Tam than phan liet

Tags: benh tam than phan liet, benh nhan tam than, tang lop xa hoi, thuoc an than, co tac dung, cho gia dinh, nhiem sac the, trieu chung, dieu tri, hoang tuong, tai phat, cung co, ao thanh, nhat, so


Tam than phan liet la mot benh tam than nang co cac trieu chung lam sang rat da dang. Trieu chung hay gap nhat cua benh la cac hoang tuong va ao giac, chung chi phoi hanh vi cua benh nhan. Benh thuong bat dau o tuoi 25 va keo dai suot doi, gap o moi tang lop xa hoi. Benh nhan dan tro thanh ganh nang cho gia dinh va xa hoi.

Nguyen nhan

Yeu to gen di truyen

Gen di truyen gay ra benh tam than phan liet nam o dau den nay van chua ro. Nhung cac tac gia deu thong nhat rang benh tam than phan liet khong phai do mot gen gay ra, ma do to hop nhieu gen gay benh. Cac gen nay nam tai cac vi tri khac nhau cua cac nhiem sac the. Cac nhiem sac the co chua cac gen gay benh la nhiem sac the so 6, 8, 10, 13 va 22.

Yeu to dopamin

Roi loan ve gen di truyen trong benh tam than phan liet dan den hoat dong qua muc he thong dopamin. Gia thiet nay can cu vao hai bang chung sau:

Cac thuoc an than uc che cac thu cam the dopamin o nao co tac dung dieu tri benh tam than phan liet.

Cac thuoc lam tang hoat tinh cua dopamin nhu amphetamin, cocain thi gay ra cac trieu chung loan than giong nhu tam than phan liet.

Su giai phong qua nhieu dopamin gay ra cac trieu chung loan than (hoang tuong, ao giac).

Tam than phan liet
 Cap phat thuoc cho benh nhan tai Benh vien Tam than Trung uong I.

Trieu chung

Trieu chung duong tinh

Trieu chung duong tinh bao gom cac bien doi qua muc qua trinh tu duy (hoang tuong), tri giac (ao giac), loi noi va thong bao (ngon ngu hon loan) va kiem soat hanh vi (hanh vi thanh xuan va cang truong luc). Cac trieu chung duong tinh nay co the duoc chia thanh hai muc do khac nhau: muc do loan than bao gom cac hoang tuong va ao giac, va muc do hon loan bao gom roi loan ngon ngu va hanh vi.

Cac hoang tuong

Hoang tuong la trieu chung loan than co ban cua benh tam than phan liet. Hoang tuong phai co cac dac trung sau: sai lam; co dinh tren benh nhan; chi phoi hanh vi cua benh nhan; khong phai la cac niem tin ton giao pho bien; benh nhan mat hoan toan kha nang phe phan (nghia la khong bao gio thua nhan y nghi cua minh la sai lam).

Mot so y nghi co the bi coi la hoang tuong trong mot nen van hoa (vi du: phu thuy va bua phep) nhung duoc coi la binh thuong trong nen van hoa khac.

Noi dung hoang tuong co the bao gom nhieu chu de khac nhau, hay gap nhat trong tam than phan liet la: Hoang tuong the bi hai, hoang tuong lien he, hoang tuong bi kiem tra, hoang tuong tu cao hoac the hoang tuong ky quai.

Cac ao giac

Ao giac la tri giac khong co doi tuong. Ao giac co the o bat ky giac quan nao (vi du ao thanh, ao thi, ao khuu, ao xuc, ao vi giac) nhung ao thanh hay gap nhat va dac trung hon cho tam than phan liet.

+ Ao thanh co o 60 - 70% so benh nhan tam than phan liet. Benh nhan nghe thay nhung tieng noi khong co that, nhung duoc benh nhan cho la that. Chung thuong duoc chia lam ao thanh that va ao thanh gia.

- Ao thanh that la nhung tieng noi duoc benh nhan nghe thay tu moi truong, ben ngoai co the cua benh nhan. Nhung tieng noi nay nghe rat ro rang, benh nhan co the phan biet duoc do la giong dan ong hay dan ba, tieng nguoi quen hay nguoi la... Ao thanh that co o giai doan som cua tam than phan liet. Theo thoi gian, ao thanh that se dan chuyen thanh ao thanh gia.

- Ao thanh gia la nhung tieng nguoi noi nhung rat mo ho, xuat hien trong co the cua benh nhan (trong dau, trong da day, trong tim cua benh nhan). Vi the, benh nhan khong the phan biet duoc do la giong noi cua ai, khong ro do la tieng dan ong hay dan ba, nguoi quen hay nguoi la... Co khi ao thanh gia duoc cam nhan la y nghi cua chinh benh nhan. Chung giong nhu y nghi cua benh nhan vang len thanh tieng.  

Cac trieu chung am tinh

 Trieu chung am tinh cua tam than phan liet the hien su tieu hao, mat mat cac hoat dong tam than san co. Trong giai doan dau, chung rat kin dao, kho phat hien. Sau mot vai nam bi benh, cac trieu chung nay ngay cang ro rang va den giai doan di chung thi benh nhan chi con cac trieu chung am tinh ma thoi.

Co 3 trieu chung am tinh chinh trong tam than phan liet, do la phang lang cam xuc, ngon ngu ngheo nan va mat y chi.

Tai phat cua benh tam than phan liet

Neu khong dieu tri cung co se co 60-70% so benh nhan tai phat sau mot nam, gan 90% benh nhan tai phat sau 2 nam. Ty le tai phat o cac benh nhan tam than phan liet dieu tri cung co lien tuc bang thuoc sau 1 nam la duoi 20%, sau 2 nam la duoi 30%.

