პრეპარატ კეტილეპტის კლინიკური ეფექტურობის შეფასება შიზოფრენიის, შიზოაფექტური, ბოდვითი და აფექტური აშლილობების მკურნალობაში (საქართველოს ფსიქიატრიის მოამბე #7)

 preparat “ketileptis” (Quetiapine) klinikuri efeqturobis Sefaseba Sizofreniis, Sizoafeqturi, bodviTi da afeqturi aSlilobis  mkurnalobaSi.

g. sixaruliZe, g. naneiSvili, n. okribelaSvili, v.kenWaZe

fsiqikuri janmrTelobis centri “mentalvita”

kvlevis mizani

kvlevis mizani iyo samkurnalwamlo saSualebis “ketileptis” (Quetiapine) efeqturobis gansazRvra iseTi speqtris fsiqikuri aSlilobebis dros, rogoricaa: Sizofrenia, Sizoafeqturi, bodviTi da afeqturi aSlilobani.

kvlevis dizani

kvleva ganxorcielda  fsiqikuri janmrTelobis centr “mentalvitaSi”  24 stacionirebul  pacientze. aRniSnul kvlevaSi CarTuli iyvnen pacientebi daavadebaTa saerTaSoriso klasifikaciis (ICD-10) Semdegi nozologiuri jgufebidan: afeqturi aSlilobani F30-F39,  Sizofrenia, Sizotipuri aSlilobani F20- F29, organuli bunebis aSlilobani, F06-F07,  nevrozuli, stresTan dakavSirebuli da somatoformuli aSlilobani F40-F4.

daavadeba verificirebuli iyo dsk-10-is kriteriumebis Sesabamisad. kvlevaSi CarTuli pacientebi, aseve, akmayofilebdnen Semdeg kriteriumebs: asaki – 18 - 65 weli; fsiqozis gamo araumetes 5 stacionireba.

agreTve kvlevaSi CarTul iyvnen fsiqikuri janmrTelobis centr “mentalvita”-Si momuSave fsiqiatrebTan ambulatoriul mkurnalobaze myofi pacientebi. sul 39 pacienti.  aRniSnuli jgufis kvlevaSi CarTvis kriteriumebi iyo igive rac stacionarul mkurnalobaze myof pacientebSi.

 preparat ketileptis dozireba ganisazRvreboda 25 mg/dR, - 1000 mg/dR. kvlevis xangrZlivoba stacionarul mkurnalobaze myof pacientebSi ganisazRvreboda 5-dan 15 dRemde, xolo ambulatoriul mkurnalobaze myof pacientebSi 15-dan 45 dRemde.

pacientis fsiqikur statusze preparat “ketileptis” efeqturoba ganisazRvreboda rogorc eqimis mier subieqturad aseve saerTaSoriso praqtikaSi aprobirebuli kiTxvarebiT: pozitiuri simptomebis Sefasebis skala (SAPS); negatiuri simptomebis Sefasebis skala (SANS); bekis depresiis skala (BDI II)

kvlevaSi CarTul pacientebSi xdeboda Semdegi gverdiTi efeqtebis kontroli da aRnusxva: arteriuli wneva, insomnia, eqstrapiramiduli movlenebi, Tavis tkivili, Zilianoba, Tavbrusxveva, hiperaqtivoba, SfoTva.

miRebuli Sedegebi

stacionarul mkurnalobaze myofi pacientebis raodenobam, romlebic CarTuli iyvnen ketileptis kvlevaSi Seadgina 24.

ambulatoriul mkurnalobaze myofi pacientebis raodenobam, romlebic CarTul iyvnen aRniSnuli preparatis kvlevaSi Seadgina 39,

stacionarul mkurnalobaze myof pacientebSi preparatis dozireba Seadgenda 25 – 1000 mg-s.

ambulatoriul mkurnalobaze myof pacientebSi preparatis dozireba umetes SemTxvevebSi Seadgenda 50- 600 mg-s.

fsiqozuri registris aSlilobebis dros pozitiuri simtomebis reducirebis xarisxi ganisazvra kvlevis dawyebamde da kvlevis damTavrebis Semdeg Catarebuli zemoT aRniSnuli skalebis saSualebiT.

qvemoT moyvanil cxrilebSi warmodgenilia pozitiuri da negatiuri simptomebis gradualuri kleba kvlevis periodSi:

cxrili # 1 –

pozitiuri simptomebis Sefasebis kiTxvari stacionari – “ketilepti” (Quetiapine)

SAPS	preparatis miRebamde	kvlevis dasrulebisas
qulebi	48	18

cxrili # 2 –

negatiuri simptomebis Sefasebis kiTxvari stacionari – “ketilepti” (Quetiapine)

SANS	preparatis miRebamde	kvlevis dasrulebisas
qulebi	38	28

cxrili # 3 –

pozitiuri simptomebis Sefasebis kiTxvari ambulatoria – “ketilepti” (Quetiapine)

