Ukunciphisa Ngokweqile Ngokwecansi Kuhanjiswe Naltrexone Monotherapy (2018)

I-Prim Care Companion CNS Disord. 2018 Feb 15; 20 (1). i-pii: 17l02109. i-doi: 10.4088 / PCC.17l02109.

Camacho M1, I-Moura AR1,2, U-Oliveira-Maia AJ3,1,2,4,5.

I-PMID: 29469239

I-DOI: 10.4088 / PCC.17l02109

Kulo mhleli: Ukuziphatha okucindezelayo ngokocansi kuyinkimbinkimbi engavamile noma engalawuliwe ngokocansi noma ukuziphatha okuholela ekucindezelekeni okuphawulekayo emtholampilo ngemiphumela engavumelekile yezokwelapha, ezenhlalakahle, ezomsebenzi, ezomthetho noma ezomnotho.1 Ngokuvamile, ukuziphatha okucindezelayo ngokobulili kubonakala ukungaphumeleli ukulwa nesifiso sokuziphatha ngokobulili, okuyinto evame ukulandelwa imizwa yecala, ukuzisola nokuzihlambalaza, okuholela ekufakeni kwabo ukuhlukumezeka kokulawula ukucindezeleka.2 Ukwelashwa kokuziphatha okuphoqeleka ngokocansi kuyinselele, kanye nemibiko3 yokuphumelela okuhlukahlukene kokungenelela kwe-psychotherapeutic kanye ne-pharmacologic, kufaka phakathi i-serotonin reuptake inhibitors, izimo zokuqiniswa kwemizwelo, kanye nama-antipsychotics. Ubufakazi4,5 iphakamisa ukuthi i-naltrexone, umphikisi we-opioid osetshenziswa kakhulu ekwelapheni ukuxhomeka kwe-opioid, kungaba yindlela yokwelashwa kwale mibandela. Imiphumela ye-naltrexone ihlongozwa ukuthi ibangelwe ukuvinjelwa kwama-opioid receptors kuma-γ-aminobutyric acid interneurons endaweni ye-ventral tegmental (VTA), ngaleyo ndlela ivimbela i-VTA i-neopon dopaminergic ecatshangelwa ukuthi ibeke izindawo eziqinisayo zokuziphatha okuphoqelekile.6 Sitshela icala lesiguli ngokuziphatha okuphoqeleka ngokocansi okuphathwa ngempumelelo nge-naltrexone monotherapy.

Umbiko wendaba. Indoda eneminyaka engu-27 eneminyaka yokuqala ihanjiswe emtholampilo wethu wokugula ngengqondo ngenxa yokuzibophezela ngokobulili. Isiguli sigcizelele ukuchitha isikhathi esiningi nemali ukucabanga ngokuqasha nokudayisa imisebenzi yobufebe, kuchaza ukulungiswa okukhethekile "ngamadoda ashintshiwe. "Wazicabangela ubulili obuhlukile futhi wachaza lezi zenzo zokuziphatha ngokobulili njenge" ukungaqondakali okungajwayelekile, "okwenza ukuba abe namahloni nokwenyanya okungenakukwazi ukulawula. Isiguli sasibizwa ngokuhlolwa kwengqondo futhi saqedela ukuphoqelelwa kokuphoqelelwa kwe-Yale-Brown Obsessive Compulsive Scale-II7 ukuhlola isimo nesibindi sokucindezelwa kwakhe ngokocansi (Ithebula 1). Ngenkathi ukucindezelwa okucindezeleka kakhulu kwakukulala nabantu abashintshayo, okwenzeka okungenani kanye njalo ezinyangeni ze-2, futhi wabika ukubuka ngokweqile kwezithombe zobulili ezingcolile ezingekho ngaphansi kwamahora we-3 kuze kufike kumahora angu-10 nsuku zonke. Nakuba ukuziphatha okuvame ukuziphatha ngokobulili, akazange abike ngokushaya indlwabu. Isiguli sasizwa singakwazi ukulawula lezi ziphathamandla futhi sabika ukucindezeleka okuphawulekayo emitholampilo kanye nezinkomba zokukhathazeka. Wayethatha i-fluoxetine i-20 mg / d futhi wajoyina uhlelo lokusekela kwengqondo, kodwa akazange abike inzuzo yesikhathi eside kulezi zandulela kanye nokwelapha, kuhlanganise nokucindezeleka okuningi, ukucindezeleka kwemizwa, izinkinga ze-neuroleptics, nezinye izifundo ze-psychotherapy. Kungakhathaliseki ukwelashwa nokwenza kahle (i-fluoxetine 40 mg / d ne-aripiprazole 10 mg / d), izimpawu azishintshi, futhi ukuhlolwa kwe-naltrexone (i-50 mg / d) kuhlongozwa.

