Ngokuvumelana nomsebenzi walo, Ibhodi Lokuhlela le-MedTvoiLokony lenza yonke imizamo yokuhlinzeka ngokuqukethwe kwezokwelapha okuthembekile okusekelwa ulwazi lwakamuva lwesayensi. Ifulegi elengeziwe elithi "Okuqukethwe Okuhloliwe" libonisa ukuthi i-athikili ibuyekezwe noma yabhalwa udokotela ngokuqondile. Lokhu kuqinisekisa okuyizinyathelo ezimbili: intatheli yezokwelapha kanye nodokotela basivumela ukuthi sinikeze okuqukethwe kwekhwalithi ephezulu ngokuhambisana nolwazi lwamanje lwezokwelapha.
Ukuzibophezela kwethu kule ndawo kuye kwathakaselwa, phakathi kokunye, yiNhlangano Yezintatheli Zezempilo, eyaklomelisa Ibhodi Lokuhlela le-MedTvoiLokony ngesihloko sokuhlonipha esithi Umfundisi Omkhulu.
Amaphesenti angu-40 abantu baseYurophu ahlushwa ukuphazamiseka kwengqondo. Ukwesaba kuyabusa. Umuthi bekufanele kube i-benzodiazepines. Ngokushesha bacindezela ukukhathazeka futhi balalise. Odokotela bazibhalele iziguli eziphelelwe ithemba ngaphandle kokungabaza. Kuvele ukuthi uma zisetshenziswe ngendlela engafanele, ziyalutha, zandisa ukukhathazeka, futhi zidale izikhala zenkumbulo. Ingabe kufanele wesabe i-benzodiazepines nendlela yokulwa nokukhathazeka? UZuzanna Opolska, intatheli ye-MedTvoiLokony, ubuza udokotela wengqondo ovelele - Sławomir Murawiec, MD, PhD.
- Cishe i-40% yabantu baseYurophu ihlushwa ukuphazamiseka kwengqondo. Zedlula ngisho nesifo senhliziyo nomdlavuza ngezibalo. Okuvame kakhulu yizinkinga zokukhathazeka
- Iziguli eziphelelwe ithemba zicela odokotela amaphilisi azonciphisa ngokushesha ukukhathazeka. Lezi zinikeza i-benzodiazepines. Kuyiqembu lezidakamizwa ezine-anxiolytic esheshayo, i-sedative, hypnotic kanye nemiphumela ye-anticonvulsant.
- Abantu baseBrithani abayisigidi bayimilutha yalezi zidakamizwa, amaJalimane ayizigidi eziyisithupha aphuza amaphilisi okwehlisa umoya nsuku zonke. E-Poland, ukulinganisa kwalesi simo kungase kufane
Zuzanna Opolska, MedTvoiLokony: Udokotela, kuthiwa i-benzodiazepines kulula ukuqala ukuthatha, kodwa kunzima kakhulu ukuyeka. Kungani?
Sławomir Murawiec, MD, PhD: Lokhu kuyindida kwezengqondo. Uma sibuza iziguli ukuthi zesabani ngemithi yengqondo, zivame ukuthi “izinguquko zobuntu” kanye “nomlutha.” Ngesikhathi esifanayo, iqembu elidume kakhulu lezidakamizwa yi-benzodiazepines. Futhi yilelo kuphela iqembu eliluthayo.
Ingabe zonke ziyingozi ngokulinganayo?
Hhayi. Ngokuya ngesigamu sempilo, singakwazi ukuhlukanisa ama-benzodiazepines amafushane, aphakathi nendawo kanye nesikhathi eside. Ezakuqala ziyingozi kakhulu.
Kungani?
Zinomphumela wokupholisa osheshayo nocacile ophela ngemva kwamahora ambalwa. Ngakho-ke, kunesilingo sokufinyelela elinye iphilisi bese uphinda umphumela otholiwe. Ngaso sonke isikhathi sizizwa sikhathazekile, futhi ingunaphakade. Impilo yethu incike ekuphuzeni imithi. Kuyingozi.
