Milandu iwiri ya kugonana kwachiwerewere Mwina akugwirizana ndi Aripiprazole (2013)

Kufufuza Kwa Psychiatry - 2013 (Vol. 10, Nkhani 2, masamba 200-2)
 

EunJin Cheon1; Bon-Hoon Koo1; Sang Soo Seo2; ndi Jun-Yeob Lee3; 1; Department of Psychiatry, Yeungnam University College of Medicine, Yeungnam University Medical Center, Daegu,
2; Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu,
3; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea Kulephera kugonana ndi vuto lodziwika bwino kwa odwala omwe amathandizidwa ndi ma antipsychotic koma pali kusiyana kwakukulu pamitundu yosiyanasiyana. Timalongosola zakugonana kwa odwala awiri azimayi omwe ali ndi schizophrenia omwe amalandila chithandizo cha aripiprazole. Odwalawo amakhala ndi chilakolako chogonana pafupipafupi komanso kutengeka kwambiri atagwiritsa ntchito aripiprazole. Timakambirana njira zomwe zingagwiritsidwe ntchito ndi neuro-mankhwalawa ndikuti mbiri yodziwika bwino ya aripiprazole yokhudzana ndi mankhwala, agonism yapaderadera yomwe imagwirizana kwambiri ndi dopamine D2-receptor, iyenera kuti idathandizira kukulitsa zizindikirazi.
Mawu Ofunika Aripiprazole; Hypersexuality; Dopamine; Gawo agonist.

Kulembera: Bon-Hoon Koo, MD, PhD, Dipatimenti ya Psychiatry, Yeungnam University College of Medicine, 317-1 Daemyeong 5-dong, Nam-gu, Daegu 705-703, Republic of Korea
Tele: + 82-53-622-3343, Fax: + 82-53-629-0256, E-mail: [imelo ndiotetezedwa]

 

MAU OYAMBA

Kuwunikira kwaposachedwa kwaposachedwa1 idawonetsa kuti kusowa pogonana ndi njira yodziwika yomwe imachitika mwa odwala omwe amathandizidwa ndi ma antipsychotic koma kusiyana kwakukulu kumakhalapo kosiyanasiyana. Aripiprazole adalumikizidwa ndi chiwerewere chochepa kwambiri, pomwe olanzapine, risperidone ndi clozapine adalumikizidwa ndi ziwalo zapamwamba zogonana. Umboni wapano ukusonyeza kuti gawo lalikulu la kusokonezeka kwa kugonana komwe kumayenderana ndi mankhwala a antipsychotic kumachokera mwachindunji kuchokera ku dopamine antagonism yophatikizidwa ndi zosadziwika zina zowonjezera kuchuluka kwa serum prolactin.2,3,4 ㅔKomabe, ofufuza anena za kuchepa kwa magazi komwe kumachitika chifukwa cha kudya mankhwala a antipsychotic, odwala atenga quetiapine5 kapena aripiprazole.6 Aripiprazole amasiyana ndi mankhwala ena omwe amavomerezedwa ndi antipsychotic tsopano chifukwa cha gawo lawo la agonistic la dopamine D2 receptors. Amatinso kuti kusinthana ndi aripiprazole kapena kuwonjezera kwa aripiprazole ku boma lina la antipsychotic kumalumikizidwa ndi kuchepa kwa vuto logonana.7 ㅔApa, timanena za hypersexeness mwina zomwe zimachitika mothandizana ndi chithandizo cha aripiprazole mwa odwala awiri aakazi omwe ali ndi matenda a schizophrenia.

