Kugwiritsira ntchito bwino mphamvu ya maginito yolimbikitsa kugwiritsira ntchito matenda opatsirana pogonana (2016)

Kudalirika

MAU OYAMBA

Matenda opatsirana pogonana makamaka amalingalira ngati chisokonezo cha chilakolako cha kugonana, ndi chikhumbo chokhudzidwa. [1] Zili ndi zizindikiro zomwe zimagwera m'maganizo osasokonezeka, okhudzidwa, ndi oledzeretsa, monga maganizo okhudzana ndi kugonana, zokhumba, kapena makhalidwe, osakhoza kulamulira kapena kusiya khalidwe la kugonana, ndi kubwereza mobwerezabwereza zizolowezi zogonana popanda kunyalanyaza zoopsa.1,2] Mankhwala oteteza serotonin reuptake inhibitors, mankhwala a antihormonal (medroxyprogesterone acetate [MPA], cyproterone acetate, gonadotropin-release hormone analogs), ndi othandizira ena a mankhwala (naltrexone, topiramate) awonetsedwa kuti achepetse khalidwe la kugonana kwa odwala ena; Komabe, umboni wochuluka wothandiza ulibe.2] Transcranial magnetic stimulation (TMS) yawonetsa lonjezo pakuwongolera zovuta zosiyanasiyana zomwe zimakhudza kupangika kopitilira muyeso monga chizolowezi chomwa mankhwala osokoneza bongo, obsessive-compulsive disorder (OCD), ndi Tourette's syndrome. [3] Poganizira za matenda okhudza kugonana kwa anthu okhudzana ndi kugonana kwapakati pazifukwa zosasokonekera, TMS ikhoza kukhala yothandiza pakuyang'anira.

CHIKHALIDWE CHAKE

Timayimba mlandu wa mwamuna wamwamuna wa zaka 29 yemwe adakhala ndi zodandaula za zilakolako zakugonana zosalamulirika zaka zaka 15 zapitazo. Wodwalayo angakhale wotanganidwa kwambiri ndi malingaliro opotoka opotoka nthawi zambiri. Ankawombera, kuwonongeka, kuwerenga mabuku okhudzana ndi zolaula, kuseweretsa maliseche kangapo patsiku, kukayendera ogwira ntchito yogonana, ndikumva bwino chifukwa chogonjera kugonana. Iye amamva kuti kugonana ndi kukondana uku kumakhala kokondweretsa, komabe, kupitilira limodzi ndi zotsatira zovuta. Panali kuwonjezeka pang'onopang'ono pafupipafupi ndi kuuma kwa zizindikiro, zomwe zinayambitsa kusokonezeka kwaukwati ndi kuwonongeka kwa tsiku ndi tsiku. Chifukwa cha kukhumudwa, adayesayesa kuti adziwe chifuwa chake, ngakhale kuti sanapambane.