Ngoba kude ehlathini, kubi kakhulu - ngokuhamba kwesikhathi umthamo wamanje akwanele kithi?
Yebo - ukubekezelela umuthi kuyanda. Uma isiguli sesingene kumodi yokulutheka, siba nomjikelezo ononya. Ngoba ngokuhamba kwesikhathi, udinga imithamo ephakeme ngokungenangqondo, kodwa nokho angawutholi umphumela oyifunayo. Kuyafaneleka ukugcizelela, nokho, ukuthi i-benzodiazepines ayiyona inyama. Kuyafana nangotshwala – bonke abaphuzayo, kodwa hhayi bonke abayizidakwa. I-Benzodiazepines ibeka engcupheni yokulutheka, kodwa akukhona ukuthi noma ubani obheka iphilisi uzoba umlutha.
Lezi zidakamizwa zase zisetshenziswe kakade kuma-60s, zize zisetshenziswe ngokweqile, ngoba eminyakeni engu-30 kuphela kamuva iziqondiso zokusetshenziswa kwazo okuphephile zanyatheliswa. Ingabe odokotela basawanikeza nanamuhla ngokunganaki?
Ngenhlanhla, lokhu kuyashintsha. Lapho ngiqala ukusebenza, iziguli eziningi zazisebenzisa ama-benzodiazepines angekho ilebula. Kusukela kodokotela abajwayelekile - odokotela bomndeni namuhla. Ngicabanga ukuthi bekunokungabi nasizo ngemuva kwalo mshini. Cabanga ngesiguli esinezinkinga zokuphila, siphapheme, sinovalo, sithukuthele. Kubuhlungu lapha, kuyavuza laphaya. Uya kudokotela ohlola konke okungenzeka, amnikeze imithi yesisu, yenhliziyo hhayi lutho. Namanje akazi ukuthi uphethwe yini umuntu ogulayo. Ekugcineni, udokotela uthola ukuthi uma enikeza i-benzodiazepine, isiguli siba ngcono. Uyeka ukuza nokubika izifo ezingaka. Ngenhlanhla, namuhla ukuqwashisa ngokucindezeleka kukhulu kakhulu kunakuqala, futhi odokotela bomndeni banamathuba amaningi okusebenzisa izidakamizwa ezivela eqenjini le-serotonin reuptake inhibitors (SSRIs) ekhethiwe ngoba bayazi ukuthi iyindlela engcono kune-benzodiazepines.
Ngakolunye uhlangothi, esikhathini esingengakanani edlule amagama athi “ngicindezelekile” awakaze adlule emlonyeni.
Yiqiniso. Ukucindezeleka kuhlanganisa amaqembu amaningana ezimpawu: ukudabuka, i-anhedonia, iziguli ezichaza ngokuthi: "Ngijabule, anginasithakazelo kunoma yini", umsebenzi wokuphila wehla (amandla okushayela), ukuphazamiseka kokulala nokukhathazeka. Nakuba i-benzodiazepines ingasebenza engxenyeni yokugcina, ayilaphi ukucindezeleka. Kufana nokulwa nomkhuhlane esikhundleni sokwelapha isifo esibangelwa amagciwane ngama-antibiotic. Akuyona indlela yokwelapha eyimbangela engasiza. Ngenxa yalokho, ukukhathazeka kwethu kuyancipha, kodwa sisadabukile futhi asikakhuthazi ukwenza okuthile.
Ubani osengozini enkulu yokuluthwa yi-benzodiazepine? Ingabe kuyiqiniso ukuthi umlutha wotshwala?
Hhayi kuphela. Ngokomtholampilo, sikubeka kabanzi: abantu abathambekele ekubeni umlutha.
Abesifazane basengozini kakhulu kunamadoda?
Sinamaqembu eziguli ahlukene. Intsha izama ukusebenzisa izidakamizwa ukuze iguqule isimo sayo sokuphaphama, futhi ngokuvamile iba ngcono kunodokotela bengqondo abafuna imiyalelo kadokotela ukuthi isebenza kanjani.
