Neuroleptic - yog dab tsi? Yuav ua li cas yog lub mechanism ntawm qhov kev txiav txim ntawm antipsychotic yeeb tshuaj?

Psychotropic tshuaj, nws lub hom phiaj - kev kho mob ntawm kev puas siab puas ntsws, hu ua antipsychotic (tseem antipsychotic lossis neuroleptic). Nws yog dab tsi thiab nws ua hauj lwm li cas? Cia peb xam nws.

Neuroleptic. Nws yog dab tsi? Keeb kwm thiab yam ntxwv

Neuroleptics nyob rau hauv cov tshuaj tshwm sim tsis ntev los no. Ua ntej lawv nrhiav tau, rau cov kev kho mob ntawm kev puas siab puas ntsws, cov tshuaj yeeb tshuaj feem ntau yog cov noob nroj tsuag (piv txwv, tshuaj dawb, belladonna, opiates), calcium intravenous, bromides, thiab pw tsaug zog.

Nyob rau hauv 50-xyoo ntxov ntawm lub xyoo pua 20th, antihistamines los yog lithium ntsev raug siv rau cov hom phiaj no.

Ib qho ntawm cov tshuaj tiv thaiv ntxov tshaj plaws yog chlorpromazine (los yog aminazine), uas tau yav dhau los tau pom tias yog hom tshuaj antihistamine. Lug thov nws pib nrog 1953, tsuas yog raws li ib tug sedative los yog neuroleptic (nyob rau hauv schizophrenia).

Tom ntej no neuroleptic yog cov alkaloid reserpine, tab sis tsis ntev tau muab txoj kev rau lwm, ntau dua cov tshuaj, raws li nws suab tsis ua hauj lwm.

Thaum pib ntawm xyoo 1958, lwm cov kev puas hlwb ntawm thawj lub cim tau tshwm sim: trifluoperazine (triftazine), haloperidol, thiopperazine, thiab lwm tus.

Lub sij hawm "neuroleptic" tau npaj tseg thaum xyoo 1967 (thaum lub sij hawm ntawm kev siv cov tshuaj psychotropic ntawm thawj lub cim tsim) thiab nws kho cov tshuaj tsis yog siv tshuaj tiv thaiv nkaus xwb, tiam sis kuj muaj peev xwm ua rau cov kev mob ntsws (acacia, neuroleptic Parkinsonism, ntau yam kev dystonic, thiab lwm tus). Feem ntau cov mob no ua rau muaj tshuaj xws li aminazine, haloperidol thiab trifazin. Tsis tas li ntawd, kev kho mob nrog lawv yog yuav luag txhua zaus nrog tsis kaj siab tsis zoo: kev nyuaj siab, kev ntxhov siab, kev ntshai, kev xav tsis zoo.

Cov neuroleptics yav dhau los kuj tau hu ua "tranquilizers tranquilizers", yog li cov neuroleptics thiab tranquilizers yog tib yam. Vim li cas? Vim hais tias lawv tseem ua rau cov neeg sedative, hypnotic thiab tranquilizing-anti-anxiety teebmeem, thiab raws li lub xeev tshwj xeeb ntawm kev tsis txaus siab (ataraxia). Tam sim no lub npe no tsis yog thov kom neuroleptics.

Tag nrho cov tshuaj tua kab mob tuaj yeem raug faib ua qhov raug thiab atypical. Xws li cov tshuaj tua kab mob uas peb tau piav qhia, tam sim no xav txog kev mob hlwb tshuaj atypical. Nws yog dab tsi? Qhov no yog ib pab pawg ntau dua cov tshuaj "mos". Lawv tsis ua raws li lub cev ntau npaum li lawv ua. Lawv yog cov neuroleptics ntawm lub cim tshiab. Qhov zoo ntawm atypical antipsychotics yog tias lawv tsis muaj teebmeem rau dopamine receptors.

