ian kolinsi
Canawerebi Sotlandiidan
me pativi mergo davwero am JurnalisTvis. me gadavwyvite, kofeinis moxmarebis Sedegad ganviTarebul efeqtebze, maT marTvasa da standartul fsiqiatriul mkurnalobaSi amiT Setanili wvlilis Sesaxeb visaubro. me ar vici Tu arsebobs raime didi klinikuri kvleva am Temis Sesaxeb, Tumca mjera, rom Cem msjelobas racionaluri safuZveli aqvs farmakologiaSi da SeiZleba gamoyenebul iqnas, rogorc am Temis Sesavali.
yava aris yvelaze xSirad moxmarebuli fsiqoaqtiuri nivTiereba dedamiwaze. istoriulad is sawyiss iRebs jer kidev wina qristianuli periodidan. is aris meTilqsanTini, romelic gvxvdeba sxvdadsxva mcenareebSi, sadac is moqmedebs, rogorc bunebrivi pesticidi, iwvevs ra mwerebis paralizebas. adamianebSi igi warmoadgens fsiqostimulators, moqmedebs ra rogorc adenozinis receptoris antagonisti. adenozini aris neirotransmiterebis mniSvnelovani inhibitori centralur nervul sistemaSi. kofeini aris ergogenuri da nootropuli.
kofeini swrafad Seiwoveba kuW-nawlavidan da metabolizirdeba RviZlSi (2). misi naxevrad daSlis periodia 3-7 saaTi, Tumca is SeiZleba 10-jer gaizardos, magaliTad RviZlis ukmarisobis dros, an fluvoqsaminTan urTierTqmedebiT, agreTve orjer gaizardos orsulobis dros.
kofeinis efeqtebis Sesaxeb fsiqiatriaSi cnobilia ukve garkveuli drois ganmavlobaSi (3, 4). Cemi gamocdilebiT misi miReba ar fasdeba saTanadod did britaneTSi. ICD 10 cnobs kofeinTan dakavSirebul fsiqiatriul aSlilobebs, rogoric aris intoqsikacia, borotad moxmareba, damokidebuleba, aRkveTa da a.S. F15.XX nawilSi. Tumca farTod gavrcelebuli termini kofeinizmi ar aris aRiarebuli da miRebuli.
ramdeni kofeini?
kofeinis Semcveloba sasmelebSi, rogoric aris Cai da yava damokidebulia bevr rameze, Tumca saSualod misi Semcveloba Semdegia:
ukofeino yava 5-15mg (da es simarTlea)
330ml kolas boTlSi 34mg
finjani Cai 50mg
„red buli“ energetikuli sasmeli 80 mg
unaleqo yava 65-100mg
iaponuri mwvane Cai 100mg
starbaqsis didi gafiltruli yava 240mg
tolerantoba kofeinis mimarT viTardeba ramodenime kviraSi. adamians, romelic Rebulobs kofeins ramodenime kviris ganmavlobaSi SeiZleba ganuviTardes Semdegi fsiqologiuri da fiziologiri simptomebi, romlebic aseve doza damokidebulia:
25-50mg SesamCnevi cvlilebebi yuradRebasa da TviTsegrZnebaSi zomieri uZiloba;
300mg SfoTva, taqikardia, oflianoba, tremori, uZiloba;
1000mg aJitacia da SesaZloa deliriumi;
2000mg halucinaciebi da fsiqozi;
5000mg SesaZloa letaluri gamosavali (kardialuri ariTmia).
aris aseve kargad aRwerili aRkveTis sindromi romelic 24 sT-Si iwyeba, aRwevs piks 48-sT-ze da sruldeba 3-5 dReSi. mas axasiaTebs Tavis tkivili (SesaZloa ZlieriT da Sakikis msgavsi niSnebiT), SeuZlod yofna, gamRizianebloba da saxsrebis tkivili. albaT ar aris gasakviri, rom Tavis tkivilis da Sakikis popularuli saSualebebis nawili kofeins Seicavs.