SAPS	preparatis miRebamde	kvlevis dasrulebisas
qulebi	32	11

cxrili # 4–

negatiuri simptomebis Sefasebis kiTxvari ambulatoria – “ketilepti” (Quetiapine)

SANS	preparatis miRebamde	kvlevis dasrulebisas
qulebi	33	20

cxrili # 5 –

depresiis Sefasebis kiTxvari stacionari – “ketilepti” (Quetiapine)

BECK	preparatis miRebamde	kvlevis dasrulebisas
qulebi	21	11

cxrili # 6 –

depresiis Sefasebis kiTxvari ambulatoria – “ketilepti” (Quetiapine)

BECK	preparatis miRebamde	kvlevis dasrulebisas
qulebi	24	8

arasasurveli Tanamovlenebi “ketilepti” (Quetiapine) gamoyenebisas gamovlinda Semdegi sixSiriT

cxrili # 3 -

ketilepti  - arasasurveli Tanamovlenebi

arasasurveli Tanamovlenebidan yvelaze maRali sixSiriT gamovlinda Zilianoba (11.1%), Semdeg SfoTva (7.4%), hiperaqtiuroba (3.7%), Tavis tkivili (3.7%).

eqstrapiramiduli garTulebebi praqtikulad ar gamovlenila, Tu gaviTvaliswinebT imas, rom preparatis SedarebiT maRali dozebiT gamoyenebisas (200-800 mg/dR) pacients damatebiT eZleoda koreqtori. Zilianoba ar warmoadgenda xSir garTulebas da aRniSnuli arasasurveli gverdiTi efeqtis kupireba moxda efeqturi dozis SerCevidan ramodenime dReSi.

hiperaqtiurobis gamovlenis sixSire Cvens SemTxvevaSi Seadgenda 3.7 % -s (4 pacienti), rac, SesaZloa, ganpirobebuli iyos preparat ketileptis nawilobriv mastimulirebeli moqmedebiT. savaraudod, preparat ketileptis mastimulirebeli efeqti ganapirobebs negatiur simptomebze dadebiT moqmedebas, preparatis xangrZlivi miRebis SemTxvevaSi.

kvlevaSi CarTuli pacientidan erTs gamouvlinda hiperprolaqtinemia da galaqtorea.  

agreTve, Cvens mier Catarebuli kvlevis ganmavlobaSi gamovlinda preparat ketileptis efeqturoba afeqturi speqtris aSlilobebis dros. aRniSnuli preparatis erTdrouli gamoyeneba antidepresantebTan kombinaciaSi (25-400 mg/dR) iZleoda depresiis efeqturi kupirebis saSualebas. preparati efeqturi iyo iseTi mdgomareobebis mkurnalobis dros, rogoricaa bipolaruli afeqturi aSliloba, monopolaruli rekurentuli depresiuli aSliloba,  Sizoafeqturi aSliloba, rogorc depresiuli epizodis aseve maniakaluri epizodis dros antidepresantebTan da normoTimikebTan kombinaciaSi. aRniSnuli mdgomareobebis dros preparatis dozireba Seadgenda 25-400 mg/dR.

 kvlevaSi CarTuli pacientebis absoluturma umravlesobam dadebiTad Seafasa preparatis efeqturoba da gamoTqva survili preparatis Semdgomi miRebis Taobaze.

daskvna

fsiqikuri janmrTelobis centr “mentalvita”-Si Catarebuli klinikuri dakvirvebidan miRebuli Sedegebis analizis Sedegad, kvlevaSi CarTuli eqim-fsiqiatrebi mividnen Semdeg daskvnamde:

preparati gansakuTrebiT efeqturia afeqturi speqtris aSlilobebis dros (bipolaruli afeqturi aSliloba, monopolaruli rekurentuli depresiuli aSliloba, Sizoafeqturi aSliloba).

preparati efeqturia Sozofreniuli da sxva haluciantorul-bodviTi mdgomareobebis dros qvemwvave da remisiis stadiaSi.

preparatis naklebi arasasurveli movlenebidan gamomdinare preparati komfortulia pacientisTvis misi xangrZlivi gamoyenebis SemTxvevaSi.

prepratis nawilobriv stimulaciuri efeqti swori dozirebis da sxva preparatebTan kombinaciis SemTxvevaSi sasargebloa negatiuri simptomebis nawilobrivi reducirebisTvis xangrZlivi miRebis dros.

                      literatura

1.      A.C. Altamuraa, E. Mundoa,  at al: Quetiapine and classical mood stabilizers in the long-term treatment of Bipolar Disorder: A 4-year follow-up naturalistic study” Journal of Affective Disorder Volume 110, Issue 1, Pages 135-141 (September 2008)

2.      Bogart GT, Chavez B. “Safety and efficacy of quetiapine in bipolar depression.” Englewood Hospital and Medical Center, Englewood, NJ, USA.PMID: 19809011 [PubMed - in process]

