Imiba emibini yoBucala boBucala obuPhakathi Mhlawumbi inxulumene no-Aripiprazole (2013)

UPhando lwezeengqondo-2013 (Vol. 10, Issue 2, Amaphepha 200-2)
 

EunJin1; Bon-Hoon Koo1; Sang Soo Seo2; noJun-Yeob Lee3; I-1; iSebe lezeMpilo yezeengqondo, iYunivesithi yaseJeungnam University of Medical, iYunivesithi yaseJeungnam Medical Center, eDaegu,
I-2; iSebe lezeNyango, iSikolo seNyango, iYunivesithi yeSizwe yaseKyungpook, iDaegu,
I-3; iSebe lezeMpilo yeZengqondo, iZiko le-CHA Gumi, iYunivesithi yase-CHA, iGumi, kwiRiphabliki yaseKorea Ukungasebenzi ngokwesondo sisiphumo esichaphazelekayo kwizigulana ezinyangwe nge-antipsychotic kodwa umahluko obonakalayo ukhona kwimixube eyahlukeneyo. Sinika ingxelo yeempawu zokuziphatha kwamadoda nabafazi kwizigulana ezibini ezine-schizophrenia ezazifumana unyango nge-aripiprazole. Izigulana ziye zafumana inkanuko yesini rhoqo kunye nokuzibandakanya okukhulu ngokwesondo emva kokuthatha i-aripiprazole. Sixoxa ngeendlela ezinokubakho zeekhemikhali ze-neuro zamachiza koku kwaye siphikise ukuba iprofayili ekhethekileyo ye-aripiprazole ye-pharmacological, i-agonism eyinxalenye enobudlelwane obuphezulu kwi-dopamine D2-receptor, inokuba negalelo kuphuhliso lweempawu.
Amagama abalulekileyo I-Aripiprazole; Hypersexuality; Dopamine;

Imbalelwano: I-Bon-Hoon Koo, MD, PhD, iSebe lezeMpilo yeYengqondo, iYunivesithi yaseYeungnam Ikholeji yeZonyango, i-317-1 Daemyeong 5-dong, Nam-gu, Daegu 705-703, kwiRiphabhlikhi yaseKorea
Inombolo yomnxeba: + 82-53-622-3343, Fax: + 82-53-629-0256, E-mail: [imeyile ikhuselwe]

 

INTSHAYELELO

Uhlalutyo lwe meta nje1 Ibonakalise ukuba ukungasebenzi ngokwesondo sisiphumo esiqhelekileyo kwizigulana ezinyangwa nge-antipsychotic kodwa umahluko obonakalayo ukhona kuzo zonke iikhompawundi ezahlukeneyo. I-Aripiprazole yayinxulumene namazinga aphantsi okusebenza ngokwesondo, ngelixa i-olanzapine, i-risperidone kunye ne-clozapine zinxulunyaniswa namazinga aphezulu okusebenza ngokwesondo. Ubungqina obukhoyo ngoku bucebisa ukuba inxenye ebalulekileyo yokungahambelani ngokwesondo okunxulunyaniswa neziphumo zonyango lwe-antipsychotic ngqo ezivela kwi-dopamine antagonism zidityaniswe neziphumo ezingathanga ngqo ze-serum prolactin concentration.2,3,4 ㅔNangona kunjalo, abaphandi baxele i-hypersexeness eyenzeka ngokunxulumana ne-antipsychotic intake, kwizigulana ezithatha i-quetiapine5 okanye i-aripiprazole.6 I-Aripiprazole yahlukile kwezinye iziyobisi ezivunyiweyo ze-antipsychotic ngenxa yomsebenzi wayo okhatywayo we-agonistic kwi-dopamine D2 receptors. Kuxelwa ukuba ukutshintshela kwi-aripiprazole okanye ukongezwa kwe-aripiprazole kolunye ulawulo lwe-antipsychotic kunxulunyaniswa nokuncitshiswa kokungasebenzi ngokwesondo.7 ㅔApha, sixela i-hypersexuality mhlawumbi eyenzeka ngokudibana nonyango lwe-aripiprazole kwizigulana ezimbini zabasetyhini abane-schizophrenia.

