroleptics wax aan macquul aheyn.

Ka dib markii la baahiyay natiijooyinka cilmi ku amray in saamaynta neuroleptics aan la baari on xayawaanka hor daabacaadda suuqa dawooyinka ah, iyo in ay khatar weyn ku ah dadka.

Mid ka mid ah cilmibaadhayaasha, Nancy Andreasen, ayaa kalsooni ku qaba in hoos u mugga arrinta cawl, iyo hesho nooca daawooyinka guud ahaan waxay leedahay saamayn taban ku leh jirka insaanka iyo keenaysaa in atrophy of kiliyaha prefrontal. Dhinaca kale, waxa ay sidoo kale xusay in jirada dhimirka waa daawo muhiim ah in lagu daweyn karaa nno badan, laakiin waxay u baahan yihiin in la qaado oo kaliya in tiro aad u yar.

In 2010, cilmi John. Leo iyo Moncrieff John. Daabacay eegis lagu sameeyo cilmi-baaris ku salaysan images resonance magnetic of maskaxda. Baadhitaanka ayaa lagu qaaday inay is barbar dhigaan maskaxda bukaanka isbedel qaadashada neuroleptics, iyo bukaanka kuwaas oo aan iyaga qaato.

In 14 of 26 xaaladood (bukaanka lagu daweeyaa neuroleptics) waxaa lagu ogaaday hoos u dhac in mugga maskaxda, mugga arrinta cawl iyo caddaan.

Oo ka mid ah 21 kiis (bukaanka kuwaas oo aan qaadan jirada dhimirka, ama aqbalo, laakiin in yar ka qaataan) ka mid ah isbedel lama helin.

In 2011, oo dhan cilmi-isku Nancy Andreasen ayaa daabacay natiijada waxbarasho ah oo uu ka helay isbeddel ah ee mugga maskaxda ee 211 bukaan daaweeyo daawooyinka ee waallida dajiya muddo dheer (ka badan 7 sano). The ka weyn dose daroogada ahaa, ugu weyn xaddiga maskaxda hoos.

Horumarinta ee daroogada cusub

Xilligan la joogo horumar ayaynu nooca daawooyinka cusub in ay leeyihiin saameyn ah kuma laha receptors ah. Mid ka mid ah koox cilmibaadhayaal sheegay in saamaynta waallida dajiya waa qaybaha cannabis cannabidiol. Sidaas waxaa macquul ah in aan dhawaan arki doonaan walax this on gadhi farmasiyada.

gunaanad

Waxaan rajeynayaa, ninna weli su'aasha sida waxa waallida dajiya ah. Waa maxay, waxa uu falalka iyo cawaaqibka farsamo soo dhaweynta aan kor ku baaro. Waxaa weli kaliya in aad ku darto wax kasta oo heerka daawada ee dunida casriga ah, ma jiro oo ah walaxda aan loo baran karaa ilaa iyo dhamaadka. Oo trick aad ka fili lahayd wax, wax badan ka yar ee wax soo saarka adag sida jirada dhimirka.

Sanadihii la soo dhaafay, xaaladaha daaweynta ee waallida dajiya murugada. Isagoo ka Jaahil ah oo ka mid ah khataraha daroogada this, dadka isu qabanayaan ka xun. Dajiyaasha ay dhacdo in kasta oo aan loo isticmaali karaa ujeeddo kasta oo kale ka badan ay ujeedada looga danleeyahay. Oo ku saabsan saameynta dawooyinkan ee maskaxda saartaa, mar hore xitaa ka mid ah su'aasha.

Taasi waa sababta jirada dhimirka - maandooriyaha adiga oo aan daawada la iibsan karaa, waa in la isticmaalaa si taxadir leh (oo kaliya haddii aad tahay 100% hubiyo in aad u baahan tahay), iyo xataa wanaagsan in aan in loo isticmaalo iyadoo aan dhaqtar kuu qorin.