3.      Goldstein JM, et al. Unique mechanism of action for the antidepressant properties of the atypical antipsychotic quetiapine. Poster NR336 presented at the American Psychiatric Association 160th Annual Meeting, San Diego, California, 19-24 May, 2007

4.      Laurie Barclay, MD “Quetiapine Well-Tolerated, Effective in Refractory Schizophrenia”. CINP Annual Meeting. June 2002

5.      Montgomery S, et al. A randomised, placebo-controlled study of once-daily extended release quetiapine fumarate (quetiapine XR) monotherapy in patients with major depressive disorder (MDD). Poster presented at the International Forum on Mood and Anxiety Disorders, Budapest, Hungary, 5-7 December, 2007

6.      Riedel M, Muller N, Strassnig M,el all .”Quetiapine has equivalent efficacy and superior tolerability to risperidone in the treatment of schizophrenia with predominantly negative symptoms”  Eur Arch Psychiatry Clin Neurosci 2005;255(6):432-437

7.      S. Devarajan “Quetiapine Plus SSRI in Treatment-Resistant Depression”. Department of Psychiatry, University of Western Ontario, Canada, 2006

8.      Small JG, Kolar MC, Kellams JJ.” Quetiapine in schizophrenia: onset of action within the first week of treatment”. Curr Med Res Opin 2004;20(7):1017-1023

Evaluation of clinical efficiency of Ketilept (Quetiapine) during schizophrenia, schizoaffective, delusional and affective disorder treatment

G.Sikharulidze, G.Naneishvili, N.Okribelashvili, V.Kenchadze

Centre of Mental Health “MENTALVITA”

The aim of the study was to examine efficiency of Ketilept during such kind of psychic disorders as schizophrenia, schizoaffective, delusional and affective disorders. Also the study was intended to provide particular recommendations for use of this medicament in different psychic conditions. In this study were involved 63 patients in the centre of mental health “MENTALVITA”  from the next nosological groups of the international classification (ICD-10): affective disorders F30-F39, schizophrenia, schizotypal disorders F20-F29, disorders of organic nature F00-F09, , neurotic, stress-related and somatoform disorders F40-F48. The efficiency of Ketilept on patients’ psychic status was defined by approbated international questionnaires and the doctors’ personal experience: Positive symptoms assessment scale (SAPS); Negative symptoms assessment scale (SANS); Beck Depression Inventory (BDI II)

The number of inpatients involved in the study was 24, the number of outpatients – 39. Inpatient treatment dosage was 25-1000mg.

This medicament is particularly effective in treatment of affective disorders (Bipolar affective disorders, recurrent disorder, schizoaffective disorder)

The medicament is efficient with schizophrenic and other hallucinatory delusional cases during sub acute and remission phases.

With minor side effects this medicament is comfortable for prolonged use.

In case of correct dosage and combination with other medicaments partial stimulating effect of the medicament is efficient for partial reduction of negative symptoms, if used for a long period.

ატიპიური ანტიფსიქოტიკის - ამისულპრიდის გამოყენება შიზოფრენიით დაავადებულთა მკურნალობაში (საქართველოს ფსიქიატრიის მოამბე #7)

atipiuri antifsiqotikis amisulpridis (soliani) gamoiyeneba SizofreniiT daavadebulTa mkurnalobaSi

               v.kaSia,

s/s m.asaTianis sax.Ffsiqiatriis s/k instituti

                                       

   

axali Taobis, e.w. atipiuri antifsiqozuri medikamentebi imyofebian ara marto mkvlevarTa, aramed praqtikuli eqimebis yuradRebis centrSi, radgan dReisaTvis preparatebis es jgufi avlens axal SesaZleblobebs, rogorc Sizofreniis paTogenezis Seswavlis, aseve am daavadebis mkurnalobaSi yoveldRiuri Terapiis pirobebSi.

atipiuri neiroleptikebis jgufis fuZemdebeli gaxda klozapini (1968w), romelmac gansazRvra atipiuri antifsiqotikebis koncefcia. igi iyo pirveli saSualeba, romelSic antifsiqozuri aqtivoba ganpirobebuli iyo ara D2 receptorebiT – bodvisa da halucinaciis sawinaaRmdego preparatTa zemoqmedebis maSin erTaderTi aRiarebuli safuZvliT _ aramed misi unariT, moexdina 5HT2 da H1 receptorebis blokireba. preparati gamodga efeqturi rezistentuli da rTulad gankurnebadi fsiqozuri aSlilobebis TerapiaSi, aseve, Sizofreniis im formebis mimarT, sadac pirvel planze gamodioda negatiuri simptomebi. gamoirkva, rom preparats gaaCnia tradiciuli neiroleptikebisgan gansxvavebuli Taviseburi antifsiqozuri efeqti, dabali iSviaTad aRmocenebadi eqstrapiramiduli gamovlinebebi, romlebic iTxoven Terapiuli kriteriumebisa da stereotipebis gansazRul cvlilebebs preparatis SerCevisas.