klinikuri SemTxveva 1
27 wlis umuSevar mamakacs hqonda 6 wliani agorafobiis, panikuri aSlilobis da uZilobis istoria. mas daniSnuli hqonda ramodenime saZile saSualeba, serotoninis ukumitacebis mainhibirebeli antidepresantebi da beta blokatorebi, am drois umetes nawilSi. mkurnaloba uSedego iyo. zogjer igi Rebulobda alkohols imisTvis, rom daZineboda. igi dadioda kognitiur-qceviTi Terapiis seansebze, SfoTvis marTvis da modunebis saswavlad, radganac xsirad Tavs daRlilad, mSfoTvared grZnobda da awuxebda Tavis tkivili. Sexvedrisas gairkva rom is 30 finjan Cais svamda yoveldRiurad. Cais svamda RamiTac, roca eRviZeboda. misi yvela mcdeloba, rom Seewyvita Cais miReba Zlier Tavis tkivilebs iwvevda.
maS ra aris aq kofeinTan dakavSirebuli problema?
1. kofeini SeiZleba iyos gamSvebi meqnizmi panikuri Setevis dasawyisSi (3);
2. mas ganuviTarda damokidebulebis sindromi, romelic gamovlindeba xolme Cais miRebis Sewyvetisas Tavis tkiviliT (ICD F15.3);
3. kofeini aris misi qronikuli uZilobis erTerTi mizezi;
4. misi Zili nakleb yuaTiani iqneba da dasvenebis SegrZnebas naklebad uzrunvelyofs, radgan kofeinis gavleniT Zilis me-3 da me-4 faza aris darRveuli. amitomac grZnobs is daRlilad Tavs. yovelive es zrdis depresiis risks;
5. es damatebiTi barierebia, romelic kbT-s an sxva saxis fsiqoTerapias xels uSlis.
kiTxva mdgomareobs SemdegSi, ratom ar moxda am problemis ufro adre identificireba. ratom aravis gauCnda kiTxva? samwuxarod amaze mkafio pasuxi ar arsebosbs (garda imisa, rom is ubralod ignorirebuli iyo fsiqiatrTa mier). SesaZloa am yovelives qondes cnobieri axsna imiT, rom praqtikos eqimebs zedmetad sjeraT „pozitiuri intervenciebis“ (daniSnuli wamlis) da nakleb yuradRebas uTmoben „negatiur intervenciebs“ sadac pacientma Tavad unda gaakontrolos an uari Tqvas raRacaze. zogadad pacientebis da eqimebis mxridan SeimCeva tendencia naklebi yuradReba miaqcion „bunebrivs“ da kulturalurad daSvebul nivTierebaTa moxmarebas.
klinikuri SemTxveva 2
32 wlis mamakaci menejeri moTavsebuli iyo Cvens mwvave ganyofilebaSi, misma naTesavebma aRweres 24 sT-ani uZilobis istoria, mxedvelobiTi halucinaciebi, daukavSirebeli metyveleba da aJitirebuli qceva. es aris misi pirveli „didi“ avadmyofoba. manamde is ar mkurnalobda. anamnezi ar aris datvirTuli fsiqopaTologiiT. gasinjvisas is iyo agznebuli, dezorganizebuli, ar TanamSromlobda, iyo dabneuli. is ar pasuxobda kiTxvebs, is uyurebda da usmenda halucinaciebs. SemdgomSi, aRniSnuls daemata katatoniuri da cnobierebis perioduli Secvlis simptomatika (deliriuli). ojaxis gadmocemiT is ar moixmars alkohols da narkotikebs. winaswari daiagnozi - organuli fsiqozi (simsivne, encefaliti) an mwvave polimorfuli fsiqiuri aSliloba ICD F23.0. mas mkurnaloben lorazepamiT. kompiuteruli tomograma aris normis farglebSi, iseve rogorc rutinuli sisxlis testebi. mis mkurnalobas emateba haloperidoli. Semdgom ojaxis erT-erTi wevri eubneba eqTans, rom ukanaskneli 48 sT-is ganmavlobaSi pacienti SeuCerebliv svamda yavas da energetikul sasmelebs, raTa SeenarCuenbina sifxizle da daesrulebina samuSao. pacientis mdgomareoba gaumjobesda 3 dReSi, xolo me-5 dRes igi gaewera saavadmyofodan yovelgavri medikamentebis gareSe.
is Tavs kargad grZnobs da saboloo diagnozi aris ICD F 15.53 kofeiniT gamowveuli fsiqozuri aSliloba upiratesad polimorfuli, gamowveuli Zilis naklebobiT da kofeiniT intoqsikaciiT (Cven ar viciT, romelia ufro mniSvnelovani). sagulisxmoa, rom es aRmoaCina eqTanma romelic elaparaka pacientis naTesavs.
