Zvinoenderana nebasa rayo, Iyo Edhiyo Bhodhi yeMedTvoiLokony inoedza neparinogona napo kupa yakavimbika zvekurapa zvemukati zvinotsigirwa neruzivo rwazvino rwesainzi. Mureza wekuwedzera "Zvakatariswa Zvemukati" zvinoratidza kuti chinyorwa chakaongororwa kana kunyorwa zvakananga nachiremba. Iyi nhanho-mbiri yekusimbisa: mutori wenhau wezvekurapa uye chiremba anotitendera kuti tipe zvemhando yepamusoro zvemukati zvinoenderana neruzivo rwekurapa rwazvino.
Kuzvipira kwedu munharaunda iyi kwakaongwa, pakati pevamwe, neSangano reVatori venhau vehutano, iro rakapa iyo Editorial Board yeMedTvoiLokony ine zita rekuremekedza reMudzidzisi Mukuru.
40 muzana yevaEurope vanotambura nehosha dzepfungwa. Kutya kunodzora. Mushonga wacho wainzi benzodiazepines. Vanokurumidza kudzvinyirira kufunganya uye kukuisa iwe kurara. Vanachiremba vakazvinyorera kuvarwere vakanga vapererwa pasina kuzeza. Zvakazoitika kuti kana zvikashandiswa zvisina kufanira, zvinopinda muropa, zvinowedzera kufunganya, uye zvinokonzeresa ndangariro. Unofanira kutya benzodiazepines uye sei kurwisa kushushikana? Zuzanna Opolska, mutori wenhau weMedTvoiLokony, anobvunza chiremba wepfungwa ane mukurumbira - Sławomir Murawiec, MD, PhD.
- Inenge 40% yevaEurope vanotambura nezvirwere zvepfungwa. Vanotopfuura hosha yemwoyo negomarara munhamba. Chinonyanya kunetsa ipfungwa dzekuzvidya mwoyo
- Varwere vapererwa vanobvunza vanachiremba mapiritsi anozokurumidza kuderedza kufunganya. Izvi zvinorayira benzodiazepines. Iboka remishonga ine kukurumidza anxiolytic, sedative, hypnotic uye anticonvulsant madhara.
- Mamirioni imwe chete eBritain akapindwa muropa nemishonga iyi, mamiriyoni matanhatu eGermany anonwa mishonga yokunyaradza zuva riri rose. MuPoland, chiyero chechiitiko chinogona kunge chakafanana
Zuzanna Opolska, MedTvoiLokony: Chiremba, zvinonzi benzodiazepines zviri nyore kutanga kutora, asi zvakaoma zvikuru kumira. Sei?
Sławomir Murawiec, MD, PhD: Iyi igangaidzo mune zvepfungwa. Patinobvunza varwere zvavanotya nezvemishonga yepfungwa, vanowanzoti "kuchinja kwehunhu" uye "kupindwa muropa." Panguva imwecheteyo, boka rinonyanya kufarirwa remishonga ndiro benzodiazepines. Uye ndiro chete boka rinopindwa muropa.
Zvose zvine ngozi zvakaenzana here?
Kwete. Zvichienderana nehafu yehupenyu, tinogona kusiyanisa mapfupi, epakati uye akareba-anobata benzodiazepines. Zvekare zvine ngozi zvikuru.
Sei?
Vane kukurumidza uye kwakajeka kudzikamisa mhedzisiro inopera mushure memaawa mashoma. Nokudaro, pane muedzo wokusvika kune rimwe piritsi uye kudzokorora maitiro akawanikwa. Nguva dzose patinonzwa kuzvidya mwoyo, uye kunyange nokusingaperi. Kugara kwedu zvakanaka kunobva pakutora mishonga. Zvine njodzi.
Nokuti kure mukati mesango, zvakanyanya - nenguva iyo dose yazvino haina kukwana kwatiri?
Hongu - kushivirira kumushonga kunowedzera. Kana murwere angopinda muropa mode, isu tine hutsinye kutenderera. Nekuti nekufamba kwenguva, anoda madosi ane hutsinye akakwira, asi zvakadaro asiri kuwana mhedzisiro yaanoda. Zvakakodzera kusimbisa, zvisinei, kuti benzodiazepines haisi munyama. Zvakafanana nedoro – vose vanonwa, asi kwete vose vanodhakwa. Benzodiazepines inoisa mungozi yekupindwa muropa, asi hazvisi kuti chero munhu anotarisa piritsi anozopindwa muropa.
Iyi mishonga yakanga yatoshandiswa mu60s, kunyange yakashandiswa zvakanyanya, nokuti makore makumi matatu chete gare gare mirayiridzo yekushandiswa kwayo yakachengeteka yakabudiswa. Vanachiremba vachiri kuvaraira nokusangwarira nhasi here?