Tam than phan liet la mot benh man tinh, tru mot so benh nhan khoi han sau nhieu nam dieu tri, cac truong hop con lai benh thuong keo dai suot doi. Sau moi dot dieu tri, benh thuong on dinh, nhung benh nhan kho tro ve binh thuong hoan toan nhu truoc khi bi benh. Benh tam than phan liet thuong hay tai phat.

Neu khong duoc dieu tri cung co, ty le tai phat cua benh tam than phan liet la 10% so benh nhan/thang. Sau 1 nam ke tu ngay ngung thuoc, da so cac benh nhan deu tai phat benh. Su tai phat cua tam than phan liet phu thuoc vao cac yeu to sau: the benh va tien trien cua benh; khong dieu tri cung co, hoac dieu tri cung co qua ngan; stress tam ly manh; lam dung ruou va ma tuy; benh co the ket hop.

Ðieu tri

Nguyen tac dieu tri

Cat cac trieu chung loan than cua giai doan cap bang thuoc an than va cac lieu phap chuyen biet.

Dieu tri cung co chong tai phat.

Phuc hoi chuc nang.

Hau het cac benh nhan tam than phan liet phai dieu tri cung co bang thuoc an than suot doi.

Thuoc an than co dien

Thuoc an than co dien (haloperidol, levomepromazin (tisercin) duoc dinh nghia nhu sau: co tac dung chong loan than; gay ra ngoai thap.

Thuoc an than co dien co tac dung tot tren cac trieu chung duong tinh nhu hoang tuong va ao giac, nhung hau nhu khong co tac dung gi doi voi cac trieu chung am tinh nhu cun mon cam xuc, mat y chi va ngon ngu ngheo nan. Do vay, thuoc an than co dien khong nen dung cho cac truong hop man tinh.

Thuoc an than moi

Thuoc an than moi (olanzapin (biet duoc zyprexa, zypnex, ozip, olan, oleanz rapitab, fonzepin...) risperidol (respidon, sizodon) con goi la thuoc an than khong biet dinh. Chung co cac dac diem sau: chong loan than manh; khong gay ngoai thap o lieu dieu tri.

Thuoc an than moi cho ket qua ca tren trieu chung duong tinh va am tinh, ke ca cac truong hop da khang voi thuoc an than co dien. Vi vay thuoc thich hop voi ca tam than phan liet cap tinh va man tinh.

Thoi gian dieu tri cung co

Neu khong dieu tri cung co se co 60-70% so benh nhan tai phat sau mot nam, gan 90% benh nhan tai phat sau 2 nam. Ty le tai phat o cac benh nhan tam than phan liet dieu tri cung co lien tuc bang thuoc sau 1 nam la duoi 20%, sau 2 nam la duoi 30%. Do vay co the khang dinh rang thuoc an than co hieu qua chong tai phat cao. Tot nhat la benh nhan dung thuoc an than duong uong.

Dieu tri cung co phai dat duoc 3 yeu cau sau:

- Hieu qua (khong tai phat).

- Don gian (benh nhan de thuc hien), tot nhat la dung 1 lan/ngay (buoi toi).

- Re tien (benh nhan phai dung thuoc an than nhieu nam).

Lieu thuoc trong dieu tri cung co can bang 1/2-2/3 giai doan tan cong. Voi nhieu loai thuoc an than moi, lieu tan cong chinh la lieu cung co.

Can tranh 2 xu huong:

Dung ket hop nhieu loai thuoc an than va lieu qua cao.

Dung thuoc an than lieu qua thap (vi so doc hai, so tac dung phu).

Thoi gian dieu tri cung co: Benh nhan bi benh lan dau can dieu tri cung co toi thieu 5 nam. Neu benh nhan da co it nhat 1 lan tai phat thi phai dieu tri cung co suot doi.

Lieu phap tam ly

Su dung lieu phap tam ly ca nhan, lieu phap tam ly nhom lon co ket qua giup benh nhan dieu chinh hanh vi cua minh, thich nghi voi cac cang thang tam ly co trong moi truong song. Can luu y rang lieu phap tam ly khong thay the duoc thuoc an than. Tuy nhien chung lam cho benh nhan phuc hoi tot hon.

Lao dong la yeu to quan trong khong chi giup benh nhan phuc hoi chuc nang ma con gop phan chong tai phat. Benh nhan nen duoc bo tri viec lam hop ly (cong viec it cang thang, cang don dieu cang tot), nho co lao dong ho co thu nhap de dam bao cuoc song. Qua do ho cang thay yeu cuoc song va thay minh song co ich, vi the se tich cuc dieu tri.

Viet Bao (Theo SK&DS)

Tìm hiểu: benh tam than phan liet, benh nhan tam than, tang lop xa hoi, thuoc an than, co tac dung, cho gia dinh, nhiem sac the, trieu chung, dieu tri, hoang tuong, tai phat, cung co, ao thanh, nhat, so

Xem Bản Tiếng Việt Có Dấu: Tâm thần phân liệt

Ban co the doc ban tieng Viet co dau cua bai viet Tâm thần phân liệt bang cach nhan chuot vao duong dan tren.

Lien he ve tin Tam than phan liet

Nhan xet, hay lien he ve tin Tam than phan liet co the gui bang duong dan o duoi. Ban nen gui kem tieu de bai viet Tam than phan liet de lam tham khao. Bai viet nay thuoc chuyen de Tin suc khoe trong chuyen muc Suc khoe.

Cac tin khac:

Xem tiep ... Tin suc khoe
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