CASE

Icandelo 1

ㅔU-Ms A wayengumntu oneminyaka engama-37 isigulana esinesifo se-schizophrenia, uhlobo lweparanoid. Unembali yokubuyela umva kwakhona kunye nokulandela ngendlela engeyiyo efuna ukwamkelwa qho. Ungeniswe kwisibhedlele saseyunivesithi kunye nesithenjiso sokutshutshiswa kunye nentshutshiso, kunye ne-risperidone 5 mg / ngosuku yanikezelwa kuye. Emva konyaka, wafumana i-galactorrhea kunye ne-amenorrhea. Emva koko amayeza akhe atshintshelwa kwi-10 mg / ngosuku lwe-aripiprazole, emva koko waya kwi-20 mg / ngosuku. Iimpawu zakhe ezithandekayo ziye zancipha emva kokukonyuka komthamo, kodwa ke ilibido yakhe yanda kungekapheli nenyanga emva kokunyuswa komthamo. I-hypersexourse yakhe yaboniswa yi-1) imfuno yokulala ngesondo imihla ngemihla, i-2) ukusetyenziswa rhoqo kwe-Intanethi. Ezi ndlela zokuziphatha zazingekaze zibonakaliswe ngaphambi kokunyangwa kwakhe yi-aripiprazole. Uvavanyo oluqhelekileyo lomzimba kunye nophando olwenziwe elebhu zonke zazingaphantsi komda oqhelekileyo. Siyeke unyango lwe-aripiprazole kunye ne-risperidone 0.5 mg / ngosuku kodwa isiguli salahleka ukuba silandelele.5 kwiinyanga emva koko, uNksz A walaliswa esibhedlele ngenxa yenkulumbuso kunye nokukhohlisa. Wayephethwe nge-quetiapine 800 mg / ngosuku. Emva kweenyanga ezimbini, wakhutshwa esibhedlele. Asinangxelo yokunyuka kwesidingo sobudlelwane bezesondo kuye, kunye nokukhohlisa kwakhe ukungathembeki naye wanyamalala.

Icandelo 2

UNks B wayenesigulana esingumfazi esineminyaka engama-36 ubudala esiye safunyanwa sineschizophrenia malunga neminyaka eli-10 eyadlulayo. Wayenobuntu obunobunkunkqele kunye nokuthintela iimpawu zobuntu. Wayengazange enze ubudlelwane bezesondo okanye athandane. UNks B uphathwe kukukhohliswa okususayo, ukubona izinto ezingekhoyo, ukuxhalaba kunye nokudakumba. Unikwe i-haloperidol ngaphambili nakwikliniki yethu yokugula, wayefumene i-risperidone 2-9 mg / imini kunye ne-fluoxetine 20-40 mg / ngosuku iminyaka esi-7. Ngenxa yokufumana ubunzima, iyeza lakhe latshintshwa laba yi-aripiprazole 20 mg / ngosuku kunye ne-fluoxetine 40 mg / ngosuku. Emva kolu tshintsho lwamayeza, ubonakalisile ukonyusa iminqweno yesini kunye nemisebenzi. Umzekelo, wazibandakanya kwisini kunye neminqweno yesini, kwaye wabukela iphonografi rhoqo. Ukongeza, ngamanye amaxesha wayefumana iminqweno yesini engathandekiyo kubantu angabaziyo. Ukuziphatha kwakhe okutsha ngokwesini kwamenza waba neentloni kwaye waba nexhala kwaye wazeka ityala. Ngokunyanzelwa kwesigulana, amayeza akhe atshintshwa aba yi-risperidone quicklet 6 mg / ngosuku kwaye yagcinwa kwi-fluoxetine 40 mg / ngosuku. Ukupheliswa kwe-aripiprazole, inqanaba lakhe eliphezulu le-libido lakhawuleza laxhasa inqanaba lakhe lokuqala.

UKUQALA

Ukuhla kwe-libido kunokunxulunyaniswa ne-dopamine receptor antagonism yi-antipsychotic.3,4 Ngokwahlukileyo, ukonyuka komnqweno wesondo, njengoko kulinganiswa nge-self-ingxelo yeengcinga ezimnandi, ii-erections, kunye nemisebenzi, kuye kwabikwa kumadoda aphathwa nge-dopamine agonists anjenge-L-dopa, amphetamine kunye ne-pramipexole.8 Nangona i-testosterone ithathwa njengomlamli ophambili womnqweno wesini kumadoda nabasetyhini, i-dopaminergic ye-dopaminergic kunye neendlela ze-serotoninergic zibonakala zidlala indima ebalulekileyo. Ngokukodwa, iinkqubo ze-dopamine yobuchopho (incertohypothalamic kunye ne-mesolimbic) edibanisa i-hypothalamus kunye ne-limbic system zibonakala zenza isiseko senkqubo yokuchulumancisa, ngelixa i-serotonin inefuthe elibonakalayo lesithintelo kwisini.9 ㅔI-Aripiprazole lonyango lokuqala lufumaneka kwikliniki ye-antipsychotic isebenzisa i-agonism yesifo kwi-dopamine D2-receptor yokufezekisa iprofaylethi ye-antipsychotic.10 Sicinga ukuba iziphumo ze-aripiprazole ze-dopaminergic agonistic zinokudityaniswa ne-hypersexual yezigulana zethu. Endaweni yokuvala indlela ye-mesolimbic, i-agonism ekhethekileyo izinzisa indlela. Inokude inike ukonyusa okuthobekileyo kwimisebenzi ye-dopamine kwiindawo zobuchopho apho kufuneka inyuswe.11 Sithathe isigqibo sokuba i-aripiprazole disinhibiting ngaphambili eyayicinezela umsebenzi we-dopaminergic kwisekethe ye-mesolimbic dopaminergic wesekethe ikakhulu kwii-nucleus accumbens.

