Isebenza Kanjani Intsha Ekuthatheni Imithi Elwa Nemilwelwe

Kubhalwe kahle ukuthi isibalo sezingane ezikhuluma ngemishanguzo yokulwisana nengqondo siyakhula. Lokhu ngokuvamile kubhekwe njengento engeyinhle futhi okukhombisa ukusetshenziswa ngokweqile kwemithi. Eqinisweni, kepha kube nemininingwane emincane kakhulu yokusitshela ukuthi ngabe le mithi isetshenziswa kakhulu yini, maduzane noma ngabe ukwanda kukhombisa ukwelashwa okufanele futhi okusemthethweni kwezingane ezinezinkinga ezinkulu zokuziphatha ngokomzwelo. Imithi yokwelapha i-antipsychotic yasungulwa ukwelapha abantu abadala abanezifo ezinkulu zengqondo ezifana ne-schizophrenia ne-bipolar disorder. Eminyakeni yamuva nje, ukusetshenziswa kwabo kudlulele emaqenjini amadala nakwezinye izifo ezifana ne-autism, i-ADHD, nokuphikisana okuphikisayo. Ngoba le mithi ithwala ubungozi bezinto ezifana nokukhuluphala, isifo sikashukela, nokuphazamiseka kokunyakaza, kube nokuhlolisisa okwengeziwe ukubheka ukuthi zisetshenziswa ngendlela eyiyo.

Omunye wemisebenzi yami ukuhlala ekomidini lesifundazwe saseVermont elibizwa ngeVermont Psychiatric Medications for Children and Adolescents Trend Monitoring Workgroup. Umsebenzi wethu ukubuyekeza imininingwane ephathelene nokusetshenziswa kwemithi yokwelashwa kwengqondo phakathi kwentsha yaseVermont bese senza izincomo kusishayamthetho sethu nakwamanye ama-ejensi kahulumeni. Ku-2012, besibona ukwanda okufanayo ekusetshenzisweni kwemithi njengawo wonke umuntu, kepha bekunzima ukwenza umqondo wale mininingwane engaqondakali. Amalungu ekomidi athambekele ekungabazeni imithi yezengqondo ezwakalisa i-alamu ngenkathi amalungu anokuncika okuhle emithini ecabanga ukuthi lokhu kwanda kungaba yinto enhle njengoba izingane eziningi ezidinga zithola ukwelashwa. Konke kuvunyelwene, noma kunjalo, ukuthi ngaphandle kokumba phansi kancane, asisoze sazi.

Ikomidi lethu labe selinquma-ke ukuthi lokho ebesikudinga bekuyidatha empeleni engasitshela okuthe xaxa mayelana nokuthi kungani lezi zingane ziyiphuza kanjani le mithi. Ngenxa yalokho, sidale inhlolovo emfushane eyathunyelwa kummeli wayo yonke imishanguzo yokuvikela ukucasulwa kwengqondo enikezwa ingane yakwaVermont eneMedicaid eqinisekisiwe engaphansi kweminyaka engu-18. kuphoqelekile ngokudinga ukuthi igcwaliswe ngaphambi kokuba umuthi (izinto ezifana neRisperdal, iSeroquel, ne-Abilify) ziphinde zigcwaliswe.

Imininingwane esiyitholile emuva ibithakazelisa kakhulu bese sinquma ukuthi sidinga ukuzama nokushicilela esikutholile kumagazini ovelele. Leyo ndatshana, ebhalwe yimina kanye nabanye ochwepheshe abaningi abazinikele abasebenza kuleli komiti, iphume namuhla ephephabhukwini i-Pediatrics.

Yini esiyitholile? Nanka amanye amaphuzu avelele .....

