| Phuputso ea Psychiatry - 2013 (Vol. 10, Issue 2, Maqephe 200-2) |
EunJin Cheon1; Bon-Hoon Koo1; Sang Soo Seo2; le Jun-Yeob Lee3; 1; Lefapha la Psychiatry, K'holejeng ea Yeungnam University of Medicine, Setsi sa Bongaka sa Yeungnam, Daegu,
2; Lefapha la Psychiki, Sekolo sa Bongaka, Univesithi ea Naha ea Kyungpook, Daegu,
3; Lefapha la Psychiatry, Setsi sa Bongaka sa CHA Gumi, Univesithi ea CHA, Gumi, Rephabliki ea Korea Ho se sebetse ka thobalano ke litla-morao tse tloaelehileng ho bakuli ba alafshoang ka li-antipsychotic empa phapang e kholo e teng mefuteng e fapaneng. Re tlaleha matšoao a bosodoma ho bakuli ba babeli ba basali ba nang le schizophrenia ba neng ba fumana kalafo ka aripiprazole. Bakuli ba ile ba ba le takatso ea thobalano khafetsa le ho ameha haholo ka thobalano kamora ho nka aripiprazole. Re tšohla mekhoa e ka bang teng ea lik'hemik'hale tsa methapo ea kutlo bakeng sa sena mme re pheha khang ea hore boemo bo ikhethileng ba bongaka ba aripiprazole, agonism e sa amaneng le kamano e phahameng ho dopamine D2-receptor, e kanna ea kenya letsoho kholisong ea matšoao ana.
Mantsoe a bohlokoa Aripiprazole; Hypersexuality; Dopamine; agonist ea nakoana.
Lingoloa: Bon-Hoon Koo, MD, PhD, Lefapha la Psychiatry, Yeungnam University College of Medicine, 317-1 Daemyeong 5-dong, Nam-gu, Daegu 705-703, Rephabliki ea Korea
Mohala: + 82-53-622-3343, Fax: + 82-53-629-0256, E-mail: [imeile e sirelelitsoe]
Tlhahlobo ea morao-rao ea meta1 e bontšitse hore ho se sebetse hantle ka thobalano ke litla-morao tse tloaelehileng ho bakuli ba tšoaroang ke li-antipsychotic empa phapang e kholo e teng ka mefuta eohle e fapaneng. Aripiprazole e ne e amahanngoa le litekanyetso tse tlase tsa khatello ea thobalano, athe olanzapine, risperidone le clozapine li ne li amahanngoa le litekanyetso tse phahameng tsa ho se sebetse ka thobalano. Bopaki ba hajoale bo bontša hore karolo ea bohlokoa ea ho se sebetse hantle ka thobalano e amanang le meriana ea antipsychotic e hlahisa ka kotloloho ho tsoa ho dopamine antagonism e kopantsoeng le litlamorao tse sa tobang tsa mahloriso a eketsehileng a serum prolactin.2,3,4 ㅔLeha ho le joalo, bafuputsi ba tlalehile hypersexeness e hlahang kamanong le tšebeliso ea meriana ea antipsychotic, ho bakuli ba nkang quetiapine5 kapa aripiprazole.6 Aripiprazole e fapane le lithethefatsi tse ling tse lumelletsoeng nakong ea antipsychotic ka lebaka la ts'ebetso ea eona ea karolo ea agonistic ho li-receptors tsa dopamine D2. Ho tlalehoa hore ho fetohela ho aripiprazole kapa ho eketsoa ha aripiprazole pusong e 'ngoe ea antipsychotic ho amana le phokotso ea ho se sebetse ka thobalano.7 ㅔMona, re tlaleha hypersexuality mohlomong e etsahalang hammoho le kalafo ea aripiprazole ho bakuli ba babeli ba basali ba nang le lefu la kelello.
