Momwe Achinyamata Amayamba Kutenga Mankhwala Osokoneza Bongo

Zakhala zikulembedwa bwino kuti kuchuluka kwa ana omwe amalankhula ndi mankhwala opatsirana pogwiritsa ntchito mankhwala akuchulukirachulukira. Izi zimawonedwa ngati chinthu cholakwika komanso chisonyezero cha kumwa mankhwala mopitirira muyeso. Zowona, komabe, pakhala pali zochepa kwambiri zotiuza ngati mankhwalawa akugwiritsidwa ntchito mopitirira muyeso, posachedwa kapena ngati kuwonjezerako kukuwonetsa chithandizo choyenera komanso chovomerezeka cha ana omwe ali ndi zovuta zamakhalidwe. Mankhwala a antipsychotic adapangidwa kuti athandize achikulire omwe ali ndi matenda akulu amisala monga schizophrenia ndi bipolar disorder. Pazaka zaposachedwa, kugwiritsa ntchito kwawo kwafikira magulu azaka zazing'ono komanso matenda ena monga autism, ADHD, ndi contositional defiant disorder. Chifukwa mankhwalawa amakhala pachiwopsezo cha zinthu monga kunenepa kwambiri, matenda ashuga, komanso zovuta zamayendedwe, pakhala kuwunikiridwa kwina kuti awone ngati akugwiritsidwa ntchito moyenera.

Imodzi mwa ntchito zanga ndikukhala komiti ya boma ku Vermont yotchedwa Vermont Psychiatric Medications for Children and Adolescents Trend Monitoring Workgroup. Ntchito yathu ndikuwunika zomwe zikugwirizana ndi kugwiritsa ntchito mankhwala amisala pakati pa achinyamata ku Vermont ndikupereka malingaliro kunyumba yamalamulo yathu ndi mabungwe ena aboma. Mu 2012, tinkawona kuwonjezeka komweku kwa kugwiritsa ntchito mankhwala monga ena onse, koma tinkalimbana kuti timvetsetse zambiri zosamvetsetseka. Mamembala a komiti omwe amakayikira mankhwala azamisala amawomba alamu pomwe mamembala omwe ali ndi malingaliro abwino pamankhwala amaganiza kuti kuwonjezeka kumeneku kungakhale chinthu chabwino chifukwa ana ambiri omwe akusowa thandizo amalandila chithandizo. Onse adagwirizana, komabe, kuti popanda kubowola pang'ono, sitingadziwe.

Komiti yathu idaganiza kuti zomwe timafunikira ndi zidziwitso zomwe zitha kutiuza zambiri za chifukwa komanso momwe anawa amamwe mankhwalawa. Zotsatira zake, tidapanga kafukufuku wafupipafupi yemwe adatumizidwa kwa woperekera mankhwala aliwonse a antipsychotic omwe amaperekedwa kwa mwana wa Medicaid yemwe ali ndi inshuwaransi ya Vermont wazaka zosakwana 18. kuvomerezedwa ndikufunira kuti amalize asanagwire mankhwala (zinthu monga Risperdal, Seroquel, ndi Abilify) kuti ayikenso.

Zambiri zomwe tidalandila zinali zosangalatsa kwambiri ndipo tidaganiza kuti tiyenera kuyesa kusindikiza zomwe tidapeza munyuzipepala yotchuka. Nkhaniyo, yolembedwa ndi ine komanso akatswiri ena ambiri omwe amagwira ntchito mu komitiyi, adatuluka lero mu nyuzipepala ya Pediatrics.

Kodi tapeza chiyani? Nazi zina mwazikuluzikulu .....

