Mtsinje Wachiwiri Wachiwiri

Munthawi yonse ya 2020, United States yakhala ikusewera motsutsana ndi coronavirus. Monga momwe nkhani zingapo zofufuzidwa bwino zanenera, kusowa kwa mayankho oyenera komanso munthawi yake kwakhala patsogolo ndipo zitha kuchitika chifukwa cha zinthu zambiri kuphatikiza kufala kwa kachilomboka komanso nthawi yomweyo kuchedwa pakupanga njira zoyeserera zamankhwala ndi njira zodzitetezera.

Tsoka ilo, masewerawa adadzetsa chiwonongeko chachikulu kwambiri m'miyoyo ya anthu m'zaka zaposachedwa. Ngakhale pali zochepa, ngati zilipo, zolumikizana ndi siliva pothana ndi mliriwu, zomwezo siziyenera kukhala zowona tikayang'ana zaka zapitazo ndikuwona momwe tidayambira kuthana ndi zomwe zitha kukhala zovuta kwambiri pagulu zovuta: kupsinjika kwamaganizidwe-m'maganizo komanso kuchuluka kwakuchuluka kwa anthu ogwiritsa ntchito mankhwala osokoneza bongo.

Ngakhale zambiri zimakhalabe zoyambirira, 2020 yawonjezeka kuchuluka kwa opioid yokhudzana ndi opioid, pomwe mayiko opitilira 35 akuti akuchulukirachulukira chifukwa cha opioid. Zinthu zomwe zikuwonjezera vutoli sizikudziwika. Zitha kukhala chifukwa chakukwera kwa anthu omwe akuchira omwe adataya mtima chifukwa cha zovuta za COVID. Zitha kukhalanso chifukwa chakuti anthu omwe anali kale ndi vuto la kugwiritsa ntchito mankhwala osokoneza bongo adakakamizidwa kutengera mitundu yamphamvu kwambiri komanso yoopsa kwambiri ya ma opioid (ie fentanyl) chifukwa chazovuta zachuma kapena kulephera kupeza mankhwala omwe amawadziwa bwino.

Kuzunzidwa kokhudzana ndi opioid sikuyenera kukhala njira yokhayo yogwiritsira ntchito mankhwala osokoneza bongo yomwe ikukula. Kuyambira pomwe mayiko adayamba kutsekedwa mu Marichi, pakhala pali mbiri yogulitsa zakumwa zoledzeretsa ndi zachamba (m'maiko momwe kumwa ndikololedwa). Popeza kuchuluka kwa kugwiritsidwa ntchito kukuchitika molumikizana ndi kudzipatula pakati pa anthu, kutsekeredwa kwakanthawi, komanso zovuta zina zachilengedwe zomwe zikukhalira mliriwu, ndizomveka kuganiza kuti kuzunzidwa kwa zinthuzi kumakhala kofala.

Ngakhale kumwa mowa kumakhala kwachizolowezi pachikhalidwe chathu, akuti kumwa mowa mopitirira muyeso kwachititsa kuti anthu 93,296 aku America amwalire msanga pakati pa 2011 ndi 2015. Nthawi yayitali yomwe idametedwa pamoyo wamunthu chifukwa chomwa mowa kwambiri: zaka 29.

Kupsinjika Kwamavuto Osiyanasiyana ndi Kupsinjika Kwa Mtima

Mosakayikira, COVID-19 ipweteketsa anthu ambiri ku US Izi ndizowona makamaka kwa iwo omwe ali patsogolo pa mliriwu, iwo omwe afedwa mwadzidzidzi, kapena omwe adachita kupulumuka koma owononga Njira zamankhwala monga intubation.

Kutengera mtundu wakukumana ndi zoipazi komanso zina zambiri zomwe zimatha kupangitsa kupirira, pakati pa 5 ndi 20% ya omwe akukumana ndi zotere amatha kudwala matenda osokoneza bongo (ASD). ASD imadziwika ndi mitundu isanu yazizindikiro, kuphatikiza zododometsa, kusakhala bwino, zizindikiritso za dissociative, zizindikiro zopewa, ndi zizindikiritso zodzutsa. ASD imapezeka pamene zizindikiro zisanu ndi zinayi kapena kupitilira apo zimapitilira kwa mwezi umodzi kapena kupitilira masiku atatu zitachitika zochitikazo. Zizindikiro zikapitilira kwa nthawi yayitali, matendawa atha kukhala a post-traumatic stress disorder (PTSD), omwe amakhudza theka la iwo omwe adayamba kudwala ASD. Ngati akuchiritsidwa, nthawi yayitali yoti PTSD ichotsedwe ndi pafupifupi zaka zitatu. Ngati sanalandire chithandizo, atha kupitilira miyezi 64, kapena kupitilira apo.