• Iningi lababhali bemithi elwa ne-psychips akubona ochwepheshe bezengqondo, cishe isigamu singabahlengikazi bezokunakekelwa okuyinhloko njengodokotela bezingane noma odokotela bemindeni.
• Inani lezingane ezineminyaka engaphansi kwemihlanu ubudala ezithatha umuthi wokulwa ne-psychotic liphansi kakhulu (iVermont ingahluka kancane lapha).
• Imvamisa, udokotela manje onesibopho sokugcina imishanguzo ye-antipsychotic akusiye owayiqala ekuqaleni. Kulezo zimo, umfakisicelo wamanje kaningi (cishe u-30%) akazi ukuthi yiluphi uhlobo lwe-psychotherapy olwake lwazanywa ngaphambi kwesinqumo sokuqala umuthi wokulwa nemishanguzo.
• Ukuxilongwa okubili okuvame kakhulu okuhlobene nemithi kwakuyizinkinga zemizwa (kungafaki ukuphazamiseka kwe-bipolar) ne-ADHD. Izimpawu ezimbili ezijwayeleke kakhulu bekungukuhlukumezeka ngokomzimba nokungazinzi kwemizwelo.
• Ezimweni eziningi kakhulu, imishanguzo ye-antipsychotic yasetshenziswa kuphela ngemuva kokuthi eminye imithi nezinye izindlela zokwelapha ezingezona ezemithi (njengokululekwa) zingazange zisebenze. Kodwa-ke, uhlobo lokwelashwa obekuzanywe kaningi bekungeyona into efana ne-Behaeveal Therapy, indlela ekhonjiswe ukuthi iyasebenza ezinkingeni ezinjengokudelela nobudlova.
• Odokotela benze umsebenzi omuhle wokugcina isisindo sengane uma ethatha imishanguzo yokulwa nengqondo, kepha cishe cishe isigamu sesikhathi lapho bebenza khona imisebenzi enconyiwe yokufuna izimpawu zokuxwayisa zezinto ezinjengesifo sikashukela.
• Mhlawumbe okubaluleke kakhulu, sihlanganise izinto eziningi zokuhlola ukuzama ukuphendula umbuzo womhlaba jikelele wokuthi ingane ilimala kangaki ukuthatha umuthi wokulwa nomqondo ngokuya ngemikhombandlela "yokusebenza okuhle". Sisebenzise izincomo ezishicilelwe ezivela eAmerican Academy of Child and Adolescent Psychiatry sathola ukuthi kukonke, imihlahlandlela yokwenza okuhle ilandelwe cishe isigamu sesikhathi. Ngokwazi kwethu, lesi yisikhathi sokuqala ukuthi leli phesenti selike lalinganiselwa uma kukhulunywa ngezingane nangemishanguzo yokuthithibalisa. Lapho incwadi kadokotela “yehlulekile” ukusebenza kahle kakhulu, isizathu esivame kakhulu ukuthi ukwenziwa kwemisebenzi kwakungenziwa.
• Siphinde sabheka ukuthi imishanguzo kadokotela yayisetshenziswa kangaki ngokuya ngesibonakaliso se-FDA, okuyiqoqo elincane kakhulu lokusetshenziswa. Umphumela - 27%.

Ukuhlanganisa konke lokhu, sithola isithombe esicacile sokuthi kungenzeka yini ukuthi kwenzekani. Ngasikhathi sinye, le miphumela ayiziboleki kalula kuma-soundbites asheshayo mayelana nezingane ezimbi, abazali ababi, noma odokotela ababi. Umphumela owodwa obekuqinisekisa ngukuthi awubonakali sengathi le mithi isetshenziswa ngokunganaki ekuziphatheni okucasulayo. Noma ngabe ukuxilongwa kwakubonakala kuyiffy encane efana ne-ADHD, idatha yethu ikhombisile ukuthi inkinga yangempela ibhekiswe kaningi ngento efana nolaka lomzimba. Ngasikhathi sinye, kunzima ukuziqhenya ngokulandela izincomo zomkhuba ezinhle kakhulu isigamu sesikhathi, ikakhulukazi lapho besiphana ngandlela thile ngokuthi sasikhona nini. Engxoxweni yethu, sigxila ezindaweni ezine ezingasiza ukuthuthukisa isimo. Okokuqala, abakwa-prescribers bangadinga izikhumbuzo eziningi (nge-elekthronikhi noma ngenye indlela) ukubashukumisela ukuthi bathole umsebenzi onconyiwe ongakhombisa ukuthi sekuyisikhathi sokuma noma okungenani ukunciphisa imithi. Okwesibili, odokotela abaningi bazizwa bebambekile ngoba bebengaqali umuthi kwasekuqaleni kepha manje sebebhekene nawo futhi abazi ukuthi bangawuyeka kanjani. Ukufundisa odokotela bokunakekelwa okuyisisekelo mayelana nokuthi bangakwenza kanjani futhi nini lokhu kunganciphisa inani lezingane ezithatha imishanguzo yokulwisana ne-psychotic unomphela. Okwesithathu, sidinga ishadi lezokwelapha elingcono elilandela iziguli eduze kakhulu.Uma ucabanga ngengane ekhuliswa ngabazali, ikhuphuka isuka esifundeni esithile iye kwesinye, kulula ukucabanga ukuthi kunzima kanjani njengamanje ngodokotela wenyanga ukwazi ukuthi yini ebikade izamile ukusiza le ngane. Okwesine, sidinga ukwenza ukwelashwa okususelwa ebufakazini kutholakale kakhudlwana, okungenzeka kuvimbele izingane eziningi ukuthi zingafiki ezingeni lokuthi umuthi wokulwa nengqondo ubhekwa.

Ngokubona kwami, imishanguzo yokulwa nemithambo yegazi inendawo ekwelashweni, kepha iningi kakhulu lifika kuleyo ndawo ngokushesha okukhulu. Lokhu kuwa kwangaphambilini, ngafakaza ekomitini elihlangene le-Vermont lezomthetho mayelana nokutholwe kwethu kokuqala. Ikomidi lethu lizohlangana futhi maduze ukunquma ukuthi iziphi izinyathelo ezithile esithanda ukuzincoma ngokulandelayo. Ithemba lethu ukuthi ezinye izifundazwe zizokwenza amaphrojekthi afanayo ukuqinisekisa ukuthi le mithi kanye neminye isetshenziswa ngokuphepha nangokufanelekile ngangokunokwenzeka.

@copyright nguDavid Rettew, MD

UDavid Rettew ungumbhali weChild Temperament: New Thinking About the Boundary Between Traits and Illness nodokotela wezifo zengqondo ezinganeni eminyangweni yezengqondo nezifo zezingane e-University of Vermont College of Medicine.

Mlandele ku- @ PediPsych futhi uthanda iPediPsych ku-Facebook.