Ngemuva kwezinyanga ze-2, isiguli sigcizelele ukuthuthukiswa okuphawulekayo ekunciphiseni imizwa yobulili nokulawula izifiso zocansi. Wayengazange ahlanganyele ocansini, futhi wayenelisekile kakhulu ngemithi yakhe. Njengoba engasho ukuthi ayikho inzuzo ekusetshenzisweni kweminye imithi, wayeke ukuzithatha ngokuzithandela futhi wayekade ethatha i-naltrexone amasonto ambalwa. Waqhubeka nokuya kwengqondo ye-psychotherapy. Umthamo we-naltrexone wenyuka waba ngu-100 mg / d. Ngemuva kwezinyanga ezingu-10 ze-naltrexone monotherapy, kwaphakanyiswa ukuthuthukiswa okuqhubekayo, futhi isiguli sabika ngokuphindaphindiwe ukusetshenziswa kwezifebe. Wachaza umzamo wokuzame ukumisa i-naltrexone, kodwa waphinde waqala imithi emva kwezinsuku ezingu-2 kuphela ngenxa yokwanda kwemicabango neziphakamiso ezihlobene nezenzo zocansi. Ukuhlolwa kwengqondo okulandelayoIthebula 1) wabonisa ukuthuthukiswa ezimpawu zakhe ezicindezelayo kodwa ukwanda kokukhathazeka. Ngesikhathi isiguli sisaqhubeka nokusebenzisa izithombe zobulili ezingcolile ngaphandle kwamahora angu-3 ngosuku, akazange abheke lo mkhuba njengenkinga.

Kunezinye izincwadi4,6,10-12 ukubika ukuphumelela kwe-naltrexone ezimweni zokuziphatha okuphoqeleka ngokocansi. Raymond et al4 kubika amacala e-2 okuthuthukiswa ekuphoqelekeni ngokocansi nokusebenza kwengqondo nokusebenzisa i-naltrexone yokwandisa ukwelapha nge-fluoxetine. IBostwick noBucci6 bathola imiphumela efanayo emlandweni wokulutha kwe-intanethi ngokuziphatha okuvame ukucindezeleka ngokocansi lapho ukucindezelwa kocansi kwesiguli okwenziwe ngemuva kwe-naltrexone kwengezwe ekwelashweni nge-sertraline. I-Ryback11 wachaza ucwaningo oluvulekile lwelebula le-naltrexone ku-21 wesilisa ocansini wesilisa ocansini ngokuphathwa ngokuvumelana nokukhuthazwa, ukucindezeleka, imizwa yokucindezeleka, imithi ye-antipsychotics, noma iminye imithi. Kulezi ziguli, i-71% ibike ukunciphisa okukhulu ekuvusweni ngokocansi, imvamisa yokushaya indlwabu, nokucabanga kocansi nge-naltrexone. Ku-9 kweziguli ze-10, ukuziphatha okucindezelayo ngokobulili kubuyiselwe kumazinga okuqala lapho i-naltrexone ilawulwa ngokulawula.11 Grant noKim10 kubika ukuxoxwa kwezintshontsho kanye nesifiso socansi uma kwenzeka i-kleptomania ne-comorbid yokuziphatha ngokuziphatha ngokobulili ngemuva kokwelashwa nge-dose naltrexone (150 mg / d) ephezulu, kodwa akucaci ukuthi umphikisi opioid wayelungiselela i-high-dose fluoxetine noma isetshenziswe ku-monotherapy . Icala elichazwe lapha lengeza kulezi zincwadi kusukela ukuphoqelelwa ngokobulili kwaphathwa ngokuphumelelayo usebenzisa i-naltrexone monotherapy, ehambisana nencazelo ka Kraus et al12 kokunciphisa izithombe ezingcolile zobulili ezingcolile ze-intanethi ukubuka ngemuva kokwelapha nge-naltrexone monotherapy.