Kudziyesa nokha ndi mankhwala osokoneza bongo ndikumwa mowa ndizofala kwambiri pakati pa odwala PTSD, ndipo pafupifupi 46% ya odwalawa amakhala ndi vuto logwiritsa ntchito mankhwala osokoneza bongo kapena mowa. Komanso, kafukufuku wasonyeza kuti kuchitapo kanthu mwachangu komanso kuthandizira molunjika pambuyo pazochitikazo kumatha kuthandizira kuthana ndi vuto.

Kulemera Kwambiri kwa Allosteric

Chochenjera kwambiri cha mliriwu sichikukhudzana ndi zoopsa koma chimakhudzana kwambiri ndi kupsinjika kwamaganizidwe komwe sikufika pamalire a ASD kapena PTSD koma, pakapita nthawi, kumawononga kwambiri.Ngakhale padzakhala odwala masauzande ambiri omwe angadwale PTSD mkati kapena potsatira mliri wa COVID, anthu ochulukirapo akukumana ndi mavuto azakudya tsiku lililonse: mitu yankhanza, nkhawa za matenda, kulephera kuyenda momasuka, komanso kuwopseza za kuwonongeka kwachuma. Anthuwa atha kukhala kuti akukumana ndi zomwe Bruce McEwen adalongosola ngati kuchuluka kwambiri.

Mwachidule, kafukufuku wa McEwen adawonetsa kuti pali netiweki yolumikizana ndi thupi yomwe imalimbikitsidwa osati kungokhala ndi homeostasis, koma kuyankha pafupipafupi ndikusintha malinga ndi chilengedwe. McEwen adatcha allostasis. Kuphatikiza apo, adalemba kuti "allostasis imafotokozeranso kusamvetsetsa komwe kumapezeka mu liwu loti" homeostasis "posiyanitsa makina omwe ndi ofunikira pamoyo (homeostasis) ndi omwe amasunga makinawa moyenera (allostasis)."

Makinawa akapanikizika kwambiri, izi zimatha kubweretsa kuchuluka kwambiri. Zambiri mwa majeremusi pantchitoyi, kuchuluka kwa ma allosteric kumakhudzana ndi kusintha kwakanthawi kwakuthupi komwe kumachitika kutsatira kutsegulira kwa axothalamic-pituitary-adrenal (HPA) axis - mahomoni / minyewa yomwe imayamba kugwira ntchito tikakhala pachiwopsezo - zomwe zimadziwika ndikutulutsa ya mahomoni opanikizika, odziwika bwino kwambiri ndi cortisol (yotchedwa "mahomoni opsinjika"). Ngati kulemera kwa allosteric kuli kwanthawi yayitali ndipo makina opangidwira kuti asamawonongeke sangathe kudzikonza okha, izi zitha kubweretsa madera a allosteric monga matenda oopsa komanso matenda ena ambiri otupa. Chofunika koposa, ma allosteric nthawi zambiri amatsogolera ku zizindikilo monga kusokonezeka kwa tulo, nkhawa, komanso kusokonezeka kwa malingaliro. Izi ndi mitundu yazikhalidwe zomwe anthu padziko lonse lapansi amadzipangira mankhwala.

Pita Patsogolo

Pomwe kukwera kwamavuto ogwiritsa ntchito mankhwala osokoneza bongo pa COVID kudzawonekeranso kwambiri ngati mliriwo utha kuchepa, kulimba kwa siliva ndikuti ili si vuto lachilendo. Timamvetsetsa zovuta zakugwiritsa ntchito mankhwala osokoneza bongo kuposa momwe timamvetsetsa COVID-19, ndipo tikudziwanso kuti chimodzi mwazolepheretsa kwambiri kuchiza ndizochititsa manyazi chifukwa chovomereza kuti munthu ali ndi vuto. Kuphatikiza apo, tili ndi mankhwala opulumutsa moyo (monga Naloxone) omwe angalepheretse omwe ali ndi vuto la kugwiritsa ntchito opioid kuti asafe chifukwa chogwiritsa ntchito mankhwala osokoneza bongo.

Kupita patsogolo, ife m'magulu azamisala tiyenera kulimbikitsa zoyesayesa zothana ndi manyazi omwe amabwera chifukwa chogwiritsa ntchito mankhwala osokoneza bongo. Mwachidule, opanga mfundo ayenera kukhala okonzekera kuchuluka kwa ma opioid owonjezera ndikuwonetsetsa kuti oyankha oyamba ali ndi mwayi wogwiritsa ntchito mankhwala monga Naloxone. Kachiwiri, odwala a COVID-19 ndi abale akuyenera kulandila chithandizo chamankhwala mosavuta kuti athe kulimba mtima komanso kuti athe kuchepetsa zovuta zamankhwala osokoneza bongo zomwe zimayamba ngati mankhwala a PTSD.

Nkhaniyi idasindikizidwanso pa KevinMD.

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