Stimülanlar ile İlişkili Bozukluklar
Özet
Stimülanlar, santral sinir sistemini uyaran ve sempatomimetik etkiler yaratan, tedavi amaçlı kullanılabilen ancak kötüye kullanımı ve bağımlılık potansiyeli yüksek olan maddelerdir. Beyindeki norepinefrin, dopamin ve serotonin salınımını artırarak etki gösteren bu grup amfetamin, metamfetamin, kokain, MDMA, mefedron, khat, betel nut ve DEHB tedavisinde kullanılan metilfenidat gibi ilaçları içerir. Küreselleşen bu sorun coğrafi, kültürel ve sosyoekonomik özelliklere göre farklılıklar göstermektedir. Son yıllarda Türkiye'de özellikle metamfetamin kullanımında ve buna bağlı şiddet, psikotik belirtiler ve aile içi huzursuzluklar nedeniyle psikiyatri kliniklerine zorunlu yatışlarda ciddi bir artış gözlenmektedir. Akut stimülan intoksikasyonlarında anksiyete, ajitasyon, hipertansiyon ve psikoz gibi tablolar gelişebilirken; kronik kullanım bilişsel bozulmalara, kardiyovasküler patolojilere ve ani ölümlere yol açabilmektedir. Stimülan bağımlılığının tedavisinde spesifik ve onaylanmış yerleşik bir farmakoterapi bulunmamaktadır; yürütülen tedaviler çoğunlukla gelişen psikiyatrik semptomların yönetimine yöneliktir. Klinik pratik ve araştırmalar, farmakolojik yaklaşımların yanı sıra pekiştireç odaklı terapi ve bilişsel davranışçı terapi gibi psikososyal müdahalelerin birlikte uygulanmasının relapsları önlemede ve ayıklık süresini uzatmada en etkin yöntem olduğunu ortaya koymaktadır.
Stimulants are a group of substances and medications that stimulate the central nervous system, produce sympathomimetic effects in the body, can be used for therapeutic purposes, and have a highly widespread potential for abuse and addiction. These substances, which exert their effects by increasing the release of norepinephrine, dopamine, and serotonin in the brain, include amphetamine, methamphetamine, cocaine, MDMA, mephedrone, khat, betel nut, and methylphenidate used in ADHD treatment. This globalizing issue varies according to geographical, cultural, and socioeconomic characteristics. In recent years, a significant increase has been observed in Turkey, especially in methamphetamine use and compulsory admissions to psychiatric clinics due to related violence, psychotic symptoms, and domestic disturbances. While acute stimulant intoxication can present with conditions such as anxiety, agitation, hypertension, and psychosis, chronic use can lead to cognitive impairments, cardiovascular pathologies, and sudden deaths. There is no specific and approved established pharmacotherapy for the treatment of stimulant dependence; the treatments administered are mostly aimed at managing the developing psychiatric symptoms. Clinical practice and research reveal that combining pharmacological approaches with psychosocial interventions, such as contingency management and cognitive behavioral therapy, is the most effective method in preventing relapses and prolonging the duration of abstinence.
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