Neuroleptics: pov thawj

Tag nrho cov neuroleptics muaj ib qho khoom vaj khoom tsev - ib qho txiaj ntsim zoo rau cov kev mob tshwm sim (kev pom kev, kev ntxias, kev xav pom, kev mob, kev coj tus cwj pwm, kev ua siab phem, thiab kev ntxhov siab). Tsis tas li ntawd, neuroleptics (feem ntau cov neeg atypical) kuj yuav raug sau tseg rau cov kev kho mob ntawm kev nyuaj siab lossis kev mob hlwb (autism, kev xav siab, kev xav, kev sib txuas lus, thiab lwm yam). Txawm li cas los xij, cov txiaj ntsig zoo ntawm txoj kev kho cov tsos mob ntawm cov txiaj ntsig yog qhov teeb meem loj. Cov kws kho mob pom tias cov tshuaj tua kab mob yuav tshem tawm tau cov tsos mob siab.

Atypical antipsychotics, uas txoj cai ntawm kev ua haujlwm yog qhov qaug zog tshaj li cov raug coj los siv, kuj yog siv los kho cov kev puas siab puas ntsws bipolar.

Lub koom haum American Psychiatric Association txwv kev siv cov neuroleptics los kho cov kev mob puas hlwb thiab kev coj tus cwj pwm tsis zoo. Tsis tas li ntawd, lawv yuav tsum tsis txhob siv rau insomnia.

Nws yog ib qho tsis tsim nyog yuav tau kho nrog ob lossis ntau qhov tshuaj tiv thaiv mob ntsws tib lub sijhawm tib lub sijhawm. Thiab nco ntsoov tias kev siv tshuaj tua kab mob siv los kho cov kab mob phem, nws tsis tau pom zoo kom noj.

Cov teebmeem loj thiab cov tswv yim ua haujlwm

Niaj hnub nimno neuroleptics muaj ib qho kev tawm tsam kev tsim tshuaj tiv thaiv, vim hais tias lawv tuaj yeem txo qhov kis kab mob ntawm cov hlab ntsha xwb nyob rau hauv cov hlwb hlwb uas impulses kis dopamine. Cia siv sij hawm saib cov tshuab thiab cov nyhuv ntawm cov neuroleptics rau lawv.

• Mesolimbic kev. Txo qhov kev sib kis ntawm cov hlab ntsha kev ua haujlwm nyob rau hauv txoj kev no tshwm sim nrog kev tswj hwm ntawm cov tshuaj tiv thaiv kev puas hlwb, vim nws txhais tau tias tshem tawm cov kev mob tshwm sim (piv txwv, kev xav, kev ntxias, thiab lwm yam)
• Txoj kev cob qhia me ntsis. Ntawm no, qhov txo qis ntawm qhov ua rau tuaj yeem ua rau pom tshwm ntawm cov tsos mob ntawm tus mob schizophrenia (qhov tsis zoo xws li kev tsis ncaj ncees xws li tsis zoo, xws li qaug zog, hais lus tsis zoo, cuam tshuam rau lub cev, anhedonia) thiab kev paub tsis meej (qhov ntsej muag liab, kev ua haujlwm txawv txav, thiab lwm yam). Kev siv cov tshuaj tiv thaiv kab mob siab, tshwj xeeb tshaj yog ntev, ua rau muaj kev mob tsis zoo ntxiv, thiab kev loj hlob ntawm lub hlwb ua haujlwm loj. Lub abolition ntawm neuroleptics nyob rau hauv cov ntaub ntawv no yuav tsis pab.
• Nigrostriar kab. Dopamine receptor blockade nyob rau hauv cov ntaub ntawv no feem ntau yog ua rau ib tug raug antipsychotic phiv (akathisia, parkinsonism, dystonia, salivation, dyskinesia, Mob Zawm Ncauj thiab t. D.). Cov kev mob tshwm sim no tau pom nyob rau hauv 60% ntawm cov neeg mob.
• Tuberoinfundibular txoj kev (hloov ntawm kev cuam tshuam ntawm qhov limbic system thiab pituitary caj pas). Tiv thaiv cov receptors ua rau kev nce hauv cov tshuaj hormone prolactin. Tiv thaiv no tom qab, ib qho xov tooj loj ntawm lwm cov kev mob tshwm sim, xws li gynecomastia, galactorrhea, kev sib deev kawg, kev qog nqaij hlav thiab txawm tias yog pituitary qog.

