Ukubuyiselwa kwisifo sokutya kuyinselele. Ukuba wena okanye umntu obathandayo unesifo sokutya, usenokuzibuza: Ngaba uncedo lwamachiza luncedo? Impendulo iyinkimbinkimbi. Ngokungafani nezinye iinkathazo zempilo yengqondo ezingaphathwa ngempumelelo ngamachiza, ukuphazamiseka kokutya akufunyanwanga ukuba kuphendulwa kwiyeza.
Ukutya kwezidlo, ukutya (kunye nokuqheleka kokutya kwimizekelo) yonyango lokuqala .
Kwezinye iimeko, unyango lonyango lunokwenza ukuba unyango luphumelele. Abantu abaninzi abaneengxaki zokutya nabo banengxaki yokuxhalabisa nokuxinezeleka kunye namayeza anganceda ngeempawu zokuxhalaba nokuxinezeleka.
Uvavanyo oluhlolisayo lwe-diagnostic ne- psychiatrist luhlala lunconywa ngaphambi kokuqala nayiphi na imirhumo yeyeza zonyango. Phakathi kwezinye izinto, kunokubaluleka ukufumanisa ukuba iimpawu ezixhalabileyo kunye nemizwelo yeza ngaphambi kokuphazamiseka kokutya okanye zibe ziimpawu zokungondleki.
Anorexia Nervosa
Amachiza akufuneki ukuba abe ngowokuqala okanye unyango oluphambili lwe- anorexia nervosa . Ngokutsho kukaDkt. Tim Walsh (ngo-2013), "Kukho ubungqina obuninzi" obuxhasa ukulungiswa kwesondlo kunye ne-psychotherapy ekunakekeleni i-anorexia nervosa, xa kuthelekiswa namayeza.
Akukho mayeza ayenayo i-FDA evunyelwe ukonyango lwe-anorexia. Ngokuqhelekileyo, xa unyango lugqityiweyo, injongo ephambili inokuba yinto yokuzuza ubunzima.
Ngokuqhelekileyo ibhalwe ukuba izigulane ezingaphendulwanga ekubuyiseleni okunomsoco kunye ne-psychotherapy. Nangona kunjalo, nakwiimeko, ukuphumelela kwamachiza akuzange kufundwe kakuhle-izilingo zonyango kubonakala kunzima ukuqhuba kwizigulane ezine-anorexia kuba ezi zigulane zivame ukungafuni ukuthatha amayeza ngenxa yokwesaba ukuzuza ubunzima.
Kukho ubungqina obuncitshiweyo bokuthi imithi yesibini yokulwa ne-antipsychotic (ebizwa ngokuba yi-antipyychotics e-atypical), njenge-Zyprexa, inokukunceda ekunyuseni ukunyuka kwesisindo. Nangona kunjalo, indlela eyenziwa ngayo le nto ayiqondanga kakuhle. Kuyathakazelisa, nangona izigulane ezine-anorexia zidla ngokugqithisa kakhulu imibono yokutya kunye nomzimba wazo ofana neengcamango zengqondo, ezi zibonakaliswa zingaphenduli kwimithi yokulwa ne-antipsychotic. Ukuba i-antipsychotics isetyenziswe, ziyacetyiswa ukuba zisetyenziswe ngokubambisana neendlela zokuziphatha ezijolise ekuncedeni isigulane ukufezekisa nokugcina isisindo esifanelekileyo.
Amachiza okuxhatshazwayo awancedi ukufumana ubunzima, nangona angasetyenziswa ekuphatheni ukuxhalaba kunye nokudandatheka. Ngelishwa, amaninzi amayeza awabonakali asebenza kakuhle kwizigulane ezine-anorexia nervosa. Oku kungenxa yokuba indlala ichaphazela umsebenzi wama-neurotransmitter kwingqondo. Ngamanye amaxesha, i-benzodiazepines inokumiselwa ukuba isetyenziswe ngaphambi kokutya ukunciphisa uxhalaba; Nangona kunjalo, akukho phando lokuxhasa lo mkhuba kwaye i-benzodiazepines ingaba ngumlutha.
Izigulane ezine-anorexia nervosa zisengozini yokunqongophala kwethambo (i-osteopenia kunye ne-osteoporosis) kunye nokwanda kweziza ngenxa yokungondleki.
Oku kudla ngokuhamba kunye nokulahlekelwa kwexesha lokuya esikhathini. Iipilisi zolawulo lokuzalwa ziqheleke ngokugqithiswa oogqirha kwizame zokuqalisa ii-mens nokunciphisa ubuthathaka besithambo.