Wodwalayo adayesa kufunsana ndi odwala ambiri ndipo adalandira mayesero ochepetsa kupanikizika (fluoxetine, sertraline, clomipramine, yokha komanso kuphatikiza) kwa mlingo woyenera komanso nthawi yokwanira. Kuyesera kupatsirana kwa antipsychotic, psychological intervention, ndi mankhwala opangira magetsi nayenso anayesedwa opanda phindu lalikulu. Iye adawonetsa bwino pa depot MPA koma adaleka chifukwa cha zovuta. Mbiri yake ya zamankhwala inali yopanda mphamvu. Masewera a tomography a ubongo ndi hormonal mayesero (kuyesa machitidwe a chithokomiro, msinkhu wa prolactin, cortisol mlingo, ndi magulu a androgen) anali oyenera. Kupezeka kwa kugonana koopsa kwambiri (ICD-10 F52.7) kunapangidwa. Anapanga 109 pazithunzithunzi za kugonana zogonana za 14 (SDI) ndi 40 pa 10-chinthu chogonjera kugonana (SCS); chiwerengero chachikulu chopezeka pazitsulo zonsezo. Wodwala sanafune mankhwala ophera mahomoni chifukwa cha zovuta zomwe anakumana nazo kale. Anamulembera escitalopram (mpaka 20 mg / tsiku). Njira zokhudzana ndi maganizo monga kukonzekera ntchito za tsiku ndi tsiku, kusinkhasinkha, komanso kusinkhasinkha kwabwino kunapangidwa. Popeza panalibe kusintha kwakukulu pakati pa chithandizo chamankhwala, kubwereza-TMS (rTMS) kunakonzedweratu kuwonjezeka kwa mankhwala. Njira yothandizidwa ndi matendayo inamufotokozera, ndipo chilolezo chinalembedwa. Malo osungirako magalimoto (RMT) adatsimikiziridwa, ndipo 1 Hz TMS pa 80% ya RMT inkaperekedwa pamtunda woyendetsa galimoto (SMA) pogwiritsira ntchito MediStim (MS-30) TMS njira yothandizila (njira za Medicaid). Malo otsekemera anali pamphambano ya anterior awiri-faifi ndi pambuyo pake zitatu-faifi (molingana ndi International 10 / 20 System yosungiramo magetsi) malo osiyana-siyana pakati pa midline. Gawo lililonse la mankhwala linapangidwa ndi masitima a 14 okwana makumi asanu ndi atatu omwe ali ndi masekondi a 5 apakati pa sitima ya 19, kupereka zonse za 1120. Zonse za 22 magawo, pamasabata oposa 4, adaperekedwa. Zina mwazidzidzidzi zinamuyendera bwino. Iye anali ndi mphamvu yabwino pazogonana zake ndipo nthawi zambiri chiwerewere chinachepa. Panali pafupi kuchepetsa 90% m'mabuku a SDI ndi SCS pa nthawi ya masabata a 4 pa rTMS komanso pharmacotherapy. Kupititsa patsogoloku kunapitirira mpaka miyezi ya 3 ikutsatila pomwe nthawi zambiri kugonana kunali kochepa kwambiri ndipo anayambiranso ntchito yake.

KUKANGANANI

Matenda opatsirana pogonana angakhale ndi zovuta zapamwamba zofanana ndi zomwe zimachititsa kuti munthu asamangokhalira kugwiritsira ntchito mankhwala omwe amachititsa kuti dysfunction of cortical-striatal-thalamic-cortical (CSTC) ziwonetsedwe. [4] M'madera a CSTC, malo osiyana siyana (monga dorsolateral prefrontal cortex, SMA, orbitofrontal cortex, kapangidwe ka makina oyang'anizana, ndi zina zotero) zingagwiritsidwe ntchito. [4,5] SMA yasonyezedwa kuti ili ndi mauthenga ogwira ntchito ndi mbali zina za ubongo zomwe zimakhudzidwa ndi kayendedwe ka kayendedwe ka kayendedwe ka magetsi. Komanso, kusintha kwa SMA kuwonetsedwa kwa odwala oCD. Kafukufuku akuwonetseratu kuti malamulo ochepa a cortico-subcortical ndi ochepa komanso okhudzidwa kwambiri akuthandizira kuti azichita zinthu mobwerezabwereza.6,7] TTMS yotsogolera izi (makamaka kwa SMA) yasonyezedwa kuti ichepetse makhalidwe okhudzidwa ndi odwala OCD, ndipo njira zomwezi zikhoza kukhala zothandiza pa wodwalayo. [6]

TMS ndi njira yabwino yothandizira. Pafupifupi 5% odwala akhoza kudandaula za zochitika zosautsa zowawa monga mutu ndi chisokonezo, potsatira gawo la TMS. [8] Odwala okhala ndi zitsulo zamagetsi (aneurysmal machaputala, implants) Zomwe zimagwiritsidwa ntchito popanga mpweya zimatha kusamala pamene maginito amatha kusintha ntchito zawo kapena amachititsa kuti thupi liwonongeke.9] Kuwopsa ndi njira yosavuta kwambiri yothandizira ndi TMS, ikhoza kuwonedwa kwa odwala omwe akugwiritsa ntchito mankhwala omwe amachepetsera malo awo opumira. [9]

Izi ndizo, zomwe timadziwa bwino, lipoti loyambirira lofotokoza momwe ntchito yothetsera vutoli ikugwiritsidwira ntchito pa matenda a chilakolako chogonana. Kwa ife, TMS inali yothandiza kuthetsa zovuta zowononga zizindikiro za hypersexual bwinobwino. Choncho, TMS ikhoza kuonedwa ngati njira ya chithandizo kwa odwala omwe ali ndi vuto la hypersexual.

ZOKHUDZA