SevajamoT, ra unda vicodeT kofeinis Sesaxeb?
1. kofeinis moxmareba TiTqmis universalur xasiaTs atarebs da xSirad aqvs gverdiTi efeqtebi fsiqiatriul aSlilobebze. misi problemad identificireba xSirad ver xdeba;
2. mis mimarT viTardeba damokidebuleba da mas aqvs mkveTrad gamoxastuli damokidebulebis sindromi;
3. is gamSvebia da xels uwyobs SfoTvis gamolenas;
4. is cvlis Zilis struqturas amcirebs Rrma Zilis proprocias (nonrem Zilis me-3 da me-4 fazas), Tundac pacienti ambobdes, rom Zinavs kargad. aman SeiZleba gaarTulos depresiis daZlevis procesi;
5. is iwvevs qronikul uZilobas rac zrdis depresiis risks da/an uwyobs xels damokidebulebis ganviTarebas damamSvideblebis, saZile saSualebebis an alkoholis mimarT;
6. is iwvevs mwvave uZilobas da zrdis bipolaruli aSlilobis gamwvavebis SesaZleblobas;
7. maRal dozebSi man SeiZleba gamoiwvios mwvave fsiqozi gansakuTrebiT Tu Serwymulia Zilis deprivaciasTan.
kofeinTan dakavSirebuli problemebis praqtikuli marTva:
G
1. gaxsovdeT, kiTxoT kofeinis Sesaxeb yvela Tqvens avadmyofs (ar dagaviwydeT energetikuli sasmelebi, mexsierebis „gasaumjobesebeli“ abebi da a.S.) Cven vuxsniT pacients, ris gamo SeiZleba iyos kofeini problema;
2. Cven vurCevT pacients ar miiRos kofeinis Semcveli sasmeli saRamos 4 sT-s Semdeg. es aris imisTvis, rom aviciloT nonrem Zilis me-3 da me-4 fazis daRveva;
3. rodesac miReba maRalia (10-30 finjani dReSi) Cven vuxsniT pacients damokidebulebis da moxsnis sindromis Sesaxeb, Cven vurCevT mas Seamciros miReba Zalian nela, 4 kviris ganmavlobaSi da daiwyos saRamos an Ramis dozis SemcirebiT. es gulisxmobs ufro mcire Wiqebis gamoyenebas, gamotovebas, an nawilobriv Canacvlebas ukofeino eqvivalentebiT;
4. zogadad Cven vurCevT pacients miiRos naklebi vidre 150mg kofeini dRiurad. garda amisa Cven vurCevT yvela pacients romlebic mkurnaloben mdgrad panikur aSlilobas sul cota erTi Tve icxovron kofeinis gareSe (Sesabamisi fsiqoTerapiis da medikamentebis TanxlebiT).
sabolood Cven vamtkicebT, rom kofenis moxmareba aris mxolod erTi aspeqti mkurnalobis yovlis momcvel paketSi. ufrTxildiT martiv ganmartebebs.
Temis irgvliv gTavazobT Semdeg ufaso sakiTxavs internetSi:
literatura:
1. Wikipedia (on line English version) adenosine.
2. Wikipedia (on line English version) caffeine.
3. Greden JF Anxiety or Caffeineism: A Diagnostic Dilemma American Journal of Psychiatry 131: 1089-1092 1974
4. Greden JF et al Anxiety and depression associated with caffeineism among psychiatric inpatients American Journal of Psychiatry 135: 963-966 1978
5. Landolt HP Caffeine Reduces Low-Frequency Delta Activity in the Human Sleep EEG Neuropsychopharmacology 12: 229-238 19956. Ripu D et al Electroencephalographic sleep profiles in single-episode and recurrent unipolar forms of major depression: II. comparison during remission Biological Psychiatry 51: 230-236 2002
No comments:
Post a Comment