Nangona kunjalo, uphando aluzange lubonise oku kusebenzayo: iipilisi zokulawulwa kokuzalwa akuncedi ngokuxinwa kwethambo kwaye ziyakubamba iimpawu ze-anorexia ngokubangela amaxesha angenziwanga. Ekugqibeleni, iipilisi zokulawulwa kokuzalwa azikhuthazwa ngeenjongo ezingaphaya kolawulo lokuzalwa. Uphando lukhumbuza ukuba ukunyameka kwethambo ephantsi kukuphathwa ngokubuyiselwa kwesisindo, okwangoku, yile ndlela, kuphela indlela eyaziwayo yokulungelelanisa i-hormone ebangela ukuba ithambo linciphise.
Bulimia Nervosa
Iiyeza zengqondo ziye zaboniswa ukuba zincedo ekwenzeni unyango lwe- bulimia nervosa kwaye zihlala zisetyenziselwa ukongeza ukulungiswa kwesondlo kunye ne-psychotherapy. Ukubuyiselwa kwempilo kugxile ekusekeni ukutya okuqhelekileyo kunye nokwakhiwa . Imithi yodwa ayidla ngokucetyiswa ukuba i-bulimia nervosa ngaphandle kokuba isiguli singenakho ukufikelela kwengqondo ye-psychotherapy kunye nonyango lokutya.
Injongo ephambili yonyango ye-bulimia nervosa ibeka ukuxinwa nokuhlanjululwa . I-serotonin reuptake inhibitors (i-SSRI i-anti-depressants) ekhethiweyo yile mithi efundwayo kakhulu yokunyanga kwe-bulimia nervosa yaye ngokuqhelekileyo ibekezelwa zizigulane. Akusaziwa ngokucacileyo isizathu sokuba basebenze; kucatshulwa ukuba ubuncinane ezinye izigulane iinkqubo ze-nervous system zeprootonin ziphazamiseka. Le klasi ye-antidepressant iye yaboniswa ukunciphisa ukutya okudliwayo, ukuhlanjululwa, kunye neempawu zeengqondo ezifana nokuqhutyelwa komzimba. Eli klasi lamachiza liye labonisa ukuba luncedo ekuphuculeni iimpawu zokuxhalabisa kunye nokuxinezeleka.
Izifundo zonyango zibonisa ukuba i-SSRI iyasebenza kakhulu xa idibene ne-psychotherapy. Amachiza angenza i-psychotherapy iphumelele ngakumbi kwabanye. Amachiza yedwa ayisebenzisekanga kwizigulane ezininzi njengengqondo yonyango. Amachiza angaphumelela xa edibaniswa nokuzinceda kunye nokuzithengisa .
I-SSRIs, i-Prozac (igama loshishino lweFluoxetine) liyona nto ifundwa kakhulu kunyango ye-bulimia nervosa, kwaye nayo yodwa imithi evunyiweyo yi-US Food and Drug Administration (FDA) kubantu abadala abane-bulimia nervosa. Ngenxa yezi zizathu, kudla ngokucetyiswa njengemithi yokuqala yokuzama. Nangona kunjalo, kufuneka kuqatshelwe ukuba amaninzi amayeza asetyenziswa ngabagula ngengqondo "ngaphandle kwelebuli," echazwa yi-FDA ngokuthi "ukusetyenziswa kweziyobisi ngenxa yesalathisi, ifom yefayili, i-regimen, isigulane okanye esinye isithintelo sokusetyenziswa esingakhankanyiweyo kwiibhile ezivunyiweyo . "
Uphando lubonisa ukuba ukuba isigulane nge-bulimia nervosa siya kuphendula kakuhle ku-Prozac, ngokuqinisekileyo iya kubonisa impendulo enhle kwiiveki ezintathu zokuthatha leyeza. Kubalulekile ukuba uqaphele ukuba izilingo ezininzi zokulawulwa ngokulandelelanisa ziye zakha i-60 mg yeprozac njenge-dose ejwayelekile ye-bulimia nervosa. Oku kuphakamileyo kunomlinganiselo osemgangathweni osetyenziswa ukuxinezeleka okukhulu (20 mg).
Ukuba i-Prozac ayisebenzi, ezinye i-SSRI idlalwa ngokuzayo. Akuqhelekanga kwamanye ama-agent, njenge-anticonvulsant Topirimate, ukuba isetyenziswe ngaphandle kwileyibhile ye-bulimia. Ngokuqhelekileyo kucetyiswa ukuba izigulane zihlale kumachiza kwiinyanga ezintandathu ukuya kwezi-12 emva kokufikelela ekuphuculeni kwiyeza.
I-Binge Eating Disorder
Imithi ibonakala isebenzayo ekuncedeni izigulane ngokutya okudliwayo (BED) ukuyeka ukutya okudliwayo kodwa kungabikho ukuvelisa ukulahleka kwesisindo esinjongo esisodwa kwizigulane ezifuna uncedo kule ngxaki. Kwi-BED, iiklasi ezintathu eziphambili zonyango ziye zafundwa: izidalwa zokudandatheka (ngokukodwa ii-SSRI, kubandakanywa neProzac); imishanguzo yokuxhatshazwayo, ngokukodwa i-Topic; kunye noMavvanse (amayeza e-ADHD).