    80-iani wlebis bolos da 90-ani wlebis dasawyisSi gamoCndnen sxva atipiuri neiroleptikebi _ preparatebi, ,romlebic gacilebiT naklebi gverdiTi efeqtebiT xasiaTdebian (upiratesad nevrologiis sferoSi) da aqvT unari SizopreniiT daavadebulTa negatiuri simptomatikis koreqciisa.

antipsiqozur saSualebaTa gamoCenam, romlebic ar iwveven  eqstrapiramidul gverdiT movlenebs, eWvis qveS daayena TviT termini ,,neiroleptiki” – G.Delley da P.Denikez - frangi avtorebis gagebiT. ueWvelad, Tanamedrove poziciebidan ufro swori iqneboda am jgufis fsiqotropuli preparatebi agveniSna rogorc antifsiqotikebi maTi ZiriTadi klinikuri moqmedebis mixedviT. miTumetes, gansazRvreba “neiroleptiki” garkveulwilad rCeba swori, imdenad ramdenadac mravali axali preparati –maRal dozebSi, romlebic zogjer aRemateba aucilebel Terapiul dozebs, iwveven qerqqveSa kvanZebis blokirebasa da tipiur eqstrapiramidul simptomatikas.

atipiurebs miakuTvneben mTel rig Tanamedrove antifsiqozur saSualebebs, romlebic gansxvavdebian klasikuri neiroleptikebisgan, maT Soris:

1.                    eqstrapiramiduli aSlilobis warmoqmnis mcire sixSiriT;

2.                   gviani depresiebis warmoSobis mcire sixSiriT;

3.                   prolaqtinis donis klinikurad umniSvnelo matebiT, da Sesabamisad iseTi simptomebis dabali sixSiriT, rogoricaa: ginekomastia, galaqtorea, menstrualuri ciklis darRveva, seqsualuri darRvevebi;

4.                   ufro efeqturi kontroli Sizofreniis negatiur simptomebze;

5.                   neiroqimiuri zemoqmedebis speqtrSi 5HT2 receprorebis blokada D2 receptorebis blokadasTan SedarebiT;

6.                   azrovnebis formaluri aSlilobani.

ukanaskneli pirobiTad SeiZleba ganvixiloT ,rogorc ZiriTadi Cveneba atipiuri antifsiqotikis daniSvnisa uwyvetad mimdinare da masTan axlos mdgomi SeteviT mimdinare Sizopreniis farglebSi.

     im stereotipebis mixedviT, romlebic Camoyalibda yoveldRiur praqtikaSi mwvave fsiqozur avadmyofTa mkurnalobisas klasikur neiroleptikebTan mimarTebaSi, eqimi orientacias axdens Semdeg wesebze;

1.                    upiratesoba eniWeba antifsiqozur preparats gamoxatuli sedaciuri efeqtiT, rac ganpirobebulia surviliT miRweul iqnas sedacia Terapiis pirvel dReebSi da asaxavs warmodgenas sedaciuri da antifsiqozuri efeqtebis pirdapir kavSirze;

2.                   upiratesoba eniWeba ineqciur formebs, romlebic gamoiyeneba

ufro xangrZlivad, vidre es aucilebelia agresiiT da fsiqomotoruli agznebiT mimdinare mdgomareobebis kupirebisaTvis, radgan farTod aris gavrcelebuli warmodgena maTi Zlieri antifsiqozuri aqtivobis Sesaxeb;

3. antifsiqotikebis dozebi swrafad izrdeba Terapiis ukve pirvel dReebSic rac ganpirobebulia swrafi sedaciuri da antifsiqozuri efeqtis miRebis surviliT, roca Terapiis zogadi efeqtis Sefasebisas gverdiTi efeqtebis maRali done gadadis meore planze;

4. xSirad gamoiyeneba kombinaciebi Terapiis adreul etapebze, rac aixsneba antifsiqozuri efeqtis gaZlierebisaken miswrafebiT;

5. eqstrapiramiduli aSliloba fasdeba, rogorc preparatis antifsiqozuri aqtivobis maCvenebeli;

6. miRebulia qolinerguli preparatis koreqciis mizniT daniSvna neiroleptikis gverdiTi moqmedebis ganviTarebamde.

miuxedavad am SexedulebaTa farTo gavrcelebisa, kontrolirebadi gamokvlevebi maT ar adastureben. ase rom, warmodgena antifsiqozuri da sedaciuri efeqtebis korelaciis Sesaxeb ar damtkicda. metic, dReisaTvis  naCvenebia, rom isini Sejamebuli klinikuri movlenebia da Sesabamisad, SesaZlebelia arCeviTi moqmedeba TiToeul maTganze calcalke.

