Kudzoka kubva pane chirwere chekudya kwakaoma. Kana iwe kana munhu waunoda ane chirwere chekudya, ungangodaro unofunga kuti: Mishonga inogona kubatsira here? Mhinduro yacho yakaoma. Kusiyana nehumwe humwe humwe hutano hutano hwepfungwa hunogona kurapwa kubudirira nemishonga, zvinetso zvekudya hazvina kuwanika sezviri kuita zvinoenderana nemishonga.
Nokuda kwezvinetso zvekudya, zvokudya (uye kugadziriswa kwekudya maitiro) ndiyo mishonga inokosha .
Mune dzimwe nguva, mishonga yemapfungwa inogona kuita kuti chirwere ichi kubudirire zvikuru. Vanhu vazhinji vane zvinetso zvekudya vanewo matambudziko nekuzvidya mwoyo uye kuora mwoyo uye mishonga inogona kubatsira nezviratidzo zvekuzvidya mwoyo uye kuora mwoyo.
Chirwere chekuongorora chirwere chepfungwa chinogara chichikurudzirwa usati watanga chero ruzivo rwemishonga yepfungwa. Pakati pezvimwe zvinhu, zvinogona kuva zvakakosha kuziva kana zvirwere uye zviratidzo zvepfungwa zvinouya kusati kwasangana nedambudziko rekudya kana kuti zvinogona kuva zviratidzo zvekushaya zvokudya zvinovaka muviri.
Anorexia Nervosa
Mishonga inofanira kunge isiri iyo yekutanga kana kuti kurapwa kwekutanga kweanorexia nervosa . Maererano naDkt. Tim Walsh (2013), "Kune humwe uchapupu huzhinji" hunotsigira kugadziriswa kwehutano uye psychotherapy pakurapa anorexia nervosa, kana ichienzaniswa nemishonga.
Kwete mishonga isati yave FDA inobvumirwa kuti kurapwa kweanorexia. Kazhinji, apo mishonga inorayirwa, chinangwa chikuru chinowanzova kuwedzera kukura.
Inowanzotarisirwa kune varwere vasina kupindurwa nekudzorerwa kwekudya uye psychotherapy. Zvisinei, kunyange mumatambudziko aya, kubudirira kwemishonga hauna kuongororwa zvakanaka-miedzo yekurapa inoonekwa seoma kuitisa kune varwere vane anorexia nokuti varwere ava vanowanzove vasingadi kutora mishonga nokuda kwekutya kuwedzera kuwanda.
Kune humwe uchapupu hushoma hwokuti chizvarwa chechipiri antipsychotic mishonga (inonziwo atypical antipsychotics), yakadai seZyprexa, inogona kubatsira kutungamirira kudiki kuderedza kuwedzera. Zvisinei, iyo nzira iyo inogona kushanda nayo haina kunyatsonzwisiswa. Zvinofadza kuti kunyange zvazvo varwere vane anorexia vanowanzove vakakanganisa maonero ezvokudya nemuviri wavo izvo zvinoita sezviri kufanana nepfungwa dzepfungwa, zviratidzo izvi hazviita sezvo zvinopindira mishonga yekurapa. Kana antipsychotics inoshandiswa, inokurudzirwa kuti ishandiswe pamwe chete nehutano hwekuita hunova nechinangwa kubatsira murwere kuwana nekuchengetedza hutano hwakanaka.
Mishonga inoderedza kuzvidzora haibatsiri kuwedzera kuwedzera, kunyange zvazvo inogona kushandiswa kugadzirisa kusawirirana nekuzvidya mwoyo. Zvinosuruvarisa, mishonga yakawanda haifaniri kushanda zvakanaka kune varwere vane anorexia nervosa. Izvi zvinogona kuva nokuti nzara inokanganisa basa revanhu vane chirwere chemaurotransmiteri muuropi. Dzimwe nguva, benzodiazepines inogona kurongerwa kushandiswa musati wadya kuti uderedze kuzvidya mwoyo; zvisinei, hapana tsvakurudzo yekutsigira mutsika iyi uye benzodiazepines inogona kuiswa muropa.
Varwere vane anorexia nervosa vari pangozi yefupa ronda (osteopenia uye osteoporosis) uye kuwedzera kuputika nemhaka yekushaya zvokudya zvinovaka muviri.
Izvi zvinowanzofambidzana nekurasikirwa kwemazuva (menses). Kurapa kwepiritsi kunowanzosarudzwa navanachiremba mukuedza kuedzazve kutengesa uye kuderedza kushaya simba kwepfupa.
Zvisinei, kutsvakurudza hakuna kuratidza izvi kuti zvinobudirira: kuberekwa kuzvirambidza mapiritsi haibatsiri nemapfupa emapfupa uye zvinogona kuvhara zviratidzo zveanorexia nekukonzera nguva dzenguva. Pakupedzisira, mapiritsi ekuberekwa asingabatsiri nokuda kwezvinangwa kunze kwekuberekwa. Kutsvakurudza kunotiyeuchidza kuti kuderera kwepfupa kunonyatsorapwa nekuremerwa kwekureruka, ikozvino, panguva ino, nzira chete inozivikanwa yekusimudzira mahomoni anokonzera kupera simba.
Bulimia Nervosa
Mishonga yepfungwa inoratidzirwa kuti inobatsira pakurapa bulimia nervosa uye inowanzoshandiswa kuwedzera pakugadzirisa kudya uye kugadzirisa chirwere chepfungwa. Kudzorerwa kwezvokudya kunotarirwa pakugadzira kudya kwemazuva ose . Mishonga chete haisiwanzokurudzirwa kuti bulimia nervosa kunze kwekuti murwere asingakwanisi kugadzirisa psychotherapy uye chirongwa chekudya.