Cov neuroleptics raug cov nyhuv dua rau dopamine receptors; Kev kis mob tib yam muaj feem xyuam rau serotonin los ntawm lwm cov neurotransmitters (cov tshuaj uas xa cov paj hlwb impulses). Vim hais tias ntawm no atypical antipsychotics ua tsawg hyperprolactinemia, extrapyramidal teeb meem, neuroleptic kev nyuaj siab thiab neurocognitive tiv nujnqis thiab tsis zoo cov tsos mob.

Tej yam tshwm sim ntawm α ₁ -adrenoceptor blockade yog txos cov ntshav siab, orthostatic hypotension, kiv taub hau kev loj hlob, qhov tshwm sim ntawm tsaug zog.

Thaum blockade H ₁ histamine receptors tshwm hypotension, ib tug zuj zus yuav tsum tau rau carbohydrates thiab qhov hnyav nce, thiab ua kom loog.

Yog hais tias ib tug blockade ntawm acetylcholine receptors, muaj cov nram qab no tshwm sim tsis zoo: cem quav, qhov ncauj qhuav, tachycardia, urinary tuav, nce intraocular siab thiab kev pab cuam tshuam. Muaj kuj tseem ceeb thiab tsis meej pem.

Cov neeg soj ntsuam tshawb fawb tau ua pov thawj tias cov tshuaj tua kab mob (antipsychotics tshiab lossis laus, raug lossis atypical - nws tsis txawv) thiab kev cia siab ploj tuag yog qhov txuas.

Tsis tas li ntawd, kev kho mob nrog neuroleptics significantly ua rau muaj mob stroke thiab myocardial infarction. Qhov no vim hais tias kev siv tshuaj muaj yees tuaj yeem cuam tshuam rau cov tshuaj metabolism hauv lipid. Kev tso npe ntawm cov roj ntsha paj hlwb kuj tseem ua tau hom 2 ntshav qab zib mellitus. Qhov uas yuav muaj teeb meem loj tuaj nrog kev sib xyaw ua ke nrog kev kho mob thiab tshuaj atypical.

Cov tshuaj tua kab mob tuaj yeem ua rau mob qaug dab peg, vim tias lawv txo qis ntawm kev npaj siab tawv.

Feem ntau cov tshuaj tiv thaiv kev mob hlwb (yog tshwm sim phenotiazine antipsychotics) muaj cov nyhuv loj ntawm hepatotoxic, thiab tseem tuaj yeem ua rau kev txhim kho cholestatic jaundice.

Kev kho mob ntawm cov tshuaj tiv thaiv hauv cov neeg laus tuaj yeem ua rau muaj mob ntsws li 60%.

Txawj ntse ntawm cov kev puas hlwb

Cov kev tshawb fawb qhib tau pom tias atypical neuroleptics yog me ntsis zoo tshaj qhov raug rau kev kho cov hlwb tsis paub tseeb. Txawm li cas los xij, tsis muaj pov thawj txaus siab ntawm lawv qhov tsawg kawg yog ib feem xyuam rau txoj kev puas siab puas ntsws. Atypical antipsychotics, uas nws txoj kev ywj pheej ntawm qhov kev txiav txim yog me ntsis txawv ntawm cov kws raug, feem ntau sim.

Hauv ib qho ntawm cov kev tshawb fawb soj ntsuam, cov kws kho mob muab cov txiaj ntsim ntawm risperidone thiab haloperidol hauv cov qis qis. Lub sijhawm kawm, tsis muaj qhov txawv ntawm qhov tshwm sim. Nws kuj tau pov thawj tias haloperidol nyob rau hauv qis tshuaj muaj feem xyuam zoo rau cov hlab ntsha paj hlwb.

Yog li, lo lus nug ntawm cov nyhuv ntawm cov neuroleptics ntawm thawj lub los yog ob tiam ntawm kev paub lub ntsiab yog tseem muaj teeb meem.

Kev faib tawm ntawm kev puas siab ntsws

Nws twb tau hais saum toj no tias neuroleptics raug muab faib ua qhov raug thiab atypical.

Ntawm cov neuroleptics raug qhia tau tias:

1. Cov tshuaj tua kab mob hlwb (muaj cov nyhuv dhau los tom qab daim ntawv thov): promazine, levomepromazine, chlorpromazine, alimamazine, chlorprotixen, pericyazin thiab lwm tus.
2. Induction antipsychotics (muaj kev puas hlwb thoob ntiaj teb): fluphenazine, trifluoperazine, thioproperazine, pipotiazine, zuclopentixol, thiab haloperidol.
3. Disinhibitory (muaj activating, disinhibiting nkaus): carbidine, sulpiride thiab lwm tus.