      dozis swrafi momateba Terapiis pirvel dReebSi saSualod rekomendirebul dozaze metad, aseve neiroleptikebis kombinireba antifsiqozuri efeqtis daCqarebis mizniT, xSirad Terapiulad gaumarTlebelia. swored preparatis antifsiqozuri (da ara sedatiuri) efeqtis realizaciisTvis saWiroa ufro xangZlivi dro, xolo maRali efeqturobisa da gverdiTi efeqtebis dabali fonis optimaluri balansisaTvis saWiroa neli titracia individualurad minimaluri dozis dadgenis mizniT. vadam, romelic aucilebelia preparatis antifsiqozuri aqtivobis gamosavlenad, rogorc wesi, unda Seadginos 4-6 kvira.

      kombinirebulma Terapiam, arasasurveli urTierTqmedebis saSiSroebis garda SeiZleba gamoiwvios sirTuleebi medikamenturi rezistentobis ganviTarebis gamo preparatis Secvlis aucileblobis dros.

      rac Seexeba eqstrapiramidul aSlilobebs, isini korelireben antifsiqozur efeqtTan, mxolod maSin, roca gamoiyeneba preparati gamoxatuli D2 mablokirebeli moqmedebiT, romelic vrceldeba aramarto mezolimbiur, aramed nevrostrialur sistemebzec.
klasikuri da atipiuri antifsiqotikebis SedarebiTma kvlevam aCvena, rom meore generaciis preparatebis, (anu atipiuri neiroleptikebis) antifsiqozuri speqtri moicavs aramarto produqtiul, aramed negatiur simptomebsac.  eqstrapiramiduli gverdiTi efeqtebi, romlebic warmoCindebian klasikuri antifsiqotikebiT mkurnalobisas, TamaSoben SesamCnevad ufro mniSvnelovan negatiur rols daavadebis mimdinareobisa da Terapiis efeqturobaSi (Srestkas, 2000).

atipiuri antifsiqotikebiT Sizofreniis sxvadasxva formebis mkurnalobis efeqturoba cnobilia. kidev ufro matulobs maTi roli Terapiulad rezistentul SemTxvevebSi xangrZlivi antifsiqozuri SemanarCunebeli Terapiis warmoebisas.

am momentisaTvis atipiur antifsiqozur medikamentebs miakuTvneben Semdeg preparatebs: amisulprids, klozapins, risperidons, aripiprazols, qvetiapins, remoqsiprids, ziprazidons, sertindols, zotepins.

60-70-ian wlebSi histoqimiuri da radioimunologiuri meTodebis saSualebiT dadginda, rom Tavis tvinSi arsebobs diferenciuli neiroqimiuri sistemebi-noradrenerguli, dofaminerguli, serotoninerguli da sxva. isini warmoadgenen tvinis struqturul kompleqss, romelTa funqciac ganisaRvreba zogadi transmiteriT da masTan urTierTqmedi receptoriT.

Sizofreniis biologiur TeoriaTa Soris am droisTvis ufro metad farTo gavrceleba Hhpova neirotransmiterulma, gansakuTrebiT, dofaminurma Teoriam. dofami nuri receptorebis ZiriTad tipebs warmoadgens D1 da D2 receptorebi. isini Warboben striatumSi – kudian birTvsa da qerqSi.

antifsiqozuri moqmedebisaTvis dakavebuli unda D2 receptorebis 70%, eqstrapiramiduli simptomebi ki maTi 80%-is dakavebisas vlindeba. amgvarad ixsneba antifsiqozuri d agverdiTi efeqtebi klasikuri antifsiqozurebiT mkurnalobisas. Tumca situacia Sizofreniis dofaminur hipoTezasTan dakavSirebiT ufro rTuli aRmoCnda axali generaciis antifsiqozuri preparatebis gamoCenis Semdeg. gairkva, rom es neiroleptikebi boWaven ara marto dofaminur (D2, D3, D4), aramed serotoninul (5HT2), adrenergul (A1), qolinergul da histaminur receptorebsac.

tvinis neiroqimiuri sistemis sxvadasxva receptorebze antifsiqozuri saSualebebis urTierTqmedebis Sesaxeb arsebuli monacemebis Tanaxmad, Sizofreniis dofaminuri hipoTeza ar SeiZleba ganxilul iqnas izolirebulad da sworia warmodgena zogadi transmiteruli Teoriis arsebobis Sesaxeb, romlis CarCoebSic SesaZlebelia mWidro kavSiri da SeWiduloba cvlilebebisa sxvadasxva sistemebSi, rac jer kidev Sesaswavlia.

