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Yıl:2008; Cilt: 18; Sayı: Ek 1>> Özet
TAM METİN
Klinik Psikofarmakoloji Bülteni; 2008;18(Ek 1):0-0
Şizofreni tedavisinde yeni kuşak antipsikotikler: Dopamin sistemi dengeleyicileri ve aripiprazol
K Alptekin
Dokuz Eylül Üniversitesi, Tıp Fakültesi, Psikiyatri AD İzmir-Türkiye
Şizofreni ergenlik döneminde ortaya çıkan ve yeti yitimine yol açan bir hastalıktır. Pozitif, negatif belirtiler ve bilişsel işlev bozulması şizofrenide görülen en temel belirtilerdir. Mezolimbik bölgede dopamin sisteminin etkinleşmesi pozitif belirtileri, prefrontal bölgede dopamin sistemi etkinliğinin azalması negatif belirtileri ve bilişsel işlev bozulmasını oluşturmaktadır, ideal bir antipsikotik ilaç, bu düşünceye göre mezolimbik bölgede dopamini azaltıcı etki ederken, prefrontal bölgede de dopamini arttırıcı etki sağlayabilmelidir. Yeni geliştirilen Serotonin Dopamin Antagonisti (SDA) ilaçlar bu etkiye sahiptirler. Ayrıca yakın zamanda kullanıma giren Dopamin Sistemi Dengeleyici (DSD) ilaçlar da bu dopamin teorisiyle örtüşmektedir. DSD ilaçların en önemli avantalı, ortamdaki dopamin düzeyine göre işlevlerini gerçekleştirmesidir. Eğer ortamda fazla dopamin varsa azaltıcı, az dopamin varsa arttırıcı yönde ("ikili etki"] etkinlik göstermektedirler. DSD ilaçlardan ilk klinik kullanıma giren aripiprazol, şizofreni hastalarında pozitif ve negatif belirtilerde düzelme sağlarken, aynı zamanda haloperidol ve diğer SDA ilaçlarla karşılaştırıldığında daha düşük oranda ekstrapiramidal sistem yan etkisi oluşturması, prolaktin artışına yol açmaması ve metabolik sendromla ilişkili kilo, kan basıncı, serum glukoz, kolesterol, trigliserid düzeylerine olumsuz etkisinin bulunmaması nedeniyle güvenilir bir antipsikotiktir.
New generation antipsychotics in the treatment of schizophrenia: dopamine stabilizing agents and aripiprazole
Schizophrenia is a major mental disorder starting mostly during adolescence and cause significant disability. Positive and negative symptoms and cognitive dysfunctions are main domains of schizophrenia. Dopaminergic hyperactivation in mesolimbic regions is related to positive symptoms whereas hypodopaminergic activity in prefrontal regions is related to negative symptoms and cognitive impairments. Therefore an ideal antipsychotic must have the ability to decrease hyperdopaminergic activity in mesolimbic areas and increase dopaminergic hypoactivation in prefrontal lobes. Recently developed Serotonin Dopamine Antagonists (SDA] have this ability. Dopamine Stabilizing Agents (DSA1 demonstrate similar characteristics resembling to this hypothesis. DSA functions according to to the levels of dopamine. SDA decreases dopamine if high, and increases it if low ("Dual Effect"]. Aripiprazole, a DSA that was approved first by regulatory agencies, improves positive and negative symptoms clinically in patients with schizophrenia and is safe. It also causes less Extrapyramidal Side Effects, no increase in prolactin levels, serum glucose, cholesterol and triglyceride levels, weight, and blood pressure that are all related to metabolic syndrome.

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