Alkol Kullanım Bozuklukları Psikofarmakolojisi
Özet
Alkol kullanım bozuklukları (AKB), küresel hastalık yükü ve önlenebilir ölümlerde ciddi payı olan, bireyin sosyal, bedensel ve ruhsal iyilik halini etkileyen önemli bir halk sağlığı sorunudur. DSM-5 tanı kriterlerine göre hafif, orta ve ağır şiddette sınıflandırılan bu bozukluğun nörobiyolojisinde, GABA sinapslarındaki inhibisyonun artması ve glutamat uyarımının baskılanması temel mekanizmalardır. AKB tedavisinde arındırma ve nüks önleme süreçlerinde psikososyal müdahalelerin yanında farmakoterapi vazgeçilmez bir unsurdur. Alkol yoksunluk sendromu (AYS) ve ölümcül olabilen delirium tremens (DT) tablosunun tedavisinde primer olarak diazepam ve karaciğer yetmezliğinde tercih edilen lorazepam gibi benzodiazepinler; belirti odaklı, sabit veya doz yükleme rejimleriyle kullanılır. Ayrıca kronik alkol alımının yol açtığı emilim kusurları nedeniyle oluşan tiamin eksikliğini ve buna bağlı Wernicke-Korsakof sendromunu önlemek için tiamin replasmanı ile sıvı-elektrolit dengesinin korunması hayati önem taşır. Dirençli yoksunluk olgularında antiepileptikler, antipsikotikler, barbitüratlar veya alfa-2 agonistler tedaviye eklenebilir. Tedavinin idame aşamasında ise aşermeyi ve depreşmeyi önlemek, tam ayıklığı sağlamak veya ağır içiciliği azaltmak amacıyla akamprosat, naltrekson, nalmefen ve disülfiram gibi onaylı ajanların yanı sıra topiramat ve baklofen gibi ilaçlardan da yararlanılmaktadır.
Alcohol use disorders (AUD) represent a major public health problem with a significant share in the global burden of disease and preventable deaths, affecting an individual's social, physical, and mental well-being. Classified as mild, moderate, and severe according to DSM-5 diagnostic criteria, the neurobiology of this disorder is fundamentally characterized by increased inhibition at GABA synapses and suppression of glutamate excitation. Pharmacotherapy is an indispensable component alongside psychosocial interventions in the detoxification and relapse prevention processes of AUD treatment. Benzodiazepines, primarily diazepam and lorazepam—preferred in liver dysfunction—are used in symptom-triggered, fixed-dose, or loading regimens to treat alcohol withdrawal syndrome (AWS) and potentially fatal delirium tremens (DT). Furthermore, due to malabsorption caused by chronic alcohol consumption, thiamine replacement and maintaining fluid-electrolyte balance are of vital importance to prevent thiamine deficiency and the associated Wernicke-Korsakoff syndrome. Antiepileptics, antipsychotics, barbiturates, or alpha-2 agonists may be added to the treatment in resistant withdrawal cases. In the maintenance phase of treatment, approved agents such as acamprosate, naltrexone, nalmefene, and disulfiram, as well as medications like topiramate and baclofen, are utilized to prevent craving and relapse, maintain total abstinence, or reduce heavy drinking.
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