amisulpridi atipiuri antifsiqozuri preparatia, romelic mniSvnelovnad gansxvavdeba sxva atipiuri antifsiqotikebisgan. misi ZIriTadi gamasxvavebeli Taviseburebaa D2, D3 receptorebis mimarT upiratesi arCeviToba. amisulpridi gamoiyeneba antifsiqozur saSualebad 1987 wlidan. am drois ganmavlobaSi msoflios sxvadasxva qveyanaSi am preparatiT warmoebulia Terapia 600 milioni dRis manZilze (Guo, 2007; Perrault, 1996).

klinikur praqtikaSi amisulpridi xasiaTdeba eqstrapiramiduli aSlilobebis ganviTarebis dabali riskiT da zemoqmedebiT rogorc pozitiur, aseve negatiur simptomebze (Mohler, 2000; Burns, 2001).

amisulpridi rogorc arCevis preparati SeiZLeba gamoyeneul iqnas Sizofreniis mwvave epizodebis kupirebisTvis, dabal dozebSi ki is SesaZleblia, warmoadgendes dReisaTvis saukeTeso saSualebas qronikuli negatiuri simptomebis samkurnalod (Olie, 2006). amisulpridis mTliani farmakologiuri efeqti, rac am momentisTvis aris cnobili, dakavSirebulia D2, D3, qvetipis dofaminuri receptorebis blokirebasTan.

amisulprids ar gaaCnia swrafva arc erTi sxva receptoris mimarT. am azriT amisulpridi mniSvnelovnad gansxvavdeba yvela sxva klasikuri neiroleptikisgan da yvela atipiuri antifsiqotikisgan. yvela sxva antifsiqotiki urTierTqmedebs did an mcire ricxvTan sxvadasxva receptorebisa. amisulpridi ablokirebs pre - da postsinafsur  receptorebs, amasTan, aCqarebs tvinSi dofaminis cvlas.

amisulpridi mcire dozebSi upirvelesad ablokirebs presinafsur receptorebs, romlebic aregulireben dofaminis gamotyorcnas, amitom maTi blokireba amaRlebs dofaminis gamoyofas da amsubuqebs dofaminergul gadacemas. amisulpridi upiratesad ablokirebs limbur struqturebSi ganTavsebul dofaminur receptorebs da ufro mcired, zoliani sxeulis receptorebs.

amisulpridis efeqti tvinis sxvadasxva areSi araeTgvaria, rac dakavSirebulia tvinis sxvadasxva nawilSi pre- da postsinafsuri receptorebis gansxvavebul struqturasTan.

amisulpridis gavlenis regionaluri gansxvaveba Seadgens misi atipuri antifsiqozuri moqmedebis safuZvels /Bertolini G., 2005, NUSS p.2007/.

literaturis mixedviT es preparati, erTis mxriv, ar Camouvardeba Tavisi antifsiqozuri aqtivobiT klasikur neiroleptikebs, romlebic gamoyenebaSia (haloperidoli, triftazini), xolo meores mriv, mniSvnelovnad aRemateba maT usafrTxoebisa da gadatanadobis maCvenebliT. vvaraudobT, rom neiroqimiuri moqmedebis es Tavisebureba ganapirobebs amisulpridis maRal efeqturobas Sizofreniuli aSlilobebis mTeli speqtris mimarT, rogorc pozitiuri, aseve negatiuri simptomebis dros. /Rein W. 2000/.

dozirebis meTodi unda warmoebdes ramdenime ZiriTadi principiT: 

a)                  dozis SerCeva unda warmoebdes individualurad;

b)                 ZiriTadi mwvave fsiqozuri mdgomareobisas – pozitiuri simptomatikis siWarbiT – 800 mg/dR, or miRebaze (maqsimaluri dozaa 1200 mg/dR).

g) stabiluri fsiqikuri mdgomareobis miRwevis an fsiqozis ararsebobis SemTxvevaSi – 400 mg/dR. Sereuli pozitiuri da negatiuri simptomatikis mqone pacientebisaTvis dozebi ise unda SeirCes, rom uzrunvelyofili iyos maqsimaluri kontroli pozitiur simptomebze. qronizirebuli fsiqozuri mdgomareobis dros – negatiuri simptomebis upiratesobiT – SemanarCunebeli mkurnaloba unda dadgindes minimalurad efeqturi dozebiT (50-dan 300 mg/dR.-mde dReSi erTjeradi miRebiT).

pozitiuri simptomatikis ganaxlebisas aucilebelia dozebis gazrda sawyis donemde stabilizaciis stadiis miRwevamde.

amisulpridis fsiqotropuli moqmedebis speqtrSi SeiZleba gamovyoT 3 faza:

I faza – fsiqosedaciuri moqmedeba, romelic sWarbobs agznebis, aJitaciis, mousvenrobis SemTxvevaSi.

II faza – gamaaqtiurebeli moqmedeba – xasiaTdeba harmoniulobiT da vlindeba interesTa gamococxlebaSi, urTierTobebis, kontaqturobis gaumjobesebaSi.

