Litlamorao tsa ho kopanela liphate li qobelloa ho tšoaroa ka Naltrexone Monotherapy (2018)

Motsoalle oa Prim Care 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

Ho mophatlalatsi: Boitšoaro bo matla ba thobalano ke litakatso tsa bootsoa tse feteletseng kapa boits'oaro bo lebisang tlokotsing e kholo ea maikutlo bo sa rateheng ba bongaka, boits'oaro, mosebetsi, molao, kapa litlamorao tsa lichelete.1 Ka tloaelo, boitšoaro bo qobelloang ba thobalano bo bonts'oa ke ho hloleha ho hanela takatso ea boitšoaro bo kopanetsoeng ba thobalano, boo hangata bo lateloang ke maikutlo a ho ikutloa molato, ho ikoahlaea le ho ikoahlaea, bo lebisang ho kenyelletsong ea bona pherekanong ea mathata a taolo a susumetsang.2 Phekolo ea boitšoaro bo hatelletseng ba thobalano e thata, ebile ho na le litlaleho3 katleho e fapaneng bakeng sa ts'ebetso e 'maloa ea psychotherapeutic le pharmacologic, ho kenyelletsa le li-inhibitors tsa serotonin reuptake inhibitors, maikutlo a ho feto-fetoha ha maikutlo le lithibela-mafu. Bopaki4,5 e fana ka maikutlo a hore naltrexone, mohanyetsi oa opioid eo ka tloaelo a sebelisitsoeng kalafo ea ho ts'epa opioid, e ka ba khetho bakeng sa kalafo ea maemo ana. Litlamorao tsa naltrexone ho reriloe hore li hlahisoe ke ho phatloha hoa li-opioid receptors ho γ-aminobutyric acid interneurons sebakeng sa ventral tegmental (VTA), ka hona ho thibela VTA dopaminergic neurons eo ho nahanoang hore e tlatsetsa thepa ea matla ea boitšoaro bo hatelletseng.6 Re tlaleha taba ea mokuli ea nang le boits'oaro bo qobelloang bo ileng ba phekoloa ka katleho le naltrexone monotherapy.

Tlaleho ea. Monna ea lilemo li 27 o ile a qala ho hlahisa tliliniki ea rona ea mafu a kelello ea batho ba sa tsotelleng bakeng sa ho itlhahisa e le "khatello ea thobalano." Mokuli o bontšitse ho qeta nako e ngata le chelete a nahana ka ho hira litšebeletso tsa botekatse, a hlalosa tokiso e itseng le "banna ba transvestite. ”O ne a inka a ratana le batho ba bong bo fapaneng mme a hlalosa boitšoaro bona ba thobalano e le" bokhopo bo sa tloaelehang, "a baka lihlong le manyala tseo a neng a ikutloa a sa khone ho li laola. Mokuli o ile a fetisetsoa tlhahlobo ea kelello mme a qeta ho tlatsa subsidale ea Yale-Brown Obsessive Compulsive Scale-II7 ho lekola mofuta le boima ba khatello ea hae ea thobalano (Lethathamo 1). Le ha khatello e sithabetsang ka ho fetisisa e ne e le ho kopanela liphate le banna ba transvestite, ho etsahala bonyane hang ka likhoeli tse ling tsa 2, o boetse a tlaleha ho shebella litšoantšo tse litšila tse tsosang takatso ha ho tlase ho lihora tsa 3 le ho fihlela lihora tsa 10 letsatsi le leng le le leng. Le ha e ne e le tloaelo e tloaelehileng ea thobalano, ha a ka a tlaleha ho ipholla litho. Mokuli o ile a ikutloa a sa khone ho laola mekhoa ena mme a tlaleha bohlokoa ba khatello ea maikutlo le matšoao a ho tšoenyeha. O ne a ntse a nka fluoxetine 20 mg / d mme a kena lenaneong le tšehetsang psychotherapy, empa a tlaleha ho se na molemo oa nako e telele ho tsa kalafo tsena le tsa kalafo, ho kenyelletsa li-antidepressants tse ngata, li-stabilizer, li-neuroleptics, le lithuto tse ling tsa psychotherapy. Ho sa natsoe ts'ebetso ea ts'ebetso ea kalafo (fluoxetine 40 mg / d le aripiprazole 10 mg / d), matšoao a ne a sa fetoha, 'me ho ile ha etsoa tlhahiso ea naltrexone (50 mg / d).

Kamora likhoeli tsa 2, mokuli o tlaleha lintlafatso tsa bohlokoa phokotsong ea litoro tsa thobalano le taolo ea maikutlo a thobalano. O ne a sa kopanela likamano tsa botekatse, 'me o ne a khotsofetse haholo ke kalafo ea hae. Kaha o ne a re ha a na molemo oa tšebeliso ea meriana e meng, o ne a emisitse ho e sebelisa ka boeena 'me o ne a bile libeke tse' maloa feela. O ile a tsoela pele ho ea ho psychotherapy. Motsoako oa naltrexone o ile oa eketsoa ho 100 mg / d. Kamora likhoeli tsa 10 tsa naltrexone monotherapy, ntlafatso e tsitsitseng e ile ea hlokomeloa, mme mokuli o tlaleha ho pheta-pheta ha a sebelisa litšebeletso tsa botekatse. O hlalositse teko ea boithatelo ea ho emisa naltrexone, empa o ile a boela a sebelisa meriana ka mor'a matsatsi a 2 feela ka lebaka la menahano e matla le likeletso tse amanang le liketso tsa thobalano. Tlhahlobo ea morao-rao ea kelello (Lethathamo 1) o bontšitse ntlafatso matšoao a hae a sithabetsang empa keketseho ea matšoenyeho. Ha mokuli a ntse a tsoela pele ho sebelisa litšoantšo tse litšila tse tsosang takatso ntle le lihora tse 3 ka letsatsi, ha a ka a nka boitšoaro bona bo le thata.

