Cov Tub Ceev Xwm Kev Sib Deev Nrog Kho Naltrexone Monotherapy (2018)

Tus Saib Xyuas Kev Khomob (Primary Care Companion) CNS Disord. 2018 Feb 15; 20 (1). pii: 17l02109. doi: 10.4088 / PCC.17l02109.

Camacho M1, Moura AR1,2, Oliveira-Maia AJ3,1,2,4,5.

PMID: 29469239

DOI: 10.4088 / PCC.17l02109

Tus editor: Tus cwj pwm ntawm kev sib daj sib deev yog tus cwj pwm ntau dhau los yog tsis muaj kev sib deev uas ua rau muaj kev nyuaj siab nyuaj nrog kev kho mob, kev ua haujlwm, kev ua haujlwm, kev cai lij choj, lossis nyiaj txiag.1 Feem ntau, kev coj tus cwj pwm ntawm kev sib daj sib deev yog tus cwj pwm tsis kam ua qhov kev sib deev rau tus cwj pwm kev sib deev, uas nquag ua raws li kev txiav txim siab ntawm kev txhaum, kev khuv xim, thiab kev thuam tus kheej, ua rau lawv muaj kev cuam tshuam ntawm kev tswj cov kev ntshawv siab.2 Kev kho mob ntawm kev coj tus cwj pwm sib deev yog qhov nyuaj, nrog cov ntawv tshaj tawm3 ntawm kev ua tau zoo rau ntau cov kev pabcuam psychotherapeutic thiab pharmacologic, xws li serotonin reuptake inhibitors, parasitic stabilizers, thiab antipsychotics. Pov thawj4,5 pom zoo tias naltrexone, ib qho kev tiv thaiv optoid antagonist hauv kev siv tshuaj kho opioid, nws yog ib qho kev xaiv rau kev kho mob ntawm cov mob no. Cov teebmeem ntawm naltrexone tau raug npaj los ntawm kev txhaws ntawm opioid receptors rau γ-aminobutyric acid interneurons nyob hauv ventral tegmental thaj tsam (VTA), yog li inhibiting VTA dopaminergic neurons uas tau xav hais tias yuav tsum tau ua hauv qab qhov kev txhawb zog ntawm kev coj tus cwj pwm.6 Peb tau hais tawm rooj plaub ntawm tus neeg mob nrog kev coj tus cwj pwm ntawm kev sib daj sib deev uas tau txais kev kho mob zoo heev nrog kev kho tus mob naltrexone.

Case report. Ib tug txiv neej 27 tau pib qhia rau peb lub tsev kho mob psychiatry rau nws tus kheej qhia txog "kev yuam deev." Tus neeg mob tau qhia siv sijhawm ntau thiab nyiaj txiag xav txog thiab ntiav cov kev pabcuam niam ntiav, piav txog ib qho kev txhim kho nrog "transvestite men. "Nws suav hais tias nws tus kheej yog neeg txawv txav thiab tau piav txog cov kev coj cwj pwm xws li" kev coj txawv txawv, "ua rau kev txaj muag thiab qias neeg uas tsis muaj peev xwm tswj hwm. Tus neeg mob tau raug xa mus rau kev ntsuam xyuas kev puas siab puas ntsws thiab ua tiav qhov compulsion subscale ntawm Yale-Brown Obsessive Compulsive Scale-II7 kom ntsuam xyuas qhov xwm txheej thiab qhov phem ntawm nws kev yuam deev (rooj 1). Txawm hais tias qhov kev nyuaj siab tshajplaws feem ntau ua nrog cov txiv neej transvestite, tshwm sim tsawg kawg ib zaug txhua txhua 2 lub hlis, nws kuj tau tshaj tawm saib saib duab liab qab tsis pub tsawg dua 3 cov sij hawm thiab mus txog 10 teev txhua hnub. Txawm hais tias tus cwj pwm sib deev tsis sib deev, nws tsis qhia txog kev ua siab loj. Tus neeg mob tsis muaj peev xwm tswj cov kev coj cwj pwm thiab qhia txog kev ntxhov siab thiab kev ntxhov siab. Nws tau noj tshuaj fluoxetine 20 mg / d thiab tuaj koom ib qho kev pabcuam hlwb, tabsis nws tsis qhia cov kev pabcuam ntev npaum li cas los ntawm cov kev kho mob ua ntej, thiab ntau yam tshuaj tua kabmob (antidepressants), tus cwjpwm zoo siab, lub hlwb, thiab lwm yam kev qhia txog kev kho. Txawm yog kev kho mob optimization (fluoxetine 40 mg / d thiab aripiprazole 10 mg / d), cov tsos mob tsis hloov, thiab kev sim ntawm naltrexone (50 mg / d) tau thov.