III faza – sakuTriv antifsiqozuri – romelic moicavs halucinaciuri da bodviTi simptomebis Semcirebas da Semdgom sedacias.

I fazis moqmedeba iwyeba ramdenime saaTis Semdeg da aRwevs maqsimums  

meore - mesame dRisTvis. pirvel rigSi icvleba agznebis motoruli komponenti (Jestikulacia, agresiuli qceva), normalizdeba Zili, qcevaze pirovnuli kontroli. amisulpridi iTvleba erT-erT urgentul preparatad da iniSneba im SemTxvevaSi, roca saWiroa saswrafo sedaciuri efeqtis miReba. 

pozitiur da negatiur simptomTa Terapia da cvlilebaTa dinamika mwvave fsiqikuri mdgomareobis magaliTze (12 avadmyofi afeqtur-bodviTi SetevebiT).

amisulpridiT mkurnalobisas klinikurad ukve pirveli kviris dasasrulsa da meore kviris dasawyisisaTvis, aRiniSneboda avadmyofTa mdgomareobaSi xarisxobrivi cvlilebebi, rac gamoixateba daZabulobis, iWvneulobis, fsiqozuri SiSis mniSvnelovan SesustebaSi. pacienti ganicdis mdgomareobis mniSvnelovan Semsubuqebas, mZime gancdebisa da SiSis donis daqveiTebas. yuradRebas ipyrobs pacientis “misawvdomoba”, isini naTlad da Tanmimdevrulad aRweren im movlenebs, rac Tavs gadaxdaT. am mdgomareobas Tan axlavs garkveuli emociuri aweva, Tavisufali azrovnebis gaumjobeseba. avadmyofebi xdebian ufro  megobruli, aqtiuri, garegnulad mowesrigebuli qcevebiT. aRwerili mdgomareobis xangrZlivoba ar aRemateboda 10 dRes. Semdgom dReebSi iwyeboda halucinatoruli aSlilobis Sesusteba, mcirdeboda maTi intensivoba, Sinaarsis mniSvneloba. isini aRar warmoadgendnen avadmyofTa gancdis intensivobis msazRvrels. halucinatorul gacdaTa gamoxatulebis Semcirebis paralelurad iwyeboda paranoiduli simptomebis Secvla, miT ufro swrafad, rac ufro naklebad iyo igi damokidebuli halucinaciebze. pacientebi ufro naklebad fiqrobdnen sakuTar eWvebze, SiSebze, xdebodnen ufro kritikulebi.

amrigad, SizofreniiT daavadebulTa mwvave mdgomareobis kupirebisas amisulpridma gamoiCina didi efeqturoba. amisulpridi swrafad axdenda mwvave fsiqozuri mdgomareobisas produqtiuli simptomatikis kupirebas, amasTan gamoxatuli antifsiqozuri moqmedeba vlindeboda mkurnalobis pirvelsave dReebSi. amisulpridi axdenda dadebiT zemoqmedebas ara marto bodviT da halucinatorul simptomebze, aramed SfoTvaze da daZabulobis afeqtze, anu mwvave grZnobadi bodvis gamovlinebebze.

Sizoafeqturi fsiqozebis kupirebisas amisulpridi (4 avadmyofSi) avlens moqmedebis zogierT Taviseburebas, efeqturad axdens ra halucinatoruli simptomatikis reducirebas. amas mivyavarT avadmyofis qcevis swraf mowesrigebamde, rac saSualebas aZlevs maT aqtiurad miiRon monawileoba mkurnalobis procesSi; vlindeba bunebrivoba, kontaqturoba, kritikuloba.

miuxedavad amisa aucileblad unda aRiniSnos, rom sustdeba sakuTriv maniakaluri afeqtis kupirebis tempi.

mTlianobaSi mwvave fsiqozuri mdgomareobis reduqcia atarebs harmoniul xasiaTs. umravles SemTxvevaSi aRiniSneba rogorc halucinaciur-paranoiduli, aseve motoruli agznebis gamoxatulebis Tanabarzomieri daqveiTeba.

amisulpridis arsebiT upiratesobas warmoadgens SesamCnevi madeprimirebeli gavlenis arseboba. qronikuli bodviTi simptomebis gamwvavebiT (15 av-i) avadmyofebSi, rac gamoixateboda difuzuri eWvebiT, usagno SiSebiT, wyvetili-fragmentuli TvalTvalis ideebiT, mowamvlis Sinaarsis azrTa mozRvavebis epizodebiT, am preparatiT mkurnalobisas ar SeimCneoda damuxruWebuli moqmedeba.

amisulpridi 400-800 mg/dR. dozebiT Terapiis dawyebisas, pirvel dReebSi SeimCneoda moduneba, sisuste, Zilianoba.

qronikuli paranoiduli simptomatika reducirdeboda ufro Tanabrad, SeimCneoda emociuri fonis garkveuli daqveiTeba.