NAKO
Case 1
ㅔMme A e ne e le mokuli oa mosali ea lilemo li 37 ea neng a tšoeroe ke lefu la kelello. O na le nalane ea ho khutla hangata ka ho se tsamaisane hantle le ho hloka tumello ea nako le nako. O ile a amoheloa sepetleleng sa rona sa univesithi ka litakatso tsa litšupiso le mahloriso, mme risperidone 5 mg / letsatsi a mo fuoa. Kamora selemo, o ile a ba le galactorrhea le amenorrhea. Kamora nako meriana ea hae e fetotsoe ho 10 mg / letsatsi la aripiprazole, ea ntan'o fetoloa 20 mg / ka letsatsi. Matšoao a hae a matle a ile a fokotseha kamora ho eketseha ha litekanyetso, empa libido ea hae e ile ea eketseha nakong ea khoeli kamora khoeli keketseho ena ea tekanyetso. Hypersexourse ea hae e bontšitsoe ke 1) tlhoko ea thobalano ea letsatsi le letsatsi, 2) ts'ebeliso ea khafetsa ea litšoantšo tsa bootsoa marang-rang. Boitšoaro bona bo ne bo qala ho bontšoa pele ho kalafo ea hae ea aripiprazole. Tlhahlobo e tloaelehileng ea 'mele le lipatlisiso tsa laboratori li ne li le maemong a tloaelehileng. Re khaolitse kalafo ea aripiprazole mme re laetse risperidone 0.5 mg / ka letsatsi empa mokuli o ile a lahleheloa ke ho latela.5 likhoeli hamorao, Mme A o ile a kena sepetlele bakeng sa ketsahalo ea psychotic ka ho qhekella ho sa tšepahaleng. O ile a phekoloa ka quetiapine 800 mg / letsatsi. Kamora likhoeli tse peli, o ile a lokolloa sepetlele sa rona. Ha re na tlaleho ea tlhokeho e eketsehang ea likamano tsa botona le botšehali ho eena, mme bofetoheli ba hae ba ho se tšepahale le bona bo ile ba nyamela.
Case 2
Mofumahali B e ne e le mokuli ea lilemo li 36 ea fumanoeng a na le schizophrenia lilemong tse 10 tse fetileng. O ne a e-na le litšobotsi tse qobellang ho qobella le ho qoba botho ba hae. O ne a e-s'o kopanele liphate kapa ho ratana. Mme B o ile a ba le mathata a hlorisang, lipono tse sa utloahaleng, ho tšoenyeha le ho sithabela maikutlo. O laetsoe haloperidol pele le kliniking ea rona ea bakuli ba kantle ho bakuli, o ne a fumane risperidone 2-9 mg / ka letsatsi le fluoxetine 20-40 mg / ka letsatsi bakeng sa lilemo tse 7. Ka lebaka la ho nona, meriana ea hae e ile ea fetoloa hore e be aripiprazole 20 mg / ka letsatsi le fluoxetine 40 mg / ka letsatsi. Kamora phetoho ena ea meriana, o ile a bonts'a litakatso tse eketsehileng tsa thobalano le mesebetsi. Mohlala, o ile a etsa thobalano le litoro tsa thobalano, mme a shebella litšoantšo tsa bootsoa khafetsa. Ntle le moo, ka linako tse ling o ne a ba le litakatso tsa ho kopanela liphate ntle ho mabaka tsa batho bao a sa ba tsebeng. Boitšoaro ba hae bo bocha ba thobalano bo ile ba mo hlabisa lihlong haholo mme a tšoenyeha a ba a ba le molato. Ka ho tsitlella ha mokuli, meriana ea hae e ile ea fetoloa risperidone quicklet 6 mg / ka letsatsi mme ea bolokoa ho fluoxetine 40 mg / ka letsatsi. Kamora ho emisoa ha aripiprazole, boemo ba hae bo phahameng ba libido bo ile ba theoha kapele ho boemo ba hae ba mantlha.