Atypical antipsychotics muaj cov tshuaj xws li aripiprazole, hardindole, ziprasidone, amisulpride, quetiapine, risperidone, olanzapine thiab clozapine.

Nws muaj lwm cov dej num ntawm cov neuroleptics, raws li cov nram qab no yog qhov txawv:

1. Phenothiazines, zoo li lwm cov khoom xyaw tricyclic. Ntawm lawv muaj xws li hom:
   
   ● Neuroleptics nrog ib qho yooj yim aliphatic bond (levomepromazine, alimamazine, promazine, chlorpromazine), muaj zog thaiv acetylcholine receptors thiab adrenoreceptors, muaj cov nyhuv qhia yooj yim thiab yuav ua tau rau extrapyramidal mob;
   ● Neuroleptics nrog cov pa nucleus (thioridazine, pipotiazine, pericyazin), uas muaj ib qho tshuaj tiv thaiv kab mob ntsws loj thiab tsis zoo txog neutrochine thiab extrapyramidal phais;
   ● Neuroleptics nrog tub ntxhais piperazine (fluphenazine, prochlorperazine, perphenazine, thioproperazine, frenolone, trifluoperazine), tuaj yeem cuam tshuam rau dopamine receptors, thiab tseem muaj cov nyhuv me me rau acetylcholine thiab adrenoreceptors.
   
   
2. Tag nrho cov derivatives ntawm thioxanthene (chlorprotixen, flupenthixol, zuclopentixol), uas qhov kev txiav txim yog zoo li cov phenothiazines.
3. Hloov ua piv rau benzamides (tiaprid, sultopride, sulpiride, amisulpride), nws qhov kev txiav txim kuj zoo li phenothiazine neuroleptics.
4. Tag nrho cov derivatives ntawm butyrophenone (trifluperidol, droperidol, haloperiodol, benperidol).
5. Dibenzodiazapine thiab nws cov derivatives (yogzapine, clozapine, quetiapine).
6. Benzisoxazole thiab nws cov derivatives (risperidone).
7. Benzisothiazolylpiperazine thiab nws cov derivatives (ziprasidone).
8. Indole thiab nws cov derivatives (hardindole, dicarbine).
9. Piperazinylquinolinone (aripiprazole).

Ntawm tag nrho cov saum toj no, nws muaj peev xwm txhawm rau paub txog cov tshuaj uas muaj neuroleptics - cov tshuaj, tsis tas yuav tshuaj nyob rau hauv cov chaw muag tshuaj, thiab ib pawg ntawm cov tshuaj tiv thaiv mob siab muag raws li tus kws kho mob cov tshuaj.

Kev sib tham ntawm kev puas hlwb nrog lwm cov tshuaj

Zoo ib yam li lwm yam tshuaj, niaj hnub tiv thaiv kev noj qab haus huv sib raug zoo nrog lwm cov tshuaj yog tias tau txais ib txhij. Qee cov kev sib tshuam yog ib qho txaus ntshai heev rau tib neeg lub cev, yog li nws tseem ceeb heev kom paub tias yam tshuaj tiv thaiv twg yuav ua rau muaj kev puas tsuaj. Nco ntsoov tias cov tshuaj lom neeg lom ntshaus feem ntau tshwm sim vim yog lawv txoj kev sib tshuam nrog lwm cov tshuaj.

Kev sib tham nrog cov tshuaj tiv thaiv kabmob antidepressants ua rau kev ua haujlwm ntawm cov tshuaj tiv thaiv ob leeg thiab cov tshuaj tiv thaiv antidepressants lawv tus kheej. Lawv txoj kev tuaj yeem tuaj yeem ua rau cem quav, kab mob paralytic hnyuv plab, kev siab kub siab.