Tom qab 2 lub hlis, tus neeg mob qhia txog kev txhim kho kev lag luam hauv kev txo kev sib deev thiab kev tswj ntawm kev sib deev impulses. Nws tsis tau koom nrog cov pojniam ua niam ua txiv, thiab nws txaus siab heev rau nws txoj kev kho mob. Txij li thaum nws tsis muaj txiaj ntsim rau kev siv lwm yam tshuaj, nws tau tsum tsis txhob siv lawv los ntawm nws tus kheej txoj kev xav thiab tsuas yog tau noj naltrexone ob peb lub lis piam. Nws tseem tuaj yeem mus koom nrog kev kho siab. Naltrexone koob tshuaj tau nce mus rau 100 mg / d. Tom qab 10 lub hlis ntawm naltrexone monotherapy, cov kev txhim kho tau zoo dua, thiab tus neeg mob qhia txog ib zaug rov qab siv cov kev pabcuam faj seeb. Nws tau piav ib qho kev sim siab kom tsis txhob muaj tus kab mob naltrexone, tab sis nws rov noj tshuaj tom qab 2 hnub vim muaj kev xav ntxiv thiab xav kom muaj kev sib deev. Kev soj ntsuam txog kev puas siab puas ntswsrooj 1) pom kev txhim kho hauv nws cov depressive cov tsos mob tab sis kev nce hauv kev ntxhov siab. Thaum tus neeg mob tseem siv cov duab liab qab tsis pub dhau 3 ib hnub twg, nws tsis xav txog qhov teeb meem no ua teeb meem.

Nws muaj lwm yam ntaub ntawv4,6,10-12 ceeb toom txog kev siv tshuaj rau kev hnyav rau thaum muaj kev sib daj sib deev ntawm kev sib deev. Raymond et al4 qhia txog 2 cov kev txhim kho hauv kev sib deev thiab kev ua haujlwm rau kev siv hlwb nrog kev siv cov naltrexone rau kev siv tshuaj kho mob nrog fluoxetine. Bostwick thiab Bucci6 pom cov txiaj ntsim zoo xws li hauv Internet kev tiv thaiv nrog kev sib deev compulsive tus cwj pwm uas tus neeg mob cov kev sib deev compulsions tom qab naltrexone tau ntxiv rau kev kho mob nrog sertraline. Ryback11 tau piav txog kev tshawb fawb ntawm naltrexone hauv 21 txiv neej txiv neej txiv neej ua txhaum poj niam txiv neej ua txhaum nrog cov tshuaj stimulants, antidepressants, tus cwj pwm hauv lub siab, cov tshuaj tiv thaiv, lossis lwm yam tshuaj. Ntawm cov neeg mob, 71% tau qhia txog kev txo qis kev sib deev, kev coj tus cwj pwm, thiab kev sib deev ua nrog naltrexone. Hauv 9 cov 10 cov neeg mob, kev coj tus cwj pwm kev sib deev raug xa mus rau theem pib thaum naltrexone tau raug txiav tawm haujlwm.11 Grant thiab Kim10 qhia txog kev ua tub sab thiab kev sib deev nyob rau hauv ib rooj plaub ntawm kleptomania nrog comorbid compulsive sexual behavior tom qab kev kho mob nrog cov ntshav siab naltrexone (150 mg / d), tab sis nws tsis paub tseeb yog tias opioid antagonist yog adjunctive high-dose fluoxetine lossis siv monotherapy . Cov ntaub ntawv tau piav qhia ntxiv rau cov ntaub ntawv no txij li thaum kev sib deev kev quab yuam tau siv kho tus mob naltrexone monotherapy, uas yog ua raws li cov lus qhia los ntawm Kraus li al12 ntawm kev txo cov pornography hauv internet saib tom qab kho nrog naltrexone monotherapy.