Amadoda aya kophuza kaningi, futhi abesifazane bazama ukudambisa inkinga “ngokuzibambela mathupha” nokuvimbela imizwelo. Ikakhulukazi abesifazane asebekhulile abazithola besesimeni esinzima sempilo, bazama ukudambisa izinhlungu zokuphila ngamaphilisi. Ngakho-ke, ngokuzithandela bafinyelela kuma-benzodiazepines, okungelona ikhambi lesi sifo, kodwa abe yindlela yokubhekana nesimo esinzima sokuphila.
Abanye abantu abanayo inkinga ye-benzodiazepines noma utshwala. Bayawaxhuma. Ithebhulethi kanye nengilazi noma ibhodlela lewayini - buyini ubungozi?
Kuyingozi kakhulu. Akunconyiwe neze. Futhi uma uyeka ukuphuza imithi, isiguli sisala nezinkinga eziningana: okubangelwa isimo esinzima sokuphila, okubangelwa ukuntuleka kwemithi nokulutha utshwala.
Ukusetshenziswa kwe-benzodiazepines kubantu abadala kuyimpikiswano. Ucwaningo luqinisekisa ukuthi ngemva kwezidakamizwa ezinjalo, banengozi eyengeziwe yokuwa, ngakho-ke ama-hip fractures.
Njenganoma yikuphi ukwelashwa kwezidakamizwa, ukwelashwa kwe-benzodiazepine kunemiphumela emibi. Ngokuyinhloko ukwanda kokulala, ukugxilisa ingqondo, ubuthakathaka, ukuphazamiseka kwenkumbulo kanye nokungasebenzi kahle kokuxhumana. Uma umuntu oneminyaka engu-20 ewa, uzoba nemihuzuko embalwa kakhulu, esimweni somuntu oneminyaka engu-80 sikhuluma ngesimo esisongela ukuphila. Ngakho-ke, ukusetshenziswa kwe-benzodiazepines kufanele kukhawulelwe endaweni ebalulekile. Ngaphezu kwalokho, udokotela kufanele axwayise kakhulu isiguli ukuthi izimpawu ezinjalo zingase zivele.
Kuthiwa ukuphuza le mithi kwandisa ingozi yokukhubazeka kwenkumbulo nokuwohloka komqondo.
Ukuphazamiseka kwenkumbulo noma ukuncipha kwengqondo kuvame ukwenzeka kubantu abasebenzisa i-benzodiazepines izinyanga noma iminyaka. Ukwengeza, lezi ziguli azinandaba kakhulu - azinaso isisusa sokwenza okuthile, azinandaba nezwe elizizungezile.
Ngakho-ke ukusetshenziswa kwezidakamizwa kuleli qembu kufaneleke nini?
Uma isetshenziswa ngobuchule, i-benzodiazepines inezinhlelo eziningi zokusebenza ngoba inohlobo olubanzi lomsebenzi. Ku-neurology, asetshenziselwa ukwelapha ukuquleka noma ukunciphisa ukungezwani kwemisipha, ku-premedication anesthesiology, nasezifundweni zengqondo, asetshenziselwa ikakhulukazi ukuphazamiseka kokulala kanye nokuphazamiseka kokukhathazeka.
Sinokwesaba okuningi namuhla...
Ngempela, kunezidakamizwa eziningi ezengeziwe ezinomphumela we-anxiolytic. Njengamanje, ama-antidepressants noma i-pregabalin asetshenziswa kaningi kune-benzodiazepines. Iphuma ku-gamma-aminobutyric acid (GABA).
Iziguli azihlukanisi ngaso sonke isikhathi phakathi kwezidakamizwa ezilwa nokukhathazeka kanye nama-antidepressants, nazo ezisiza ngokukhathazeka, kodwa nokho ziyiqembu elihlukile lezidakamizwa.
Ngakho akufanele yini i-benzodiazepines isetshenziselwe ukwelapha ukucindezeleka?