Sezvineiwo, izvi zviri kuchinja. Pandakatanga kushanda, varwere vazhinji vaive pa-off-label benzodiazepines. Kubva kuvashandi vese - vanachiremba vemhuri nhasi. Ndinofunga pakanga pasina rubatsiro kuseri kwemeshini iyi. Fungidzira murwere ane matambudziko ehupenyu, akasvinura, anotya, ane hasha. Parikurwadza apa, painobvinza apa. Anoenda kuna Chiremba wezvirwere zvese anovheneka zvese, anonyora mishonga yemudumbu, yemwoyo uye hapana. Haasati aziva kuti chii chiri kunetsa munhu anorwara. Pakupedzisira, chiremba anoona kuti kana akapa benzodiazepine, murwere anova nani. Anorega kuuya uye kutaura zvirwere zvakawanda. Sezvineiwo, nhasi kuziva kwekuora mwoyo kwakakura zvikuru kupfuura zvayaimbova, uye vanachiremba vemhuri vanowanzoshandisa mishonga inoderedza kuora mwoyo kubva kuboka rekusarudza serotonin reuptake inhibitors (SSRIs) nokuti vanoziva kuti inzira iri nani kupfuura benzodiazepines.
Ukuwo, nguva pfupi yapfuura mashoko okuti “ndakaora mwoyo” haana kumbopinda mumuromo.
Ichokwadi. Kuora mwoyo kunosanganisira mapoka akawanda ezviratidzo: kusuruvara, anhedonia, iyo varwere vanorondedzera se: "Ndiri kufara, handifariri chero chinhu", kuderera kwehupenyu hwehupenyu (kutyaira simba), kuvhiringidzika kwehope uye kuzvidya mwoyo. Kunyange zvazvo benzodiazepines inogona kushanda pane chekupedzisira, haiporese kuora mwoyo. Zvakafanana nekurwisa fivha pane kurapa utachiona hwehutachiona nemishonga inorwisa mabhakitiriya. Haisi kurapa kwechikonzero kunogona kubatsira. Somugumisiro, tinova nefunganyo shoma, asi tichiri kusuruvara uye tichiri tisina kukurudzirwa kuita chiito.
Ndiani ari panjodzi yekupindwa muropa nebenzodiazepine? Ichokwadi here kuti wakapindwa muropa nedoro?
Kwete chete. Kliniki, tinoiisa zvakanyanya: vanhu vanokarirwa kupindwa muropa.
Vakadzi ndivo vanonyanya kutambudzika kupfuura varume?
Tine mapoka evarwere akasiyana. Vechiduku vanoedza kushandisa zvinodhaka kuti vachinje mafungiro avo, uye vanowanzova nani kupfuura vanachiremba vepfungwa vanotsvaka mishonga vanoziva kuti zvinoshanda sei.
Varume vanoenda kunonwa kakawanda, uye vakadzi vanoedza kuderedza dambudziko racho ne "kuzvibata" uye kudzivisa manzwiro. Kunyanya vakadzi vepakati-kati vanozviwana vari mumamiriro ezvinhu akaoma ehupenyu, edza kuderedza marwadzo ehupenyu nemapiritsi. Nokudaro, ivo vanoda kusvika kune benzodiazepines, iyo munyaya iyi haisi mushonga wechirwere, asi inova nzira yekutarisana nemamiriro ezvinhu akaoma ehupenyu.
Vamwe vanhu havana dambudziko rekushandisa benzodiazepines kana doro. Vanozvibatanidza. Tafura pamwe negirazi kana bhodhoro rewaini - njodzi ndeyei?
Zvinotyisa zvikuru. Hazvikurudzirwi zvachose. Uye paunomira kutora mishonga, murwere anosara ane matambudziko akawanda: zvinokonzerwa nehupenyu hwakaoma, hunokonzerwa nekushayikwa kwemishonga uye doro.
Kushandiswa kwebenzodiazepines kune vanhu vakuru kune nharo. Kutsvakurudza kunosimbisa kuti mushure memishonga yakadaro, vane ngozi yakawanda yekudonha, uye naizvozvo kuputika kwechiuno.
Sezvinoita chero kurapwa kwemishonga, benzodiazepine kurapwa kune mhedzisiro. Inonyanya kuwedzera kurara, kukanganisa kukoshesa, kushaya simba, kukanganisa kuyeuka uye kukanganisa kurongeka. Kana munhu ane makore makumi maviri akadonha, achava nemavanga mashomanana zvakanyanya, munyaya yemakore 20 tiri kutaura nezvehupenyu hunotyisa. Nokudaro, kushandiswa kwebenzodiazepines kunofanira kuganhurirwa kune zvakakosha. Mukuwedzera, chiremba anofanira kunyevera zvakasimba murwere kuti zviratidzo zvakadaro zvinogona kuonekwa.
Zvinonzi kunwa mishonga iyi kunowedzera mukana wekukanganisika kwendangariro nekurasika pfungwa.
Kukanganisika kwendangariro kana kuderera kwekuziva kunowanzoitika kune vanhu vanoshandisa benzodiazepines kwemwedzi kana makore. Uyezve, varwere ava vanonyanya kusakendenga - havana chikonzero chekuita, havafarire nyika yakavapoteredza.
Saka kushandiswa kwezvinodhaka kubva muboka iri kunopembedzwa riini?
