Abstract | Shizofrenija je težak psihijatrijski poremećaj koji ima različite simptome. Oni uključuju halucinacije, zablude, smanjeni socijalni angažman, kao i anksioznost, depresiju, zaravnjeni afekt, nedostatak motivacije i emocija te nemogućnost iskazivanja emocija. Kognitivni simptomi u obliku gubitka koncentracije, narušene radne memorije te izvršnih funkcija također su prisutni. Zbog toga što je jako kompleksna, etiologija shizofrenije nije još potpuno shvaćena. Geni i okoliš igraju bitnu ulogu u njezinom razvoju. Postoje brojne neurotransmiterske teorije (koje uključuju dopamin, serotonin i glutamat) i neuroupalne teorije koje pokušavaju objasniti razvoj shizofrenije. Antipsihotici su prva linija liječenja shizofrenije. Postoje tri skupine antipsihotika: prva, druga i treća generacija antipsihotika. Prva generacija antipsihotika većinom uključuje snažne antagoniste dopaminskih D2 receptora koji većinom imaju učinak na pozitivne simptome. Oni uzrokuju brojne nuspojave, ali najopasniji oblik predstavljaju neuroleptički maligni sindrom (koji je rijedak) te vrlo česti ekstrapiramidni simptomi poput akutne distonije, akatizije, pseudoparkinsonizma i tardivne diskinezije. Osim što su jako neugodni, znatno mogu smanjiti suradljivost bolesnika u uzimanju terapije. Druga generacija antipsihotika uključuje serotoninsko-dopaminske antagoniste te multireceptorske antagoniste (MARTA). Činjenica da je učinak na serotoninske receptore jači od onog na dopaminske receptore dovela je do smanjenja incidencije ekstrapiramidnih simptoma. Njihove se nuspojave manifestiraju u obliku metaboličkih poremećaja poput porasta tjelesne težine, dislipidemije i inzulinske rezistencije. Antipsihotici treće generacije izdvojeni su na temelju njihovog mehanizma djelovanja na dopaminske receptore. Za razliku od svojih prethodnika, oni nisu antagonisti dopaminskih D2 receptora, već parcijalni agonisti dopaminskih D2 receptora. Uzrokuju puno manji broj nuspojava od antipsihotika prve i druge generacije. Nefarmakološki oblik liječenja također je vrlo važan za bolesnika jer mu omogućuje reintegraciju u društvo, bolje shvaćanje vlastite bolesti te lakše izvršavanje svakodnevnih zadataka. Psihoterapija je osnovni oblik nefarmakološke terapije, a njezin je najčešći tip u liječenju shizofrenije kognitivno-bihevioralna terapija. Ako antipsihotici nisu dovoljni, terapijski rezistentna shizofrenija liječi se elektrokonvulzivnom terapijom. Koristi se električna energija koja proizvodi konvulzije te tako dovodi do poboljšanja simptoma. Kao jedna od opcija liječenja postoji i transkranijalna magnetska stimulacija, no ona nije dovoljno istražena. |
Abstract (english) | Schizophrenia is a severe mental disorder characterized by various symptoms. They include hallucinations, delusions, reduced social engagement, as well as anxiety, depression, flat affect, lack of motivation and emotion and inability to express emotions. Cognitive symptoms in the form of loss of concentration, impaired work memory and executive functions are also present. Due to its complexity, the etiology of schizophrenia is not yet fully understood. Genes and environment play an important role in its development. There are numerous neurotransmitter theories (that include dopamine, serotonin and glutamate) and neuroinflammation theories trying to explain the development of schizophrenia. Antipsychotic medications are the first-line medication treatment for schizophrenia. There are three groups od antipsychotics: the first, the second and the third generation of antipsychotics. The first generation of antipsychotics mainly includes very potent dopamine D2 receptor antagonists which mostly affect the positive symptoms. They cause many side effects, but the most dangerous ones are the neuroleptic malignant syndrome (which is rare) and the very common extrapyramidal symptoms such as acute dystonia, akathisia, pseudoparkinsonism and late dyskinesia. Apart from being very unpleasant, they can significantly reduce the patient's compliance. The second generation of antipsychotics includes serotonin-dopamine antagonists and multi-acting receptor-targeted antipsychotics (MARTA). The fact that the effect on serotonin receptors is stronger than the one on dopamine receptors has led to a reduction in the incidence of extrapyramidal symptoms. Their side effects are manifested in the form of metabolic disorders such as weight gain, dyslipidemia and insulin resistance. Third generation of antipsychotics has been individualized on the grounds of their mechanism of action on dopamine receptors. Unlike their predecessors, they are not dopamine D2 receptor antagonists but D2 partial agonists. They cause fewer side effects than the first and second generation antipsychotics. The nonpharmacological form of treatment is also very important for the patient because it enables reintegration into society, provides better understanding of their own disease and it makes their everyday tasks easier to complete. Psychotherapy is the main form of nonpharmacological therapy and its most used type in schizophrenia treatment is cognitive-behavioral therapy. If antipsychotics are insufficient, treatment resistant schizophrenia is treated with electroconvulsive therapy. The electrical energy that produces convulsions is used and thus improves the symptoms. Transcranial magnetic stimulation represents one of the treatment options, but it is not sufficiently explored. |