Akufanele neze zisetshenziswe njengowodwa umuthi, kodwa akukhona, futhi, ukuthi akufanele neze zisetshenziswe. Ngokwethiyori, ama-antidepressants athatha amasonto amabili ukusebenza 'njengamapheshana'. Futhi uma isiguli sinokukhathazeka okukhulu, ngaphandle kwe-antidepressant, simnika i-benzodiazepine ngesikhathi esifanayo, ukuze siphile kuze kube amasonto amabili. Khona-ke siyayihoxisa, futhi isiguli sihlala ku-antidepressant.
Kuthiwani nge-benzodiazepines? Kunini lapho zisadingeka?
Basebenza ngokukhathazeka kanye nohlobo oluthile lokukhathazeka - leyo ekhubaza, isikhona manje. Kusenza sicishe siyeke ukucabanga, singakwazi ukulawula imizwa yethu nokuziphatha kwethu, sizizwe sengathi siyahlanya.
Ezinkingeni zokukhathazeka, ukuhlaselwa ukwesaba kuyisibonelo esihle sokusetshenziswa kwabo. Ukwelashwa okuyisisekelo kulesi simo ukuphathwa kwezidakamizwa ezivela eqenjini le-antidepressant, kufanele zithathwe unomphela. Okungasho ukuthi isiguli asikwazi ukuthwala i-benzodiazepine - ethathwe ngesisekelo esiphuthumayo sokuhlaselwa kokukhathazeka, futhi hhayi zonke izinsuku njengengxenye yokuxazulula izinkinga zokuphila.
Kuphela ngezikhathi ezithile, okwesikhashana, ngoba ukusetshenziswa okuvamile kuwumlutha othile?
Izidakamizwa ze-Benzodiazepine zingasetshenziswa njalo. Isikhathi esifushane kuphela - kusukela emavikini amane kuya kwayisithupha. Noma okwesikhashana ngamakhefu athatha izinsuku ezimbalwa. Lesi sakamuva sibonakala siphephe kakhudlwana ngokwemiphumela yesikhathi eside.
Futhi kufanele uqale ngemithamo emincane?
Kuya ngokuthi, kukhona ubudlelwano phakathi komthamo kanye nomphumela wokwelapha. Amandla okukhathazeka anquma ubukhulu bomthamo. Uma othile ecasuke kakhulu, umthamo omncane kakhulu ngeke umsize.
Inkinga enkulu ngama-benzodiazepines ukuthi asetshenziswa ngaphandle kwelebula. Hhayi kakhulu ekuxazululeni njengezinkinga zokucindezela. Iphilisi liba yinto ekhulula ukwesaba, ukukhathazeka, ukuqaphela isimo esizithola sikuso - licindezela lokho okubizwa ngokuthi ubuhlungu bempilo.
I-Benzodiazepine ayikwazi ukuyeka ubusuku bonke?
Cha, ngaphandle uma kuyisilinganiso esiphansi kakhulu futhi sithathwa isikhashana. Ngakolunye uhlangothi, uma sithatha izidakamizwa ze-benzodiazepine isikhathi eside, ngethamo eliphakathi noma eliphakeme, bese ukuziyeka ngobusuku obubodwa kungase kubangele ukuphinda kwezimpawu zokukhathazeka ezinzima. Futhi ngisho ne-psychosis, ukukhohlisa, nokuquleka.
Kuzwakala kancane njenge-abstinence syndrome.
Hhayi kancane, kodwa ngokugcwele futhi eqinile. Ukuhoxiswa okuphephile kwe-benzodiazepines akusheshi kune-1/4 yomthamo ngesonto. Lezi izincomo zezokwelapha ezisemthethweni, kodwa ngingaphakamisa ukuhoxiswa kancane.
Sławomir Murawiec, MD, PhD, udokotela wezifo zengqondo, i-psychodynamic psychotherapist. Umhleli oyinhloko we-"Psychiatria", umongameli we-Scientific Society for Psychodynamic Psychotherapy. Iminyaka eminingi wayehlotshaniswa ne-Institute of Psychiatry and Neurology eWarsaw. Ilungu elisungule le-International Neuropsychoanalytical Society. Uhlomule ngendondo kaSolwazi Stefan Leder, umklomelo oklonyeliswe yi-Polish Psychiatric Association ngokufaneleka emkhakheni we-psychotherapy.