Mogwirizana ndi cholinga chake, Board of Editorial Board ya MedTvoiLokony imayesetsa kupereka zodalirika zachipatala mothandizidwa ndi chidziwitso chaposachedwa cha sayansi. Mbendera yowonjezerapo "Zofufuza Zomwe Zili" zikuwonetsa kuti nkhaniyi idawunikidwa kapena kulembedwa ndi dokotala mwachindunji. Kutsimikiza kwa magawo awiri awa: mtolankhani wazachipatala komanso dokotala amatilola kuti tipereke zomwe zili zapamwamba kwambiri mogwirizana ndi chidziwitso chamankhwala chamakono.
Kudzipereka kwathu m'derali kwayamikiridwa, pakati pa ena, ndi Association of Journalists for Health, yomwe inapatsa Bungwe la Editorial la MedTvoiLokony ndi mutu waulemu wa Mphunzitsi Wamkulu.
40 peresenti ya anthu a ku Ulaya amadwala matenda a maganizo. Mantha ali ponseponse. Mankhwalawa amayenera kukhala benzodiazepines. Amafulumira kupondereza nkhawa ndikukupangitsani kugona. Madokotala adawalembera odwala omwe ataya mtima popanda kukayikira. Zinapezeka kuti zikagwiritsidwa ntchito mosayenera, zimakhala zosokoneza bongo, zimawonjezera nkhawa, komanso zimapangitsa kuti anthu azikumbukira. Kodi muyenera kuchita mantha benzodiazepines ndi mmene kulimbana ndi nkhawa? Zuzanna Opolska, mtolankhani wa MedTvoiLokony, akufunsa dokotala wodziwika bwino wamisala - Sławomir Murawiec, MD, PhD.
- Pafupifupi 40 peresenti ya anthu a ku Ulaya amadwala matenda a maganizo. Iwo amaposa matenda a mtima ndi khansa m’ziŵerengero. Zofala kwambiri ndi matenda a nkhawa
- Odwala otaya mtima amapempha madokotala kuti awapatse mapiritsi omwe angachepetse nkhawa mwamsanga. Izi zimapereka benzodiazepines. Ndi gulu la mankhwala omwe ali ndi anxiolytic, sedative, hypnotic ndi anticonvulsant
- Anthu a ku Britain miliyoni imodzi amwerekera ndi mankhwalawa, Ajeremani mamiliyoni asanu ndi limodzi amamwa mankhwala oziziritsa kukhosi tsiku lililonse. Ku Poland, kukula kwa zochitikazo kungakhale kofanana
Zuzanna Opolska, MedTvoiLokony: Dokotala, akuti benzodiazepines ndi zosavuta kuyamba kutenga, koma zovuta kwambiri kusiya. Chifukwa chiyani?
Sławomir Murawiec, MD, PhD: Ichi ndi chododometsa mu psychiatry. Tikamafunsa odwala zomwe amawopa za mankhwala amisala, nthawi zambiri amati "kusintha kwa umunthu" ndi "kuledzera." Pa nthawi yomweyi, gulu lodziwika bwino la mankhwala ndi benzodiazepines. Ndipo ndilo gulu lokhalo lomwe limakonda zizolowezi.
Kodi zonsezi ndizowopsa?
Ayi. Kutengera theka la moyo, titha kusiyanitsa ma benzodiazepines amfupi, apakatikati komanso anthawi yayitali. Zakale ndi zoopsa kwambiri.
Chifukwa chiyani?
Amakhala ndi kukhazika mtima pansi mwachangu komanso momveka bwino komwe kumatha pakatha maola angapo. Choncho, pali chiyeso chofikira piritsi lina ndikubwereza zotsatira zomwe zapezedwa. Nthawi zonse timakhala ndi nkhawa, ngakhale kwamuyaya. Kukhala ndi moyo wabwino kumadalira kumwa mankhwala. Ndizowopsa.
Chifukwa kutali m'nkhalango, choipitsitsa - ndi nthawi mlingo panopa sikokwanira kwa ife?