Kukhona nobufakazi bokusekela ukusetshenziswa kwe-naltrexone kumongo wezinye iziphazamiso ze-spectrum ephoqelekile, okuwukuthi ukuthenga okuphoqelekile,13 kleptomania,10 ukugembula okungokwemvelo,5 utshwala,14 i-trichotillomania,15 ukuphazamiseka kokudla,16 nokuzilimaza ukuzilimaza ekungeneni kwe-personalityline.17 Ezimweni eziningi, i-naltrexone isetshenziselwa ukwandisa ezinye izindlela zokwelashwa, njengezidakamizwa zokucindezeleka, kodwa kukhona ubufakazi, njengesibonelo sokudakwa ngokweqile, ukuthi i-naltrexone monotherapy iphumelela ngendlela efanayo njengokwelashwa okuhlanganisiwe, kuyilapho kunciphisa amathuba okuba nemiphumela emibi noma ukusebenzisana kwezidakamizwa.14 Ngaphezu kwalokho, i-naltrexone ayibonakali ukuphazamisa umsebenzi wocansi futhi uye wahlongozwa njengokwelashwa kokungasebenzi kahle kwe-erectile.18 Kodwa-ke, kungase kube nezinzuzo zezokwelapha ezihlangene. Lapha, sithole ukwanda kwezimpawu zokukhathazeka, okungenzeka kubangelwa ukuphazamiseka kokwelashwa nge-fluoxetine noma nomphumela oqondile we-naltrexone, njengoba kuphakanyisiwe kwezinye izifundo.19 Ekuphetheni, ngenkathi i-naltrexone i-monotherapy ingaba imithi ebekezelelwe kahle, ephephile futhi ephumelelayo yokuphoqelelwa ngokocansi, ukuhlolwa okungahleliwe nokulawulwa kuyadingeka ukuqinisekisa ukusebenza nokuphepha.

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UMarta Camacho, MSa

U-Ana Rita Moura, MDa, b

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

[i-imeyili ivikelwe]

isikhungo se-aChampalimaud Clinical, i-Champalimaud Centre ye-Unknown, iLisbon, iPortugal

BDepartment of Psychiatry and Health Mental, I-Centro Hospitalar de Lisboa Ocidental, Lisbon, ePortugal

cChampalimaud Research Center, Centre Champalimaud ye-Unknown, iLisbon, ePortugal

I-DNOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, ePortugal

Izingxabano ezingase zenzeke: Akukho.

Imali / ukwesekwa: Akukho.

Isethulo sangaphambilini: Sikhulume ku-XII National Congress of Psychiatry; I-November 10-12, i-2016; UVilamoura, ePortugal.

Imvume yesineke: Isiguli sanikeze imvume ebhaliwe yokushicilela leli cala, futhi ulwazi luye lwaziwa ngokuvikela ukungaziwa.

Ishicilelwe ku-intanethi: ngo-February 15, i-2018.

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

Ukusho: Camacho M, Moura AR, Oliveira-Maia AJ. Izimo zobulili eziphoqelelwe ziphathwa nge-naltrexone monotherapy. I-Prim Care Companion CNS Disord. 2018; 20 (1): 17l02109.

Ukuze wabelane: https://doi.org/10.4088/PCC.17l02109