Mlanduwu

Case 1

ㅔMs A anali wodwala wazaka wazaka 37 wazaka zamtundu wa schizophrenia, mtundu wa paranoid. Ali ndi mbiri yobwererera kangapo koma osatsatira mobwerezabwereza yomwe imafunikira kuvomerezedwa. Adavomerezedwa kuchipatala chathu chanyumba ndi malingaliro abodza ndi chizunzo, ndipo risperidone 5 mg / tsiku adam'patsa. Patatha chaka chimodzi, adakumana ndi galactorrhea ndi amenorrhea. Pambuyo pake mankhwala ake adasinthidwa kukhala 10 mg / tsiku la aripiprazole, kenako kupita ku 20 mg / tsiku. Zizindikiro zake zabwino zidachepa atatha kuchuluka kwa mankhwalawa, koma libido yake idakula patangotha ​​mwezi umodzi kuchuluka kwa kuchuluka. Hypersexeness yake idawonetsedwa ndi 1) kufunikira kogonana tsiku ndi tsiku, 2) kugwiritsa ntchito zolaula pafupipafupi pa intaneti. Makhalidwe awa anali asanawonetsedwe asanafike pa mankhwala a aripiprazole. Kufufuza kwakanthawi kantchito ndi kufufuza kwa labotale kunali kochepa kwambiri. Tidasiya chithandizo cha aripiprazole ndikumayikira risperidone 0.5 mg / tsiku koma wodwalayo adalephera kutsatira.5 miyezi ingapo, Ms A adagonekedwa m'chipatala chifukwa cha nkhani zachinyengo komanso zachinyengo. Anathandizidwa ndi quetiapine 800 mg / tsiku. Patatha miyezi iwiri, adatulutsidwa kuchipatala. Sitinenapo chilichonse chokhudza kuchuluka kwa anthu ogonana naye, komanso kusakhulupirika kwake kunasowanso.

Case 2

Ms B anali mzimayi wamkazi wazaka 36 yemwe amadwala matenda a schizophrenia pafupifupi zaka 10 zapitazo. Anali ndimakhalidwe okakamira komanso opewera. Sanakhalepo pachibwenzi ndi chibwenzi kapena pachibwenzi. Mayi B adakumana ndi zinyengo zakuzunza, kuyerekezera kwamutu, nkhawa, komanso kukhumudwa. Adalamulidwa haloperidol m'mbuyomu komanso kuchipatala chathu, adalandira risperidone 2-9 mg / tsiku ndi fluoxetine 20-40 mg / tsiku kwa zaka 7. Chifukwa cha kunenepa, mankhwala ake adasinthidwa kukhala aripiprazole 20 mg / tsiku ndi fluoxetine 40 mg / tsiku. Mankhwalawa atasintha, adawonetsa zakulakalaka zogonana komanso zochitika. Mwachitsanzo, ankachita maliseche komanso kulakalaka zogonana, ndipo anali kuwonera zolaula nthawi zambiri. Kuphatikiza apo, nthawi zina amakhala ndi zilakolako zakugonana zongobwera kumene kwa alendo. Khalidwe lake latsopano logonana lidamupangitsa kukhala wamanyazi ndipo adayamba kuda nkhawa komanso kudziimba mlandu. Powumirira kwa wodwala, mankhwala ake adasinthidwa kukhala risperidone quicklet 6 mg / tsiku ndikusungidwa pa fluoxetine 40 mg / tsiku. Kutha kwa aripiprazole, kuchuluka kwake kwa libido kudatsika msanga pamlingo wake woyambira.

KUKANGANANI

Libido yotsika ikhoza kulumikizidwa ndi dopamine receptor antagonism ndi antipsychotic.3,4 Mofananamo, chilakolako chowonjezeka cha kugonana, monga chimayesedwa podzidzidzimutsa zolota, zomangamanga, ndi zochitika, zanenedwa mwa amuna omwe adachitidwa ndi dopamine agonists monga L-dopa, amphetamine ndi pramipexole.8 Ngakhale testosterone imatengedwa ngati mkhalapakati wamkulu wa chikhumbo chakugonana mwa amuna ndi akazi, njira zamkati zamatumbo (CNS) dopaminergic ndi njira za serotoninergic zimawoneka kuti zimagwira ntchito yofunika. Makamaka, machitidwe a dopamine ya ubongo (incertohypothalamic ndi mesolimbic) omwe amalumikiza hypothalamus ndi dongosolo la limbic amawoneka kuti amapanga maziko achisangalalo, pomwe serotonin ili ndi zowonekeratu pazakugonana.9 ㅔAripiprazole ndi mankhwala omwe amapezeka mu atopical antipsychotic omwe amagwiritsa ntchito agonism ku dopamine D2--receptor kuti akwaniritse mbiri ya atpsical antipsychotic.10 Tinaganiza kuti aripiprazole's dopaminergic agonistic zotsatira zimatha kuphatikizidwa ndi chiwerewere cha odwala athu. M'malo motseka njira ya mesolimbic, pang'ono chabe agonism imakhazikika panjira. Itha kuperekanso chilimbikitso chochepa muzochita za dopamine m'malo amubongo momwe zikuyenera kuwonjezeredwa.11 Tidaganiza kuti aripiprazole disinhibiting m'mbuyomu yoletsa ntchito ya dopaminergic ku mesolimbic dopaminergic circ makamaka ku ma nucleus accumbens.