Nws tsis pom zoo kom coj ua ke:

• Ua ke ntawm cov neuroleptics thiab benzodiazepines ua rau kev txhawj xeeb ntawm txoj kev nyuab siab, kev phiv tshuaj.
• Thaum concomitantly nrog lithium txoj kev kho tej zaum yuav tsim hyperglycemia, tsos ntawm tsis meej pem, kiv taubhau. Lawv ua ke tuaj yeem zam taus, tab sis tsuas yog nrog kev saib xyuas kev kho mob.
• Kev siv cov adrenomimetics (ephedrine, metazone, norepinephrine, adrenaline) ua rau txo tus kab mob ntawm cov tshuaj.
• Antihistamines nrog kev tswj hwm nrog cov neuroleptics nce lawv cov nyhuv nyuab siab nyob rau hauv lub hauv paus ntawm lub paj hlwb.
• Cov nyhuv tib yam yog sib koom nrog tshuaj tua kab mob, cawv, tshuaj loog, hypnotics lossis anticonvulsants.
• Kev siv cov tshuaj tiv thaiv mob ntsws nrog kev sib daj sib deev thiab tshuaj loog ua rau kom muaj kev nce ntxiv rau lawv cov kev mob. Qhov kev sib txuas ua ke no nyuaj siab rau lub zog hauv lub cev.
• Neuroleptics noj nrog cov tshuaj insulin thiab tshuaj tua kabmob ua rau txo qis rau hauv lawv txoj haujlwm.
• Thaum noj cov tshuaj tiv thaiv mob tetracyclines, qhov kev pheej hmoo ntawm daim siab puas rau co toxins nce.

Contraindications

Ob lub atypical thiab typical neuroleptics muaj cov npe ntawm cov kev tsis sib haum xeeb:

• Tus kheej tsis kam siv tshuaj;
• Qhov muaj cov kab mob kaw glaucoma, prostate adenoma, porphyria, parkinsonism, pheochromocytoma;
• Cov kev tsis haum tshuaj rau cov leeg lub hlwb tsis haum;
• Cov mob ntawm daim siab thiab lub raum;
• Cev xeeb tub thiab lactation;
• Kab mob ntawm cov kab mob plawv;
• Cov mob uas mob ntsws;
• Coma.

Lwm cov teebmeem ntawm Neuroleptics

Nrog kev siv tshuaj ntev, txawm tias qhov zoo tshaj plaws neuroleptic pov thawj phiv.

Tag nrho antipsychotic tshuaj yuav ua rau kom txoj kev pheej hmoo ntawm npau taws me ntsis dopamine, uas nyob rau hauv lem ua rau cov tsos mob ntawm psychosis thiab tardive dyskinesia.

Feem ntau, cov tsos mob no tshwm sim thaum lub hlwb raug muab tso tseg (qhov no kuj yog hu ua "tshem tawm systrome"). Kev tshem tawm syndrome no muaj ntau yam: kev mob hlwb ntawm kev tsis sib haum xeeb, lub cev tsis muaj zog (lossis dyskinesia ntawm recoil), cholinergic "recoil" syndrome, thiab lwm yam.

Yuav kom tiv thaiv tau tus mob no, txoj kev kho mob nrog cov leeg neuroleptics yuav tsum ua kom tiav, maj mam txo cov koob tshuaj.

Thaum noj cov tshuaj tiv thaiv mob siab tshaj hauv cov koob tshuaj loj, muaj kev phiv tshuaj xws li cov hlab hlwb tsis muaj zog. Raws li cov ntaub ntawv unofficial, cov nyhuv no tshwm sim hauv 80% ntawm cov neeg mob uas siv cov tshuaj tua kab mob.

Hloov kev hloov hauv lub hlwb nrog kev siv lub caij nyoog ntev

Raws li cov kev tshawb xyuas cov placebo ntawm cov macaques, uas tau siv ob lub xyoos los ntawm cov tshuaj uas tau yogzapine los yog haloperidol, qhov ntim thiab qhov hnyav ntawm lub paj hlwb los ntawm kev siv cov tshuaj tiv thaiv los ntawm kev txo cov tshuaj nruab nrab yog 8-11%. Qhov no yog vim qhov txo qis ntawm cov xim dawb thiab grey. Rov qab kho tom qab neuroleptics tsis yooj yim sua.

Tom qab luam tawm ntawm cov txiaj ntsig, cov kws tshawb fawb tau raug liam tias qhov kev txiav txim ntawm cov neuroleptics tsis tau sim txog cov tsiaj ua ntej raug coj mus rau lub chaw muag tshuaj, thiab lawv ua teeb meem rau tib neeg.

