Maitiro Evechidiki Kumusoro Kutora Antipsychotic Mishonga

Izvo zvakanyatsorongedzwa kuti huwandu hwevana vari kutaura antipsychotic mishonga yanga ichiwedzera. Izvi zvakawanzoonekwa sechinhu chisina kunaka uye chiratidzo chekushandisa mishonga zvakanyanya. Muzvokwadi, zvakadaro, kwave paine dhata diki kwazvo kutitaurira kana mishonga iyi iri kushandiswa zvakawandisa, nekukurumidza kana kuti kuwedzera kwacho kunoratidzira kurapwa kwakakodzera uye kwakakodzera kwevana vane matambudziko akakomba emanzwiro-ehunhu. Antipsychotic mishonga yakagadzirirwa kurapa vanhu vakuru vane hosha huru dzepfungwa senge schizophrenia uye bipolar kusagadzikana. Kwemakore achangopfuura, mashandisiro avo akawedzera kusvika kumazera madiki ezvezera uye zvimwe zvekuongororwa senge autism, ADHD, uye kupokana kushora kusagadzikana. Nekuti iyi mishonga inotakura njodzi yezvinhu zvakadai sekufutisa, chirwere cheshuga, uye kusagadzikana kwekufamba, kwave nekumwe kuongororwa kuongorora kuti kuri kushandiswa nenzira kwayo here.

Rimwe remabasa angu kugara mukomiti yehurumende yeVermont inonzi Vermont Psychiatric Medications for Children and Adolescents Trend Monitoring Workgroup. Basa redu nderekutarisa data rine chekuita nekushandisa mishonga yekurapa kwepfungwa pakati pevechidiki veVermont uye nekupa kurudziro kudare reparamende yedu nemamwe masangano ehurumende. Mu2012, isu tanga tichiona kuwedzerwa kumwe chete mukushandisa kwemushonga sevamwe vese, asi takatambura kuita pfungwa yeiyi data isinganzwisisike. Nhengo dzekomiti dzinofarira kusahadzika nemishonga yepfungwa dzakaridza tsamwa apo nhengo dzine mutsindo wakanaka kumishonga dzaifunga kuti kuwedzera uku kungave chinhu chakanaka sezvo vana vazhinji vari kuda kurapwa. Zvese zvakabvumirana, zvakadaro, kuti pasina kuchera pasi zvishoma, hatingazomboziva.

Dare redu rakasarudza, zvadaro, kuti izvo zvataida yaive data iro raigona kutitaurira zvishoma zvishoma nezvekuti sei uye sei vana ava vachinwa mishonga iyi. Nekudaro, isu takagadzira ongororo pfupi iyo yakatumirwa kunyoreri yemushonga wega wega wekurapa hunyanzvi wakapihwa kuMedicaid inishuwarenzi Vermont mwana ari pasi pemakore gumi nemasere. inosungirwa nekuda kuti ipedzwe mushonga usati (mishonga yakaita Risperdal, Seroquel, uye Abilify) inogona kuzadzikiswa zvakare.

Iyo data ratakatora kumashure rainakidza uye isu takazofunga kuti isu taifanira kuyedza uye kutsikisa izvo zvatakawana mune inozivikanwa magazini. Chinyorwa ichocho, chakanyorwa neni pamwe nevamwe vazhinji vakazvipira vanoshanda mukomiti iyi, chabuda nhasi mumagazini Pediatrics.

Chii chatakawana? Heano mamwe emamwe makwikwi .....