Muaj cov pov thawj los txhawb kev siv cov naltrexone hauv cov ntsiab lus ntawm lwm cov kev mob ntawm kev ua kom tsis muaj zog, compulsive muas,13 kleptomania,10 pathological twv txiaj,5 kev quav dej caw,14 trichotillomania,15 noj mov,16 thiab kev rau tus kheej raug rau hauv kev ciam teb tus kheej.17 Feem ntau, naltrexone yog siv los txhawb lwm yam kev kho, xws li antidepressants, tab sis muaj pov thawj, piv txwv hauv kev haus dej haus cawv, kev kho tus mob naltrexone yog sib npaug zoo li kev sib xyaw ua ke, thaum txo cov kev phiv los sis kev siv yeeb tshuaj.14 Tsis tas li ntawd, naltrexone tsis tuaj yeem cuam tshuam nrog kev ua haujlwm ntawm kev sib deev thiab twb tau raug xa tawm raws li kev kho mob rau erectile kawg.18 Txawm li cas los xij, yuav muaj qhov zoo rau kev kho mob ua ke. Ntawm no, peb pom tias muaj cov tsos mob ntawm kev ntxhov siab, uas yuav raug ntaus los cuam tshuam txog kev kho mob nrog fluoxetine los yog mus rau ib qho kev siv tshuaj ntawm naltrexone, raws li tau pom nyob hauv lwm cov kev tshawb fawb.19 Thaum txiav txim siab, thaum naltrexone monotherapy yuav yog ib qho zoo, ruaj ntseg, thiab siv tshuaj rau kev sib deev yuam kev, kev sim randomized thiab tswj raug tsim nyog los xyuas txog kev ua tau zoo thiab kev nyab xeeb.

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Marta Camacho, MSA

Ana Rita Moura, MDa, b

Albino J. Oliveira-Maia, MD, MPH, PhDa, b, c, d

[email tiv thaiv]

aChampalimaud Clinical Center, Champalimaud Center rau Unknown, Lisbon, Portugal

btepartment ntawm Psychiatry thiab Mental Health, Centro Hospitas de Lisboa Ocidental, Lisbon, Portugal

CChampalimaud Research Center, Champalimaud Centre rau Unknown, Lisbon, Portugal

Cov Tsev Kawm Ntawv Kho Mob DNOVA, Faculdade de Ciências Médicas, Lub Tsev Kawm Ntawv Qib Siab Lisbon, Lisbon, Portugal

Tej yam tsis haum ntawm kev txaus siab: Tsis muaj.

Nyiaj Txiag / Kev Pabcuam: Tsis Muaj.

Kev nthuav qhia yav dhau los: Tshaj tawm ntawm XII National Congress of Psychiatry; Kaum Ib Hlis 10-12, 2016; Vilamoura, Portugal.

Tus neeg mob tso cai: Tus neeg mob tau sau ntawv tso cai rau kev luam tawm tsab ntawv, thiab cov ntaub ntawv tau raug muab pov tseg los tiv thaiv lawv tus kheej.

Luam tawm hauv internet: Lub Ob Hlis 15, 2018.

Khoos Kas Kev Khomob Raug Mob Kev Khomob CNS Disord 2018; 20 (1): 17l02109

Txhaws rau: Camacho M, Moura AR, Oliveira-Maia AJ. Cov kev coj tus cwj pwm sib deev raug kho nrog kho tus mob naltrexone. Tus Saib Xyuas Kev Khomob (Primary Care Companion) CNS Disord. 2018; 20 (1): 17l02109.

Tshaj tawm: https://doi.org/10.4088/PCC.17l02109