Inde - kulolerana kwa mankhwalawa kumawonjezeka. Wodwalayo akalowa m'malo osokoneza bongo, timakhala ndi chizolowezi choyipa. Chifukwa m'kupita kwa nthawi, iye amafunikira Mlingo womwe ndi wokwera kwambiri, koma osapeza zomwe akufuna. Ndikoyenera kutsindika, komabe, kuti benzodiazepines si thupi. N'chimodzimodzinso ndi mowa - onse omwe amamwa, koma osati zidakwa zonse. Benzodiazepines imayambitsa chiwopsezo choledzeretsa, koma sikuti aliyense amene amayang'ana mapiritsi adzakhala oledzera.
Mankhwalawa anali atagwiritsidwa ntchito kale m'zaka za m'ma 60, ngakhale atagwiritsidwa ntchito mopitirira muyeso, chifukwa patatha zaka 30 malangizo ogwiritsira ntchito mosamala adasindikizidwa. Kodi madokotala akuwalemberabe mankhwala mosasamala masiku ano?
Mwamwayi, izi zikusintha. Nditayamba kugwira ntchito, odwala ambiri anali kugwiritsa ntchito benzodiazepines. Kuchokera kwa asing'anga - madokotala apabanja lero. Ndikuganiza kuti panalibe thandizo kuseri kwa makinawa. Tangoganizirani wodwala amene ali ndi mavuto m'moyo, ali maso, wamanjenje, wokwiya. Zimawawa apa, zimatsikira uko. Amapita kwa GP yemwe amayesa zonse zomwe angathe, amamupatsa mankhwala a m'mimba, mtima komanso chilichonse. Iye sakudziwabe chimene chavuta ndi munthu wodwala. Pambuyo pake, dokotala amazindikira kuti ngati apereka benzodiazepine, wodwalayo amakhala bwino. Amasiya kubwera ndikunena za matenda ambiri. Mwamwayi, masiku ano chidziwitso cha kuvutika maganizo ndi chachikulu kwambiri kuposa kale, ndipo madokotala a mabanja amatha kugwiritsa ntchito mankhwala osokoneza bongo kuchokera ku gulu la selective serotonin reuptake inhibitors (SSRIs) chifukwa amadziwa kuti ndi njira yabwino kuposa benzodiazepines.
Kumbali ina, osati kale kwambiri mawu akuti “ndapsinjika maganizo” sanaloŵe m’kamwa.
Ndizowona. Kukhumudwa kumakhala ndi magulu angapo a zizindikiro: chisoni, anhedonia, omwe odwala amawafotokozera kuti: "Ndine wokondwa, sindiri ndi chidwi ndi chirichonse", kuchepa kwa moyo (kuyendetsa galimoto), kusokonezeka kwa tulo ndi nkhawa. Ngakhale kuti benzodiazepines amatha kugwira ntchito yomaliza, samachiritsa kuvutika maganizo. Zili ngati kulimbana ndi kutentha thupi m’malo mochiza matenda a bakiteriya ndi mankhwala opha tizilombo. Si chithandizo chamankhwala chomwe chingathandize. Zotsatira zake, timakhala ndi nkhawa zochepa, koma timakhalabe achisoni komanso osalimbikitsidwa kuchitapo kanthu.
Ndani makamaka ali pachiwopsezo cha chizolowezi cha benzodiazepine? Kodi ndi zoona kuti mwaledzera?
Osati kokha. Zachipatala, timaziyika momveka bwino: anthu omwe amakonda chizolowezi.
Akazi ndi omwe ali pachiwopsezo kwambiri kuposa amuna?
Tili ndi magulu osiyanasiyana odwala. Achinyamata amayesa kugwiritsa ntchito mankhwala osokoneza bongo kuti asinthe malingaliro awo, ndipo kaŵirikaŵiri amakhala abwinopo kusiyana ndi akatswiri amisala amene amafunafuna mankhwala odziŵa mmene amagwirira ntchito.