• Olemba ambiri mankhwala a antipsychotic siamisala amisala, pafupifupi theka lawo ndiachipatala oyang'anira ana kapena asing'anga.
• Chiwerengero cha ana osakwana zaka 5 omwe amamwa mankhwala a antipsychotic ndiotsika kwambiri (Vermont itha kukhala yosiyana pano).
• Kawirikawiri, dokotala yemwe tsopano ali ndi udindo wothandizira mankhwala a antipsychotic siwo amene adayambitsa. Pazochitikazi, wolemba pakadali pano nthawi zambiri (pafupifupi 30%) sadziwa mtundu wanji wamankhwala amisala omwe adayesedwa asanaganize zoyamba mankhwala a antipsychotic.
• Matenda awiri ofala kwambiri okhudzana ndi mankhwalawa anali mavuto amisala (osaphatikizaponso kusinthasintha kwa malingaliro) ndi ADHD. Zizindikiro ziwiri zomwe zimadziwika kwambiri zinali zankhanza komanso kusakhazikika pamalingaliro.
• Nthawi zambiri, mankhwala a antipsychotic amagwiritsidwa ntchito pokhapokha mankhwala ena ndi mankhwala ena osagwiritsa ntchito mankhwala (monga upangiri) asanagwire ntchito. Komabe, mtundu wa mankhwala omwe adayesedwa nthawi zambiri sanali ngati Behaeveal Therapy, njira yomwe yawonetsedwa kuti ndiyothandiza pamavuto monga kunyoza komanso kupsa mtima.
• Madokotala anachita ntchito yabwino yosunga kulemera kwa mwana ngati amamwa mankhwala ochepetsa matenda opatsirana pogonana, koma pafupifupi theka la nthawi ndi omwe anali kugwira ntchito yolembedwa kuti ayang'ane zizindikiro zonga matenda ashuga.
• Mwinanso chofunikira kwambiri, tidaphatikiza zinthu zambiri zofufuzira kuti tiyese kuyankha funso lapadziko lonse lapansi lonena kuti ndi kangati kamwana kamene kamamwa mankhwala a antipsychotic malinga ndi malangizo "abwino kwambiri". Tidagwiritsa ntchito malingaliro omwe adasindikizidwa kuchokera ku American Academy of Child and Adolescent Psychiatry ndipo tidapeza kuti, malangizo abwino kwambiri adatsatiridwa theka la nthawiyo. Kudziwa kwathu, iyi ndi nthawi yoyamba kuti kuchuluka kumeneku kuyerekezedwa pankhani ya ana ndi antipsychotic. Pamene mankhwala "adalephera" kukhala njira yabwino kwambiri, chifukwa chodziwika kwambiri chinali chakuti ntchitoyi sinali kuchitidwa.
• Tidawunikiranso momwe mankhwala amagwiritsidwira ntchito kangapo malinga ndi chiwonetsero cha FDA, chomwe chimagwiritsidwanso ntchito pang'ono. Zotsatira - 27%.

Kuyika zonsezi palimodzi, timapeza chithunzi chodziwika bwino cha zomwe zitha kuchitika. Nthawi yomweyo, zotsatirazi sizimangobwereketsa kulira mwachangu za ana oyipa, makolo oyipa, kapena madotolo oyipa. Zotsatira zina zomwe zinali zolimbikitsa ndikuti sizikuwoneka ngati mankhwalawa akugwiritsidwa ntchito mopepuka pamakhalidwe osakwiya pang'ono. Ngakhale atapezeka kuti ali ndi vuto ngati ADHD, zidziwitso zathu zimawonetsa kuti vuto lenileni limangoyang'aniridwa ndi zinthu zina monga kupsa mtima. Nthawi yomweyo, ndizovuta kunyadira kutsatira njira zabwino kwambiri theka la nthawi, makamaka pomwe tinali owolowa manja za nthawi yomwe analipo. Pokambirana, timayang'ana mbali zinayi zomwe zingathandize kukonza vutoli. Choyamba, olemba mankhwala angafunike zikumbutso zambiri (zamagetsi kapena zina) kuti awalimbikitse kupeza ntchito zomwe zingawonetse kuti ndi nthawi yoti ayime kapena achepetse mankhwalawo. Chachiwiri, madokotala ambiri amakakamira chifukwa sanayambe kumwa mankhwalawo koma tsopano ali ndi udindo wawo ndipo sakudziwa kuti angawathe bwanji. Kuphunzitsa madokotala oyambira za momwe angachitire izi komanso nthawi yanji kungachepetse kuchuluka kwa ana omwe amamwa mankhwala a antipsychotic mpaka kalekale. Chachitatu, tikufunika tchati chachipatala chabwino chomwe chimatsata odwala kwambiri.Ngati mukuganiza za mwana yemwe akukhala kulera ana, kuchokera kudera lina kupita kudera lina, ndikosavuta kulingalira momwe zimavutira dokotala wamwezi kudziwa zomwe adayesedwa kale kuti athandize mwanayu. Chachinayi, tikufunika kuti mankhwala opangira umboni apezeka, zomwe zingalepheretse ana ambiri kuti afike poti mankhwala a antipsychotic amalingaliridwa.

M'malingaliro mwanga, mankhwala opatsirana ndi ma psychotic alidi ndi malo ochiritsira, koma ambiri akufika kumalo amenewo mwachangu kwambiri. Kugwa kwaposachedwa, ndidachitira umboni komiti yopanga zamalamulo ku Vermont pazomwe tidapeza koyambirira. Komiti yathu ikumananso posachedwa kuti isankhe zochita zomwe tikufuna kutsatira. Tikukhulupirira kuti mayiko ena apanga ntchito zofananira kuti awonetsetse kuti mankhwalawa ndi ena akugwiritsidwa ntchito motetezeka komanso moyenera momwe zingathere.

@copyright ndi David Rettew, MD

David Rettew ndi mlembi wa Child Temperament: New Thinking About the Boundary Pakati pa Makhalidwe ndi Matenda komanso mwana wazamisala m'madipatimenti azamisala ndi ana ku University of Vermont College of Medicine.

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