• Vazhinji vanyori veanorapa antipsychotic mishonga havazi varapi vepfungwa, pamwe nehafu inenge iri yekutanga varapi vezvekurapa sevana vevana kana vezvemhuri vanachiremba.
• Huwandu hwevana vari pasi pemakore mashanu-ekuberekwa vanotora mushonga weantipsychotic wakaderera zvakanyanya (Vermont inogona kunge yakati siyanei pano).
• Kazhinji, chiremba uyo ave nebasa rekuchengetedza iyo antipsychotic mishonga haazi iye akaitanga pakutanga. Muzviitiko izvi, iyezvino prescriber kazhinji (anenge 30%) haazive kuti nderupi rudzi rwekurapwa kwepfungwa kwakange kwayedzwa pamberi pesarudzo yekutanga mushonga weantipsychotic.
• Aya maviri akajairwa kuongororwa ane hukama nemushonga aive kusagadzikana kwepfungwa (kusanganisa bipolar kusagadzikana) uye ADHD. Iwo maviri akajairika tarisiro zviratidzo aive echisimba emuviri uye kusagadzikana kwemood.
• Mune yakawanda kesi, antipsychotic mishonga yaishandiswa chete mushure meimwe mishonga uye kumwe kurapa kusiri kwemishonga (sekupa zano) kwanga kusati kwashanda. Nekudaro, iyo mhando yekurapa iyo yakange yaedzwa kazhinji yaisave chimwe chinhu senge Behavioural Therapy, nzira yakaratidzirwa kuti inoshanda kumatambudziko sekuzvidza uye hukasha.
• Vanachiremba vakaita basa rakanaka chaizvo rekucherechedza huremu hwemwana kana iye ainwa mushonga weantipsychotic, asi ingangoita hafu yenguva ivo vaiita iwo marabha akakurudzirwa kutsvaga zviratidzo zvekunyevera zvezvinhu zvakaita seshuga.
• Zvichida zvakanyanya kukosha, isu takabatanidza zvinhu zvakawanda zvekuongorora kuyedza nekupindura mubvunzo wepasirese wekuti kangani mwana achirwara achitora mushonga weantipsychotic zvinoenderana ne "yakanakisa tsika" nhungamiro. Isu takashandisa zvakaburitswa kurudziro kubva kuAmerican Academy yeMwana uye Adolescent Psychiatry uye takaona kuti zvakazara, yakanakisa tsika nhungamiro dzakateverwa chete hafu yenguva. Kuzivo yedu, ino inguva yekutanga kuti chikamu ichi chakambofungidzirwa kana zvasvika kuvana uye mishonga inorapa mishonga. Kana mushonga "ukakundikana" kuva tsika yakanakisa, nechikonzero chakajairika ndechekuti iro basa rakanga risiri kuitwa.
• Isu takatarisawo kuti kangani mushonga waive uchishandiswa maererano nechiratidzo cheDFA, inova yakatetepa seti yekushandisa. Mhedzisiro - 27%.

Kuisa zvese izvi pamwechete, tinowana mufananidzo wakajeka wezvingave zviri kuitika. Panguva imwecheteyo, mhedzisiro iyi haisi nyore kukweretesa kukurumidza kurira pamusoro pevana vakaipa, vabereki vakaipa, kana vanachiremba vakaipa. Mumwe mhedzisiro wanga uchikurudzira ndewekuti hauonekwe sekunge mishonga iyi irikushandiswa zvisina hunhu zvounhu hunotsamwisa. Kunyangwe apo kuongororwa kwacho kwaiita kunge diki iff senge ADHD, data redu rakaratidza kuti iro dambudziko chairo rinotariswa kazhinji nechimwe chinhu senge hutsinye hwepanyama. Panguva imwecheteyo, zvakaoma kuzvikudza zvakanyanya nekutevera zvakanakisa maitiro ekurumbidza hafu yenguva, kunyanya patinenge tiine rupo nezvekuti yaivepo. Mukukurukurirana kwedu, tinotarisa pazvinhu zvina zvinogona kubatsira kugadzirisa mamiriro acho ezvinhu. Kutanga, vanyoreri vangangoda zviyeuchidzo zvakawanda (zvemagetsi kana zvimwe) kuvakurudzira kuti vatore basa rakakurudzirwa iro rinogona kuratidza kuti inguva yekumira kana kumboderedza mushonga. Chechipiri, vanachiremba vazhinji vanonzwa kunamira nekuti havana kutanga mushonga pakutanga asi ikozvino ndivo vane basa nazvo uye havazive kuti vamisa sei. Kudzidzisa vanachiremba vekutanga nezvekuti sei uye nguva yekuita izvi kunogona kudzikisa huwandu hwevana vanotora mishonga yekurapa nemasikirini nekusingaperi. Chechitatu, tinoda chati iri nani yekurapa inotevera varwere zvakanyanya.Kana iwe uchifunga nezvemwana ari mukurerwa nevabereki vasiri vake, achirova kubva kudunhu renyika kuenda kune rimwe, zviri nyore kufungidzira kuti zvakaoma sei parizvino chiremba wemwedzi kuziva izvo zvakange zvamboedzwa kubatsira mwana uyu. Chechina, tinofanirwa kuita humbowo-hwakavakirwa kurapa hunowanikwa, izvo zvinogona kudzivirira vana vazhinji kuti vasvike padanho rekuti mushonga weantipsychotic unofungidzirwa.

Mune maonero angu, mishonga inorwisa mabhakitiriya ine nzvimbo yekurapa, asi yakawandisa iri kusvika kunzvimbo iyoyo nekukurumidza. Kudonha kwakapfuura uku, ndakapupura kune rakabatana komiti yeVermont yezvemitemo nezve zvatakatanga kuwana. Dare redu richasangana zvakare munguva pfupi kuti rione matanho api atinoda kukurudzira zvinotevera. Tariro yedu ndeyekuti mamwe matunhu achaita mapurojekiti akafanana kuti ave nechokwadi chekuti iyi nemimwe mishonga irikushandiswa zvakachengeteka uye zvakafanira sezvazvinogona.

@copyright naDavid Rettew, MD

David Rettew munyori weChild Temperament: New Thinking About the Boundary Between Traits and Illness and a child psychiatrist in the psychiatry and pediatrics department paUniversity yeVermont College yeMishonga.

Mutevere pa @PediPsych uye sePediPsych paFacebook.