Amuna amapita kukamwa mowa nthawi zambiri, ndipo akazi amayesa kuthetsa vutoli mwa "kudziletsa" ndi kulepheretsa maganizo. Makamaka amayi apakati omwe amadzipeza kuti ali ndi moyo wovuta, amayesa kuthetsa ululu wa moyo ndi mapiritsi. Choncho, iwo mofunitsitsa kufika kwa benzodiazepines, amene mu nkhani iyi si mankhwala a chisokonezo, koma kukhala njira kulimbana ndi zovuta moyo.
Anthu ena alibe vuto la benzodiazepines kapena mowa. Amawagwirizanitsa. Tabuleti kuphatikiza galasi kapena botolo la vinyo - kuopsa kwake ndi kotani?
Ndizowopseza kwambiri. Mtheradi osavomerezeka. Ndipo mukasiya kumwa mankhwala, wodwalayo amasiyidwa ndi mavuto angapo: chifukwa cha zovuta za moyo, chifukwa cha kusowa kwa mankhwala ndi kuledzera.
Kugwiritsiridwa ntchito kwa benzodiazepines mwa okalamba kumatsutsana. Kafukufuku amatsimikizira kuti pambuyo pa mankhwalawa, amakhala ndi chiopsezo chowonjezeka cha kugwa, choncho fractures za m'chiuno.
Mofanana ndi mankhwala aliwonse, mankhwala a benzodiazepine amakhala ndi zotsatirapo zake. Iwo makamaka kuchuluka tulo, mkhutu ndende, kufooka, kukumbukira matenda ndi mkhutu kugwirizana. Ngati mwana wazaka 20 agwa, amakhala ndi mikwingwirima yochepa kwambiri, ponena za wazaka 80 zomwe tikukamba za vuto la moyo. Chifukwa chake, kugwiritsa ntchito benzodiazepines kuyenera kuchepetsedwa mpaka pakufunika. Komanso, dokotala ayenera kuchenjeza mwamphamvu wodwalayo kuti zizindikiro zoterezi zingawonekere.
Akuti kumwa mankhwalawa kumawonjezera chiopsezo cha kuwonongeka kwa kukumbukira ndi kusokonezeka maganizo.
Kusokonezeka kwa kukumbukira kapena kuchepa kwa chidziwitso nthawi zambiri kumachitika mwa anthu omwe amagwiritsa ntchito benzodiazepines kwa miyezi kapena zaka. Kuonjezera apo, odwalawa nthawi zambiri amakhala opanda chidwi - alibe zolimbikitsa kuchitapo kanthu, alibe chidwi ndi dziko lozungulira.
Ndiye ndi liti pamene kugwiritsiridwa ntchito kwa mankhwala a gulu ili kuli koyenera?
Ngati agwiritsidwa ntchito mwaluso, benzodiazepines ali ndi ntchito zambiri chifukwa ali ndi zochitika zambiri. Mu sayansi ya minyewa, amagwiritsidwa ntchito pochiza khunyu kapena kuchepetsa kupsinjika kwa minofu, mu mankhwala oletsa kutupa, komanso m'maganizo, amagwiritsidwa ntchito makamaka pazovuta za kugona ndi nkhawa.
Tili ndi mantha ambiri lero ...
Zowonadi, pali mankhwala ena ambiri omwe amakhala ndi nkhawa. Pakadali pano, antidepressants kapena pregabalin amagwiritsidwa ntchito pafupipafupi kuposa benzodiazepines. Ndiwochokera ku gamma-aminobutyric acid (GABA).
Odwala nthawi zonse amasiyanitsa pakati pa mankhwala odana ndi nkhawa ndi antidepressants, omwe amathandizanso ndi nkhawa, koma amakhala gulu lapadera la mankhwala.
Ndiye kodi benzodiazepines sayenera kugwiritsidwa ntchito pochiza kuvutika maganizo?