TŠOHLOA
Libido e fokotsehileng e ka hokahana le ho hlohlona ha dopamine receptor ke li-antipsychotic.3,4 Ka lehlakoreng le leng, takatso e matla ea thobalano, joalo ka ha e lekantsoe ke litlaleho tsa litoro, li-erections le liketso, li tlalehiloe ho banna ba tšoaroang ke dopamine agonists ba kang L-dopa, amphetamine le pramipexole.8 Le ha testosterone e nkuoa e le mokena-lipakeng oa takatso ea thobalano ho banna le basali, methapo ea methapo ea methapo (CNS) dopaminergic le li-serotoninergic pathways li bonahala li bapala karolo ea bohlokoa. Haholo-holo, lits'ebetso tsa dopamine tsa bongo (incertohypothalamic le mesolimbic) tse amanang le tsamaiso ea hypothalamus le limbic li hlaha e le motheo oa sistimi ea thabo, ha serotonin e na le litlamorao tse hlakileng tsa thobalano.9 ㅔAripiprazole ke lithethefatsi tsa pele tse fumanehang ka kotloloho tsa kalafo tse sebelisang agonism e fumanehang ho dopamine D2-receptor ho fihlella profest ea antipsychotic.10 Re nahana hore litlamorao tsa aripiprazole tsa dopaminergic agonistic li ka amahanngoa le bosodoma ba bakuli ba rona. Sebakeng sa ho koala tsela ea mesolimbic, agonism e sa reroang e tsitsisa tsela. E kanna ea fana ka matlafatso e nyane mesebetsing ea dopamine libakeng tsa boko moo e hlokang ho eketsoa.11 Re nkile qeto ea hore aripiprazole disinhibiting e kileng ea hatella tšebetso ea dopaminergic ho mesolimbic dopaminergic potoloho haholo-holo ho li-nucleus accumbens.
Ho latela khopolo ea khale ea semmuso, letsoalo la li-receptor le susumetsa ka kotloloho ts'ebetso ea baatlelete ba karolo e itseng.12 Ka hona, motho o ne a ka bolela esale pele hore ho pepeseha ha methapo ea pelo pele ho nako ho tla eketsa karabelo ea lisele le ho amohela boemo ba agonist ea aripiprazole.13 Koketso ea agonist e sa lekanyetsoang ea D2 ho li-hypersensitive dopamine receptors e ka lebisa ho drive ea enhan-ced dopaminergic ho potoloho ea mesolimbic. Aripiprazole le eona e na le 5-HT1A agonist ea nakoana le 5- HT2A thepa ea antagonist.14 Bopaki bo bong bo fana ka maikutlo a hore activation ea 5-HT2 receptor e senya ts'ebetso ea thobalano le ts'usumetso ea 5-HT1A receptor e thusa ts'ebetso ea thobalano.15 Lithethefatsi tse nang le 5-HT1A agonist le 5- HT2A thepa ea antagonist ie, nefazodone le mirtazapine, ha li na litlamorao tse fokolang, haeba li le teng, tse mpe tsa ts'ebetso ea thobalano.16 Cyproheptadine, 5HT2 antagonist e atlehile ho fokotsa antidepressant e bakang anorgasmia.15 Ka lehlakoreng le leng, bopaki bo tsoang lipatlisisong tse laoloang ke mahlo a mabeli bo bonts'a hore aripiprazole ha e amane le ho phahamisa prolactin.17 Ka bokhutšoanyane, lifaele tsena tsa li-receptor le ho haella ha hyperprolactinemia li ka etsa hore ho be le moea o motle bakeng sa ponahalo ea hypersexourse. Leha ho le joalo, ho hlokahala lipatlisiso tse ling ho utloisisa mekhoa eo aripiprazole e ka amang thobalano ka eona.
Maemong a rona, khatello ea maikutlo e ile ea ata har'a batho ba se nang nalane ea boitšoaro bo bobe ba ho kopanela liphate. Bakuli ba ile ba e-ba le takatso ea ho kopanela liphate khafetsa le ho ba le takatso e matla ea thobalano kamora ho aripiprazole. Khetlong la bobeli, hypersexuality e ile ea nyamela ka ho fetesisa matsatsing a mokuli ha a khaotsa aripiprazole. Leha ho le joalo, ketsahalong ea pele, re ne re sa tsebe hantle ka nako eo matšoao a hae a letsoalo a ileng a raroloha, ka lebaka la tahlehelo ea ho latela le ho khutla ha matšoao a kelello. Hypersexourse e ka 'na ea rala motheo oa thetso ea bofebe. Ha ho na mokuli ea ileng a boela a hlaheloa ke ntho e tšoanang e amanang le botona le botšehali kamora ho khaotsa ho nka aripiprazole.
Qetellong, aripiprazole e ka matlafatsa takatso ea thobalano ho bakuli ba nang le schizophrenia. Re fana ka tlhahiso ea litlamorao tsa aripiprazole tsa dopaminergic agonistic ho potoloho ea mesolimbic haholo-holo li-nucleus accumbens e kanna ea ikarabella bakeng sa ketsahalo ea bosodoma. Re boetse re fana ka maikutlo a hore lingaka li nka bosodoma e le litlamorao tse mpe tsa aripiprazole hobane ho se utloisise mathata ana a tsoang ho baoki le mahlakore a mokuli ho ka baka sesosa sa ho hloka kutloano lenyalong le mahlomola ho mokuli.