Ngokwe-theory class receptor theory, ubukhulu be-receptors baphembelela ngokuthe ngqo kwimisebenzi yangaphakathi ye-agonists eyinxalenye.12 Ke ngoko, umntu unokuxela kwangaphambili ukuba ukubonakaliswa kwangaphambili kwe-neuroleptic kuyonyusa ukuphendula kwethishu kwaye kuthande iprofayili ye-agonist ye-aripiprazole.13 Ukongezwa kwe-agonist yenxalenye ye-D2 kwi-hypersensitive dopamine receptors kunokukhokelela kwi-enhan-ced dopaminergic drive kwisekethe ye-mesolimbic. I-Aripiprazole nayo ine-5-HT1A i-agonist eyinxenye kunye ne-5- HT2A iipropathi zomchasi.14 Bukhona ubungqina obucacisa ukuba ukwenziwa kwe-5-HT2 i-receptor ithintela ukusebenza ngokwesondo kunye nokukhuthaza kwe-5-HT1A i-receptor yenza ukuba isebenze ngokwesondo.15 Iziyobisi ezine-5-HT1A i-agonist kunye ne-5- HT2A iipropathi ezichasayo okt, nefazodone kunye ne-mirtazapine, zincinci, ukuba zikhona, iziphumo ezibi ekusebenzeni ngokwesondo.16 ICyproheptadine, eyi-5HT2 I-antagonist isebenze ngempumelelo ekunciphiseni i-antidepressant indased anorgasmia.15 Ngakolunye uhlangothi, ubungqina obuvela kwizifundo ezilawulwa ngamehlo angaboniyo zibonisa ukuba i-aripiprazole ayidibananga nokuphakama kwe-prolactin.17 Ngamafutshane, ezi profiles kunye nokunqongophala kwe-hyperprolactinemia kunokubangela imeko elungileyo ekubonakaleni kwe-hypersexourse. Nangona kunjalo, uphando oluthe kratya luyafuneka ukuqonda iindlela ezichanekileyo ezinokuthi zichaphazele ukusebenza kwezesondo.

Kwiimeko zethu, ubungqingili bobuchwephesha phakathi kwabantu ngaphandle kweembali zokuziphatha kakubi ngokwesondo. Izigulana ziye zanqwenela umnqweno wesondo rhoqo kunye nokuzibandakanya okukhulu ngokwesondo emva kokuthatha i-aripiprazole. Kwimeko yesibini, i-hypersexuality yanyamalala ngokupheleleyo kwiintsuku zokuyeka kwesifo i-aripiprazole. Nangona kunjalo, kwimeko yokuqala, besingenakho ukuqiniseka malunga nexesha ngqo apho kusonjululwe iimpawu zakhe zesifo sengqondo, ngenxa yokulahleka kokulandela nokuphindaphinda kweempawu zengqondo. Hypersexourse inokubangela ukuba kuqale ukwenzeka kokungathembeki. Akukho siguli siye safumana ukuphinda sivele kwakhona emva kokuyeka ukuthatha i-aripiprazole.

Ukuqukumbela, i-aripiprazole inokuphucula umnqweno wesini kwizigulana ezine-schizophrenia. Siphakamisa ukuba i-aripiprazole's dopaminergic agonistic ifumaneke kwisekethe ye-mesolimbic ngakumbi kwi-nucleus accumbens inokuba noxanduva lwe-hypersexuality phenomenon. Sikwacebisa ukuba oogqirha bathathe ubuxhakaxhaka buqwalaselwe njengesiphumo esibi se-aripiprazole kuba ukungaqondi kwezi ngxaki ezivela kumakliniki kunye nakwicala lesigulana kunokuba ngumthombo wokungavisisani emtshatweni kunye nokubandezeleka kwesigulana.