Siziyenera kugwiritsidwa ntchito ngati mankhwala okhawo, koma sizikutanthauza kuti sayenera kugwiritsidwa ntchito. Mwachidziwitso, antidepressants amatenga milungu iwiri kuti agwire ntchito ngati 'mapepala'. Ndipo ngati wodwalayo ali ndi nkhawa kwambiri, kupatula antidepressant, timamupatsa benzodiazepine nthawi yomweyo, kuti akhale ndi moyo mpaka milungu iwiri. Kenako timachichotsa, ndipo wodwalayo amakhalabe pa antidepressant.
Nanga bwanji benzodiazepines? Kodi zikadali zofunika liti?
Amagwira ntchito ndi nkhawa komanso mtundu wina wa nkhawa - yomwe imapuwala, ili pano ndipo tsopano. Zimatipangitsa kutsala pang'ono kuleka kuganiza, timalephera kulamulira malingaliro athu ndi khalidwe lathu, timamva ngati tikupenga.
M'mavuto a nkhawa, mantha amanjenje ndi chitsanzo chabwino cha ntchito yawo. Thandizo lofunika muzochitika izi ndi kayendetsedwe ka mankhwala kuchokera ku gulu la antidepressant, ayenera kumwedwa nthawi zonse. Zomwe sizikutanthauza kuti wodwalayo sangathe kunyamula benzodiazepine - kutengedwa mwadzidzidzi chifukwa cha nkhawa, osati tsiku lililonse ngati gawo la kuthetsa mavuto a moyo.
Nthawi ndi nthawi, kwakanthawi, chifukwa kugwiritsa ntchito pafupipafupi kumakhala chizolowezi china?
Mankhwala a Benzodiazepine angagwiritsidwe ntchito nthawi zonse. Nthawi yochepa chabe - kuyambira masabata anayi mpaka asanu ndi limodzi. Kapena kwakanthawi ndikupuma kwa masiku angapo. Zotsirizirazi zikuwoneka kuti ndi zotetezeka ponena za zotsatira za nthawi yaitali.
Ndipo muyenera kuyamba ndi mlingo wocheperako?
Zimatengera, pali mgwirizano pakati pa mlingo ndi zotsatira za mankhwala. Ndi mphamvu ya nkhawa yomwe imatsimikizira kukula kwa mlingo. Ngati wina wakhumudwa kwambiri, mlingo wocheperako sudzamuthandiza.
Vuto lalikulu la benzodiazepines ndiloti amagwiritsidwa ntchito popanda zolemba. Osati zambiri zothetsera mavuto ngati kupondereza. Piritsi imakhala yochotsa mantha, nkhawa, kuzindikira za mkhalidwe womwe timadzipeza tokha - imapondereza zomwe zimatchedwa kuwawa kwa moyo.
Benzodiazepine sangathe kusiya usiku umodzi?
Ayi, pokhapokha ndi mlingo wotsika kwambiri ndipo umangotengedwa mwachidule. Kumbali ina, ngati titenga mankhwala a benzodiazepine kwa nthawi yayitali, pamlingo wapakati kapena wapamwamba, ndiye kuti kuwasiya usiku wonse kungayambitse kuyambiranso kwa zizindikiro za nkhawa kwambiri. Ndipo ngakhale psychosis, chinyengo, ndi khunyu.
Zimamveka ngati abstinence syndrome.
Osati pang'ono, koma mokwanira komanso mwamphamvu. Kuchotsa bwino kwa benzodiazepines sikuthamanga kuposa 1/4 ya mlingo pa sabata. Izi ndi zovomerezeka zachipatala, koma ndinganene kuti musiye pang'onopang'ono.
Sławomir Murawiec, MD, PhD, psychiatrist, psychodynamic psychotherapist. Mkonzi wamkulu wa "Psychiatria", pulezidenti wa Scientific Society for Psychodynamic Psychotherapy. Kwa zaka zambiri anali kugwirizana ndi Institute of Psychiatry ndi Neurology ku Warsaw. Woyambitsa membala wa International Neuropsychoanalytical Society. Laureate wa Pulofesa Stefan Leder, wopambana woperekedwa ndi Polish Psychiatric Association chifukwa cha zabwino m'munda wa psychotherapy.