Ib tug kws tshawb fawb, Nancy Andreasen, ntseeg tias qhov txo ntawm qhov teeb meem ntawm cov gray teeb meem thiab kev tswj hwm ntawm neuroleptics feem ntau adversely rau tib neeg lub cev thiab ua rau atrophy ntawm prefrontal cortex. Ntawm qhov tod tes, nws kuj tau sau tseg tias neuroleptics yog ib qho tshuaj tseem ceeb uas kho tau ntau yam kab mob, tab sis lawv yuav tsum tau noj xwb hauv cov khoom me me.

Xyoo 2010, cov kws tshawb fawb J. Leo thiab J. Monricier luam tawm kev tshawb fawb txog cov kev tshawb fawb raws li cov duab magnetic resonance ntawm lub hlwb. Txoj kev tshawb no tau ua kom sib piv cov kev hloov hauv lub hlwb hauv cov neeg mob uas siv cov tshuaj tiv thaiv mob hlwb thiab cov neeg mob uas tsis coj lawv.

Hauv 14 ntawm 26 leej (hauv cov neeg mob uas siv cov tshuaj tua kab mob), qhov txo qis ntawm lub hlwb, qhov hnyav ntawm cov grey thiab cov tshuaj dawb tau pom.

Ntawm lub 21 tus neeg mob (tus neeg mob uas twb tsis noj antipsychotics, los sis txais, tab sis nyob rau hauv me me koob tshuaj) nyob rau hauv yog tsis muaj kev hloov tau pom.

Nyob rau hauv 2011, tag nrho cov tib soj ntsuam Nancy Andreasen tau luam tawm tau ntawm txoj kev tshawb fawb uas tau pom kev hloov nyob rau hauv lub hlwb ntim rau hauv 211 cov neeg mob kho nrog antipsychotic tshuaj rau ib ntev lub sij hawm (tshaj 7 xyoo). Qhov ntau dua cov tshuaj txhaj koob tshuaj yog, qhov ntau dua tus nqi ntawm cov poob hlwb.

Cov kev loj hlob ntawm cov tshuaj tshiab

Thaum lub sij hawm no peb tsim tshiab antipsychotics uas muaj tsis ntxim rau cov receptors. Ib pab pawg neeg ntawm kev soj ntsuam hais tias lub antipsychotic nyhuv yog cannabidiol cannabis Cheebtsam. Yog li ntawd nws yog tau hais tias peb yuav sai sai no saib cov khoom no rau hauv txee ntawm cov chaw muag tshuaj.

xaus

Hopefully, tsis muaj ib tug tseem rau lo lus nug li cas yog ib qho antipsychotic. Yuav ua li cas yog nws, dab tsi nws ua thiab qhov yuav tshwm ntawm kev txais tos mechanism peb soj ntsuam saum toj no. Nws tsuas tseem mus ntxiv tias txawm lub theem ntawm cov tshuaj nyob rau hauv lub niaj hnub ntiaj teb no, tsis muaj ntawm cov tshuaj yeeb dej caw yuav tsis tau kawm txog rau thaum xaus. Thiab tus ua kom yuam koj yuav tau txais los ntawm dab tsi, npaum li cas tsawg li complex cov khoom raws li antipsychotics.

Nyob rau hauv xyoo tsis ntev los, tus neeg mob ntawm antipsychotic kev kho mob ntawm kev nyuaj siab. Tawm ntawm ignorance ntawm cov kev piam sij ntawm cov tshuaj no, cov neeg lawv tus kheej ua zuj zus. Antipsychotics nyob rau hauv txhua rooj plaub yuav siv tsis tau rau tej hom phiaj rau lwm yam tshaj li nws npaj lub hom phiaj. Thiab hais txog tej yam uas cov tshuaj rau hauv lub hlwb ua, twb txawm tawm ntawm cov nqe lus nug.

Uas yog vim li cas antipsychotics - tshuaj tsis muaj tshuaj muaj rau purchase, yuav tsum tau siv nrog ceev faj (thiab tsuas yog tias koj yog 100% paub tseeb tias koj yuav tsum tau), thiab txawm zoo dua tsis mus rau yuav siv tsis tau ib tug kws kho mob tshuaj.