Njengoko ziyenzela izigulane nge-bulimia nervosa, ukuxhatshazwa kwengcinezelo kunokunceda ekunciphiseni ubude bokutya ukutya kwiigulane ezineBED. Banokukunceda ekunciphiseni iingcamango ezinzulu kunye neempawu zokudandatheka. I-headirimate inokunceda ekunciphiseni ubude binges kwaye inganciphisa iingcamango ezingapheliyo kunye nokungafuneki.
Imithi ekhuthazayo esetyenziselwa unyango lweengxaki zokuxhatshazwa kweengxaki (ADHD) ziyaqatshelwa ukunqanda ukutya kwaye ngoko bekuye kugxininiswa kutshanje kwonyango lweBED. Kungekudala, iVivvanse (lisdexamfetamine), amayeza e-ADHD, yaba yipilisi yokuqala evunyiweyo yi-FDA yokuphatha i-BED. Kuye kwafundwa kwizilingo ezintathu kwaye yahlanganiswa nokunciphisa ukunyuka kwee-episodes ngeveki, ukunciphisa ukugqithiswa okuhlobene nokutya kunye nokunyanzelisa, kwaye kwavelisa ukulahleka okuncinci.
Kukho izifundo ezinganeleyo ngokuthelekisayo ngokuthelekisa unyango lweyeza kunyango lwengqondo lwe-BED, kodwa imithi ngokuqhelekileyo ibonwa njengeyona ngempumelelo kunokuba i-psychotherapy . Ngaloo ndlela, kufuneka ukuba bathatyathwa njengonyango lweyesibili emva kwengqondo ye-psychotherapy, njengesigxina kwi-psychotherapy, okanye xa unyango lungenakufikeleleka.
Isexwayiso kwi-Wellbutrin
Ukuxilwa kwe-anti-depressant bupropion (edla ngokuthengiswa njenge-Wellbutrin) iye yadibaniswa nokugulana kwizigulane zokuhlanza i-bulimia kwaye ayikhuthazwa izigulana ezineengxaki zokutya.
ILizwi
Ngokuqhelekileyo, amayeza ayisoloko eyona nto yokuqala, imo yonyango yesifo sokutya. Amachiza anokunceda xa athe wongezwa kwi-psychotherapy okanye xa i-psychotherapy ingekho. Ngaphezulu, amayeza aqhelekileyo asetyenziswayo xa izigulana nazo zibonakalisa iimpawu zokuxhalaba nokuxinezeleka ukunceda kule miqondiso.
Nangona kunjalo, amayeza angathatha umngcipheko weempembelelo ezingasifumananga neengqondo zengqondo. Ekugqibeleni, "unyango" olukhethiweyo kwisifo sokutya kukutya nokutya okuqhelekileyo.
Kukho iindlela ezahlukeneyo zonyango zokuphazamiseka kokutya ezicatshulwa njengento ephumelelayo, kubandakanywa unyango lokuziphatha kunye nokunyangwa kwintsapho .
> Imithombo:
> "I-Anorexia Nervosa kubantu abadala: i-Pharmacotherapy." Walsh, Tim. 2013. UpToDate. http://cursoenarm.net/UPTODATE/contents/mobipreview.htm?16/28/16847?view=print.
> Berkman, ND, Brownley, KA, Peat, CM, Lohr, KN, Cullen, KE, Morgan,. . . Bulik, CM (2015). Ulawulo kunye neziphumo zengxaki yokutya ngokugqithisileyo [Isishwankathelo esiphezulu].
> "UBulimia Nervosa kubantu abadala: i-Pharmacotherapy." UCrow, Scott. 2013 UpToDate. http://ultra-medica.net/Uptodate21.6/contents/UTD.htm?6/62/7145?source=related_link.
> Davis, Haley, noEvelyn Attia. 2017. "I-Pharmacotherapy ye-Disorder Disorders." Iingcamango zangoku kwi-Psychiatry 30 (6): 452-57. i-doi: 10.1097 / YCO.0000000000000358.
> Gorla, Kiranmai, noMaju Mathews. 2005. "Ukwelashwa kwamayeza okweMpilo yokuPhalaliswa kokutya." I- Psychiatry (Edgmont) 2 (6): 43-48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000192/.
> USysko, uRobyn, uNanshi Sha, Yuanjia Wang, uNahua Duan, kunye noB. Timothy Walsh. 2010. "Ukuphendula kwangaphambili kwi-Treatment Antidepressant kuBulimia Nervosa." Uncedo lwezengqondo 40 (6). i-doi: 10.1017 / S0033291709991218.