LITLHAHISO
Serretti A, Chiesa A. Tlhahlobo ea meta-dysfunction ea thobalano ho bakuli ba kelello ba nkang li-antipsychotic. Int Clin Psychopharmacol 2011; 26: 130-140.
Moqapi AJ. Ho se sebetse ka thobalano le kalafo ea antipsychotic. Psychoneuroendocrinology 2003; 28 (Suppl 1): 69-82.
Tonakholo ea Haddad, Wieck A. Hyppsprolactinaemia ea antipsychotic-ikiwa: mekhoa, likarolo tsa bongaka le tsamaiso. Lithethefatsi 2004; 64: 2291-2314.
Knegtering H, van der Moolen AE, Castelein S, Kluiter H, van den Bosch RJ. Litlamorao tsa li-antipsychotic ho dysfunctions tsa thobalano le tšebetso ea endocrine ke life? Psychoneuroendocrinology 2003; 28 (Suppl 2): 109-123.
Menon A, Williams RH le Watson S. Libido e eketsehileng e amanang le quetiapine. J Psychopharmacol 2006; 20: 125-127.
Schlachetzki JC, Langosch JM. Aripiprazole e hlohlelletsa hypersexeness ho mokuli ea lilemo li 24 ea nang le lefu la kelello? J Clin Psychopharmacol 2008; 28: 567-568.
Kerwin R, Millet B, Herman E, Banki CM, Lublin H, Pans M, le al. Phuputso e nang le mefuta e mengata, e sa fetoheng, ea tlhaho, e bulehileng ka mokhoa o bulehileng pakeng tsa aripiprazole le maemo a tlhokomelo ho taolo ea bakuli ba sebetsanang le lefu la kelello la Schizophrenia Teko ea Aripiprazole: (STAR). Euro Psychiatry 2007; 22: 433-443.
Sansone RA, Ferlan M. Pramipexole le thobalano e qobelloang. Psychiatry (Edgmont) 2007; 4: 57-59.
Phahamisa JG. Litsela tsa takatso ea thobalano. J Jala Med 2009; 6: 1506-1533.
Kessler RM Aripiprazole: karolo ea "dopamine D (2)" "" receptor "" "" "" "" "" "" "" "" "" "" ("receptor" "" "" "" "" "" "" "" "" "" "" "Receptor" Ke J Psychiatry 2007; 164: 1310-1312.
Litekanyetso SM. Dopamine system stabilizers, aripiprazole, le moloko o latelang oa li-antipsychotic, karolo ea 1, liketso tsa "Goldilocks" ho li-receptor tsa dopamine. J Kliniki ea Psychiatry 2001; 62: 841-842.
Hoyer D, Boddeke HW. Babuelli ba nakoana, bo-rahistori ba felletseng, bahanyetsi: mathata a tlhaloso. Trends Pharmacol Sci 1993; 14: 270-275.
Koener B, Hermans E, Maloteaux JM, Jean-Jean A, Kamehla EL. Paradoxical motor syndrome ka mor'a phetoho e tsoang ho atypical neuroleptics to aripiprazole. Ke J Psychiatry 2007; 164: 1437-1438.
Ground G, hloela M, Ebrecht M, Gorocs T, Modell S. Aripiprazole: pharmacodynamics ea agopist e arohaneng ea dopamine bakeng sa kalafo ea schizophrenia. Pharmacopsychiatry 2006; 39 (Suppl 1): S21-S25.
Meston CM, Frohlich PF. The neurobiology ea thobalano. Arch Gen Psychiatry 2000; 57: 1012-1030
Farah A. Thuso ea ts'ebetso ea thobalano e bakiloeng ke SSRI ka kalafo ea mirtazapine. J Clin Psychiatry 1999; 60: 260-261.
Dossenbach M, Hodge A, Anders M, Molnar B, Peciukaitiene D, Krupka-Matuszczyk I, et al. Ho ba teng ha khaello ea thobalano ho bakuli ba lefu la kelello: phapang e fapaneng le ho nyenyefatsoa. Int J Neuropsychopharmacol 2005; 8: 195-201.
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