Malinga ndi chiphunzitso cha classical receptor, kachulukidwe ka zinthu zolandila limayendetsa mwachindunji ntchito zamphamvu zaanthu omwe amagwirizana.12 Chifukwa chake, wina amatha kuneneratu kuti kuwonetseredwa kwa neuroleptic isanakwane kumakulitsa kuyankha kwa minofu ndikukonda mbiri ya agonipis aripiprazole.13 Kuphatikiza kwa gawo la D2 agonist ku hypersensitive dopamine receptors kumatha kuyambitsa kuyendetsa kwa enhan-ced dopaminergic pa mesolimbic circ. Aripiprazole alinso ndi 5-HT1A agonist pang'ono ndi 5- HT2A katundu wotsutsa.14 Umboni wina ukusonyeza kuti kutsegula kwa 5-HT2 zolandilira zimasokoneza magwiridwe antchito a kugonana ndi kukondoweza kwa 5-HT1A zolandila zimathandizira magwiridwe antchito ogonana.15 Mankhwala osokoneza bongo omwe ali ndi 5-HT1A agonist ndi 5- HT2A Katemera wa antagonist ie, nefazodone ndi mirtazapine, samakhala ndi zotsatira zoyipa pakugonana.16 Cyproheptadine, 5HT2 Wotsutsa akhala akugwira bwino ntchito yothana ndi vuto loletsa kuponderezana.15 Kumbali ina, umboni wochokera ku kafukufuku wowongoleredwa ndi khungu awiri uwonetsa kuti aripiprazole sichigwirizana ndi kukwezedwa kwa prolactin.17 Mwachidule, mafayilo awa a receptor ndi kuchepa kwa hyperprolactinemia zitha kulimbikitsa malo omwe angakhale abwino kwa mawonekedwe a hypersexourse. Komabe, kafukufuku wowonjezereka amafunikira kuti amvetsetse momwe njira zomwe aripiprazole zimakhudzira kugonana.

M'malo mwathu, Hypersexuality adakumana ndi anthu opanda mbiri yakugonana. Odwalawa amakhala ndi chilakolako chogonana pafupipafupi komanso amakhala ndi chidwi chachikulu chogonana atatha kugwiritsa ntchito aripiprazole. Wachiwiri,, hypersexeness idasowa patatha masiku ochepa wodwalayo atasiya aripiprazole. Komabe, poyambilira, sitinakhale otsimikiza za nthawi yeniyeni yomwe zizindikiro zake zamankhwala osokoneza bongo zimatha, chifukwa cha kuchepa kwa kutsatira ndi kubwerezanso kwa zizindikiro zama psychotic. Hypersexourse mwina imapangitsa kupanga mapangidwe achinyengo. Palibe wodwala yemwe adakumana ndi zovuta zofanizira zamtunduwu atasiya kumwa aripiprazole.

Pomaliza, aripiprazole imatha kukulitsa chilakolako chogonana mwa odwala schizophrenia. Tikuwonetsa kuti aripiprazole's dopaminergic agonistic zotsatira pamasolimbic dera makamaka pa ma nucleus accumbens atha kukhala ndi vuto lachiwerewere. Timalangizanso kuti azachipatala amalingalira za chiwerewere ngati vuto la aripiprazole lomwe lingachitike chifukwa kusamvetsetsa zovuta izi kuchokera kwa azachipatala komanso mbali za wodwala kumatha kukhala magwero azovuta m'banja komanso kuzunzika kwa wodwalayo.

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