Kana akashandiswa zvine hunyanzvi, benzodiazepines ane maapplication akawanda nekuti ane hupamhi hwekuita. Muneurology, anoshandiswa kurapa pfari kana kuderedza kushushikana kwetsandanyama, mune premedication anesthesiology, uye mune zvepfungwa, anonyanya kushandiswa mukusagadzikana kwekurara uye kusagadzikana.
Isu tine kutya kwakawanda nhasi ...
Zvechokwadi, kune mimwe mishonga yakawanda ine anxiolytic effect. Parizvino, antidepressants kana pregabalin inoshandiswa kakawanda kupfuura benzodiazepines. Inobva kune gamma-aminobutyric acid (GABA).
Varwere havawanzosiyanisa pakati pemishonga inorwisa-kuzvidya mwoyo uye antidepressants, iyo inobatsirawo nekuzvidya mwoyo, asi zvakadaro iboka rakasiyana remishonga.
Saka benzodiazepines haifaniri kushandiswa kurapa kuora mwoyo here?
Izvo hazvifanirwe kushandiswa senge mushonga wega, asi hazvisi, zvakare, kuti hazvifanirwe kushandiswa. Nechifungidziro, mishonga inoderedza kuora mwoyo inotora mavhiki maviri kushanda se 'mapepa'. Uye kana murwere ane kuzvidya mwoyo kwakanyanya, kunze kweanodzvinyirira, tinomupa benzodiazepine panguva imwe chete, kuitira kuti ararame kusvika kumavhiki maviri. Zvadaro tinozvibvisa, uye murwere anoramba ari pane antidepressant.
Zvakadini nebenzodiazepines? Zvichiri kudiwa rini?
Ivo vanoshanda nekushushikana uye imwe mhando yekushushikana - iyo inoremadza, iri pano uye ikozvino. Zvinoita kuti tirege kufunga, tinotadza kudzora manzwiro edu nemaitiro, tinonzwa kuti tava kupenga.
Mumatambudziko ekuzvidya mwoyo, kutya kwekutya muenzaniso wakanaka wekushandiswa kwavo. Kurapa kwekutanga mumamiriro ezvinhu aya ndiko kutungamirirwa kwezvinodhaka kubva kuboka rekudzivirira, dzinofanira kutorwa zvachose. Izvo hazvireve kuti murwere haagone kutakura benzodiazepine - inotorwa pane yekukurumidzira yekurwiswa kwekufunganya, uye kwete zuva rega rega sechikamu chekugadzirisa dambudziko rehupenyu.
Nguva nenguva, kwechinguvana, nekuti kushandisa nguva dzose kune imwe kupindwa muropa?
Benzodiazepine mishonga inogona kushandiswa nguva dzose. Nguva pfupi chete - kubva kumasvondo mana kusvika matanhatu. Kana kuti kwenguva pfupi nekuzorora kwemazuva akati wandei. Iyo yekupedzisira inoratidzika kuva yakachengeteka maererano nemigumisiro yenguva refu.
Uye iwe unofanirwa kutanga neiyo shoma madosi?
Izvo zvinoenderana, kune hukama pakati peiyo dose uye maitiro ekurapa. Isimba rekuzvidya mwoyo rinotarisa ukuru hweyero. Kana mumwe munhu akagumbuka zvikuru, mushonga muduku zvikuru haumubatsiri.
Dambudziko guru nebenzodiazepines nderekuti anoshandiswa kure-label. Kwete zvakanyanya kugadzirisa sekudzvinyirira matambudziko. Piritsi inova inozorodza kutya, kuzvidya mwoyo, kuziva mamiriro ezvinhu atinozviona tiri - inodzvinyirira iyo inonzi marwadzo ehupenyu.
Benzodiazepine haigone kuregedzwa husiku?
Kwete, kunze kwekunge iri iyo yakaderera dose uye inongotorwa kwenguva pfupi. Kune rumwe rutivi, kana tikatora mishonga yebenzodiazepine kwenguva yakareba, muchiyero chepakati kana chepamusoro, uye kuirega kweusiku humwe kunogona kukonzera kudzoka kwezviratidzo zvakanyanya zvekuzvidya mwoyo. Uye kunyange psychosis, unyengeri, uye pfari.
Zvinonzwika senge abstinence syndrome.
Kwete zvishoma, asi zvizere uye zvakasimba. Kubviswa kwakachengeteka kwebenzodiazepines hakuna kukurumidza kupfuura 1/4 yedosi muvhiki. Aya ndiwo kurudziro yepamutemo yekurapa, asi ini ndingakurudzira kunyange zvishoma nezvishoma kubvisa.
Sławomir Murawiec, MD, PhD, chiremba wepfungwa, psychodynamic psychotherapist. Mupepeti-mukuru we "Psychiatria", purezidhendi weScientific Society yePsychodynamic Psychotherapy. Kwemakore akawanda aibatanidzwa neInstitute of Psychiatry uye Neurology muWarsaw. Nhengo yekutanga yeInternational Neuropsychoanalytical Society. Laureate waProfessor Stefan Leder, mubairo wakapihwa nePolish Psychiatric Association nekuda kwezvakanaka mumunda we psychotherapy.