Ho na le lingoliloeng tse ling4,6,10-12 ho tlaleha katleho ea naltrexone maemong a boitšoaro bo qobelloang ba thobalano. Raymond et al4 e tlaleha linyeoe tsa 2 tsa ntlafatso litlamong tsa thobalano le ts'ebetso ea kelello le ts'ebeliso ea naltrexone ho tlatselletsa kalafo ka fluoxetine. Bostwick le Bucci6 o fumane sephetho se ts'oanang nyeoeng ea marang-rang e nang le boitšoaro bo qobelloang ka linako tse ling moo likhatello tsa thobalano tsa mokuli li ileng tsa hlakoloa kamora hore naltrexone e eketsoe kalafo le sertraline. Ryback11 o hlalositse phuputso e bulehileng ea naltrexone ho basodoma ba banna ba ts'ebetsong ea thobalano ea banna ba lilemong tsa bocha ba tšoaroang khafetsa ka lintho tse khothatsang, li-antidepressants, stabilizer tsa maikutlo, li-antipsychotic kapa meriana e meng. Ho bakuli bao, 21% e tlaleha phokotso e kholo lithutong tsa botona le botšehali, khafetsa ho ipholla litho le litoro tsa botona le botšehali le naltrexone. Ho 71 ea bakuli ba 9, boitšoaro bo qobelloang ba thobalano bo khutlisetsoa maemong a motheo ha naltrexone e khaotsoe ka taolo.11 Grant le Kim10 ho tlalehiloe ka tšoarelo ea ho utsoa le takatso ea thobalano maemong a kleptomania ka mokhoa o qobelloang oa ho etsa thobalano ka mora kalafo ka tekanyetso e phahameng ea naltrexone (150 mg / d), empa ha ho tsebahale hore na mohanyetsi oa opioid o ne a kopantsoe le lethal dose le phahameng la fluoxetine kapa a sebelisitsoe monotherapy . Nyeoe e hlalositsoeng mona e eketsa sengoliloeng sena kaha liteko tsa thobalano li ile tsa phekoloa ka katleho li sebelisa naltrexone monotherapy, e lumellanang le tlhaloso ea Kraus et al12 ea phokotso ea ho shebella litšoantšo tse litšila tse tsosang takatso tsa inthanete ka mor'a kalafo le naltrexone monotherapy.

Ho boetse ho na le bopaki ba ho ts'ehetsa ts'ebeliso ea naltrexone maemong a mafu a mang a sepakapaka se sa qobelloang, e leng ho reka ka mokhoa o qobelloang.13 kleptomania,10 ts'ebetso ea ho becha5 bokhoba ba joala,14 trichotillomania,15 mathata a ho ja,16 le boits'oaro bo intšang kotsi likerekeng tsa botho bo moeling.17 Maemong a mangata, naltrexone e sebelisetsoa ho ntlafatsa mefuta e meng ea kalafo, joalo ka litlatse, empa ho na le bopaki, ka mohlala ho joala, hore naltrexone monotherapy e sebetsa hantle joalo ka kalafo e kopaneng, ha e ntse e fokotsa menyetla ea litlamorao kapa tšebelisano ea lithethefatsi.14 Ntle le moo, naltrexone ha e bonahale e kena-kenana le ts'ebetso ea thobalano ebile e bile e reriloe e le kalafo bakeng sa ho se sebetse hantle ha erectile.18 Leha ho le joalo, ho ka ba le melemo ea kalafo e kopaneng. Mona, re fumane keketseho ea matšoao a ho tšoenyeha, a ka hlahisoang ke ho sitisoa ha kalafo ka fluoxetine kapa phello e tobileng ea naltrexone, joalo ka ha ho boletsoe lithutong tse ling.19 Qetellong, ha naltrexone monotherapy e ka ba kalafo e mamelletsoeng hantle, e bolokehileng, le e sebetsang bakeng sa ho qobelloa ka thobalano, liteko tse sa fetoheng le tse laoloang li hlokahala ho netefatsa ts'ebetso le polokeho.

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Marta Camacho, MSa

Ana Rita Moura, MDa, b

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

[imeile e sirelelitsoe]

Setsi sa Tleliniki eaChampalimaud, Setsi sa Champalimaud bakeng sa Tse sa Tsejoeng, Lisbon, Portugal

sethala sa Psychiatry le Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal

Setsi sa Patlisiso sa cChampalimaud, Setsi sa Champalimaud bakeng sa Tse sa Tsejoeng, Lisbon, Portugal

Sekolo sa Bongaka sa dNOVA, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal

Likhohlano tse ka bang teng tse khahlisang: Ha ho na.

Chelete ea tšehetso / ea tšehetso: Ha ho na.

Tlhahiso e fetileng: E ​​hlahisitsoe ho XII National Congress of Psychiatry; Novemba 10-12, 2016; Vilamoura, Portugal.

Tumello ea mokuli: Mokuli o fane ka tumello e ngotsoeng ea ho phatlalatsa nyeoe, 'me tlhaiso-leseling e tsebisitsoe ho sireletsa ho se tsejoe.

E phatlalalitsoe marang-rang: Hlakola 15, 2018.

Prim Care Companion CNS Disord 2018; 20 (1): 17l02109

Ho qotsa: Camacho M, Moura AR, Oliveira-Maia AJ. Litloaelo tse qobelloang tsa thobalano li tšoaroa ka naltrexone monotherapy. Prim Care Companion CNS Disord. 2018; 20 (1): 17l02109.

Ho arolelana: https://doi.org/10.4088/PCC.17l02109