IZALATHISO

  1. Serretti A, Chiesa A. Uhlalutyo lwe-meta-dysfunction yezesondo kwizigulana zengqondo ezithatha ii-antipsychotic. I-Int Clin Psychopharmacol 2011; 26: 130-140.

  2. Umsiki we-AJ. Ukungasebenzi ngokwesondo kunye nonyango lwe-antipsychotic. I-Psychoneuroendocrinology 2003; 28 (Suppl 1): 69-82.

  3. I-Haddad PM, iWieck A. I-hyppsprolactinaemia ye-antipsychotic-inclusions: iindlela, iimpawu zeklinikhi kunye nolawulo. Iziyobisi 2004; 64: 2291-2314.

  4. Ukudibanisa uH, van der Moolen AE, uCastelein S, uKluiter H, van den Bosch RJ. Ziyintoni iziphumo ze-antipsychotic kwizidanisi zesini kunye nokusebenza kwe-endocrine? I-Psychoneuroendocrinology 2003; 28 (Suppl 2): 109-123.

  5. UMenon A, u-Williams RH, uWatson S. Ukunyusa i-libido ehambelana ne-quetiapine. J Psychopharmacol 2006; 20: 125-127.

  6. ISchlachetzki JC, iLangosch JM. I-Aripiprazole yabangela i-hypersexeness kwisigulana esineminyaka engama-24 kwisigulana esinengxaki yokuphazamiseka kwengqondo? J Clin Psychopharmacol 2008; 28: 567-568.

  7. UKerwin R, uMillet B, uHerman E, iBanki CM, iLublin H, iPans M, et al. Uphononongo oluninzi, olungenamkhethe, olwenziwe lwendalo, oluvulekileyo oluvulekileyo phakathi kwe-aripiprazole kunye nomgangatho wokukhathalela kulawulo lwezigulana eziphathwe yi-schizophrenic izigulana ISchizophrenia Isilingo seAripiprazole: (STAR). I-Euro Psychiatry 2007; 22: 433-443.

  8. ISansone RA, uFerlan M. I-Pramipexole kunye nokunyanzelisa ukuphulula amalungu esini. Ukunyangwa kwengqondo (i-Edgmont) 2007; 4: 57-59.

  9. UPfaus JG. Iindlela zenkanuko yesini. J Ukwabelana ngeMedi ngesondo 2009; 6: 1506-1533.

  10. I-Kessler RM. I-Aripiprazole: yintoni indima ye-dopamine D (2) ye-receptor inxenye ye-agonism? I-J J Psychiatry 2007; 164: 1310-1312.

  11. I-Stahl SM. Inkqubo yedopamine yokuzinzisa, aripiprazole, kunye nesizukulwana esilandelayo se-antipsychotic, icandelo 1, isenzo se "Goldilocks" kwii-dopamine receptors. J Klinikhi yengqondo 2001; 62: 841-842.

  12. IHoyer D, Boddeke HW. Ama-agonists okwethutyana, abagcisa abagcweleyo, abachasene naye: iingxaki zenkcazo. I-Trends i-Pharmacol Sci 1993; 14: 270-275.

  13. UKoener B, uHermans E, uMaloteaux JM, uJean-Jean A, uConstant EL. I-Paradoxical motor syndrome emva kokutshintsha ukusuka kwi-atypical neuroleptics to aripiprazole. I-J J Psychiatry 2007; 164: 1437-1438.

  14. Umdaka G, kuvelal M, Ebrecht M, Gorocs T, Modell S. I-Aripiprazole: I-pharmacodynamics ye-dopamine inxenye ye-agonist kunyango lwe-schizophrenia. I-Pharmacopsychiatry 2006; 39 (Suppl 1): S21-S25.

  15. IMeston CM, uFrohlich PF. I-neurobiology yomsebenzi wesondo. I-Arch Gen Psychiatry 2000; 57: 1012-1030

  16. UFarah A. Ukuxolelwa kwe-SSRI ebangelwa kukungasebenzi ngesondo ngonyango lwe-mirtazapine. J Clin Psychiatry 1999; 60: 260-261.

  17. Dossenbach M, Hodge A, Anders M, Molnar B, Peciukaitiene D, Krupka-Matuszczyk I, et al. Ukusungulwa kokungasebenzi kakuhle ngokwesondo kwizigulana ezine-schizophrenia: ukwahluka kwamanye amazwe kunye nokungajongelwa phantsi. Int J Neuropsychopharmacol 2005; 8: 195-201.