mTlianobaSi, pacientebSi qronikuli halucinatorul-paranoiduli aSlilobiT, SeimCneoda erTiani fsiqozuri sindromebis dinamikis disociacia, rac gamoixateboda fsiqozuri daZabulobis swraf Semsubuqebasa da halucinatoruli da bodviTi simptomatikis ufro Tanabari dinamikis CamorCenaSi.

emociur simptomebs miekuTvnebian emociuri SemosazRvruloba da afeqtis daClungeba, ukontaqtoba, aspontanuroba (8 av-i).

negatiur aSlilobaTa dinamika klinikurad gamoixateboda imiT, rom avadmyofebi xdebodnen ufro kontaqturebi, iolad TanamSromlobdnen personalTan da axloblebTan, ramdenadme farTovdeboda maTi interesebis wre. es Tavis gamoxatulebas poulobda emociuri da inteleqtualuri moqmedebebis zogad gamococxlebaSi, kerZod avadmyofTa garegani gamoxatulebis SecvlaSi, Jestikulaciis, mimikis gamococxlebaSi. avadmyofebi iwyebdnen maT garemoSi cxovrebis movlenebis mimarT interesis gamovlenas, zogjer iCendnen sakuTar iniciativas urTierTobaSi da moqmedebaSi. aRiniSneboda abstraqtuli azrovnebis unaris gaumjobeseba, mniSvnelovnad mcirdeboda saazrovno moqmedebebis da qcevis rigiduloba. metyvelebiTi aqtiuroba xdeboda ufro spontanuri, iRebda ufro bunebriv xasiaTs. mkurnalobis bolosken (6-8kviramde) avadmyofTa nawili ubrundeboda fsiqiuri daavavdebis gamwvavebis gamo Sewyvetil samuSaos an swavlas.

negatiur simptomTa mTeli kompleqsi reducirdeboda erTgvarovnad, romelime wamyvani faqtoris gamoyofa SeuZlebeli aRmoCnda. Tumca ar aris naTeli amisulpridis antifsiqozuri efeqti ganpirobebulia am simptomebze pirdapiri moqmedebiT, Tu pirveladi simptomatikis alagebiTaa gaSualebuli. klasikuri neiroleptikebis negatiur simptomatikaze meoradi gaSualebuli zemoqmedeba aRiarebulia mravali avtoris mier.

gverdiTi efeqtebis speqtrisa da amisulpridis amtanobis analizisas aRmoCnda misi maRali usafrTxoeba. naCvenebia, rom SemTxvevaTa umetesobaSi amisulpridis miRebis fonze mcirdeboda nairoleptiuri gamovlinebebi, romlebsac adgili hqondaT amisulpridiT Terapiis dawyebamde  da warmoadgendnen tradiciuli fsiqotropuli saSualebiT wina mkurnalobis Sedegs.

amisulpridiT mkurnalobisas SesaZlebelia gverdiTi nevrologiuri efeqtebi. mniSvnelovania, rom akatizia gamoixateba ufro xSirad, vidre parkinsonizmi. xazgasasmelia, rom zemoT moxsenebuli gverdiTi efeqtebi, Tu isini mainc gvxvdebian, Cveulebriv iolad gadaitanebian da dozis SemcirebasTan erTad qrebian. amisulprids SeuZlia gamoiwvios prolaqtinis momateba orive sqesis warmomadgenlebSi. hiperprolaqtinemia xels uwyobs iseT darRvevebs rogoric aris amenorea, galaqtorea, qalebSi libidos Semcireba, mamakacebSi impotencia. xangrZlivi  miRebisas SesaZlebelia osteoporozis, gul-sisxlZaRvTa darRvevebis mimarT predispozicia.

amisulpridiT mkurnaloba asocirdeba avadmyofTa wonaSi mcire matebasTan, vidre ufro xSirad gamoyenebadi atipiuri antifsiqotikebis-olanzapinisa da risperidonis SemTxvevaSi.

preparati amisulpridi sakmarisad didixania (20 welze metia) Setanilia fsiqiatriis praqtikaSi da dReisaTvis Tavi daixasiaTa rogorc maRal aqtiurma antifsiqotikma fsiqotropuli aqtivobis maRali speqtriT. amisulpridi moicavs zemoqmedebas ara marto produqtiul, aramed nagatiur fsiqozur simptomatikaze, eqstrapiramiduli efeqtebis minimaluri gamoxatulebiT an sruli ararsebobiT. amasan erTad xazgasasmelia preparatis sasikeTo gavlena SizofreniiT daavadebulTa kognitiuri procesebis mimdinareobaze. arsebiTia isic, rom dasabuTebulia amisulpridis udavo upiratesoba klasikuri neiroleptikebiT Terapiis rezistentul SemTxvevebSi, xolo rigi dakvirvebebiT misi upiratesoba iseT atipiur preparatebTan mimarTebaSi rogoric aris klozapini.  

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