Chinangwa chikuru chekurapa bhalimia nervosa chiri kumisa kubhadhara nekuchenesa . Kusarura serotonin reuptake inhibitors (SSRI vanodzvinyirira) ndiyo inonyanya kudzidza mishonga yekurapa bulimia nervosa uye inowanzochengetedzwa nevarwere. Hazvizivikanwi kuti nei vachiita basa; iyo inofungidzirwa kuti mune vamwe varwere inonzi central nervous system serotonin nzira dzinovhunduswa. Iyi kirasi yekurwisa mwoyo yakave yakaratidzwa kuderedza kudya, kudya, uye zviratidzo zvepfungwa zvakadai sekufambisa kwekuneta. Iyi kirasi yemishonga yakaratidza kubatsira nekuvandudza zviratidzo zvekufunganya kwekuzvidya mwoyo uye kuora mwoyo.
Chirwere chekurapa chinoratidza kuti SSRIs inonyanya kubudirira kana yakabatanidzwa neyepfungwa. Mishonga inogona kuita kuti psychotherapy ibudirire kune vamwe. Mishonga chete haisi yakakosha kuvarwere vakawanda sepfungwa yepfungwa chete. Mishonga inogonawo kushanda kana yakabatanidzwa nekuzvibatsira uye kutungamirirwa pachako kubatsira .
Pakati peSRRIs, Prozac (zita rekutengeserana reFluoxetine) ndiro rakanyanya kudzidza kurapa bulimia nervosa, uye ndiyo chete mishonga inogamuchirwa neU.S. Food and Drug Administration (FDA) yevanhu vakuru vane bulimia nervosa. Nokuda kwezvikonzero izvi, zvinowanzokurudzirwa semishonga yokutanga kuedza. Zvisinei, inofanira kuonekwa kuti mishonga yakawanda inoshandiswa nevechirwere chepfungwa "off-label," iyo inotsanangurwa neDFA se "kushandiswa kwezvinodhaka nokuda kwekuratidzira, fomu, miitiro, chirwere kana zvimwe zvinoshandiswa kushandiswa zvisina kutaurwa mune . "
Kutsvakurudza kunoratidza kuti kana murwere ane bulimia nervosa achapindura zvakanaka kuna Prozac, vangave vakaratidza kupindura kwakanaka mukati memavhiki matatu ekutora mishonga. Zvakakosha kuziva kuti maitiro akawanda ekudzivirira maitiro akagadzira 60 mg yePzac seyero inonzi bulimia nervosa. Izvi zvakakwirira kudarika mizinga inoshandiswa mukuderera kukuru (20 mg).
Kana Prozac isingashandi, dzimwe SSRIs dzinowanzoedzwa zvakare. Hazvishamisi kune mamwe mashizha, akadai seAnticonvulsant Topirimate, kushandiswa kure-label kune bulimia. Inowanzokurudzirwa kuti varwere varambe vachirapa mishonga kwemwedzi mitanhatu kusvika kune gumi mushure mokuwana kubudirira pamishonga.
Binge Eating Disorder
Mishonga inoita seinobudirira pakubatsira varwere vane chirwere chekudya zvakanyanya (BED) kurega kudya zvakanyanya asi havawanzobereki kurasikirwa kwechiremera icho chinowanzo chinangwa chevarwere vanotsvaka rubatsiro rwechirwere ichi. Kune BED, mapoka makuru matatu emishonga akave akadzidza: antidepressants (zvikurukuru SSRIs, kusanganisira Prozac); kusvibisa mishonga, kunyanya kunyanya; uye Vyvanse (mishonga yeDHD).
Sezvavanoita kune varwere vane bulimia nervosa, zvinodhaka zvinogona kubatsira mukudzikisa kuwandisa kwezvokudya zvakanyanya kune varwere vane BED. Vanogonawo kubatsira kuderedza pfungwa dzisina kunaka uye zviratidzo zvekuora mwoyo. Kufambidzana kunogonawo kubatsira kuderedza kuwanda kwebinges uye kunogonawo kuderedza pfungwa dzakawanda uye kusada.
Mishonga inoshandiswa inoshandiswa mukurapa kwekushaya pfungwa kwehutano husina kunaka (ADHD) inozivikanwa kuti ibvise kushuva uye saka ndiyo yave ichinyanya kukoshesa kurapwa kweBED. Munguva ichangopfuura, Vyvanse (lisdexamfetamine), mishonga yeHDHD, yakava mishonga inogamuchirwa neDDA yekurapa BED. Yakadzidzwa mumitatu mitatu uye yakabatanidzwa nekuderedza muzvinyorwa zvepabhesi nevhiki, yakaderedza kudya-kwakabatana kwakagadzikana uye kumanikidzwa, uye yakabudisa kuora kwemahombekombe.
Pakave nekunyatsokwana zvidzidzo zvakananga nekuenzanisa kurapwa kwemishonga kune zvepfungwa mupfungwa dzeBED, asi mishonga inowanzoonekwa isingabatsiri kupfuura psychotherapy . Nokudaro, vanofanira kuwanzoonekwa sechipiri mitsara yekurapa mushure memazuva ekurapa, sezvinoenderana nechirwere chepfungwa, kana kuti chirwere chisingawanikwi.
Warning on Wellbutrin
Iyo inonzi antipropressant bupropion (inowanzotengeswa seWorbutrin) yakabatanidzwa nekutambudza kune varwere vane pururgine bulimia uye hazvikurudzirwi kune varwere vane dambudziko rekudya.
Shoko Rinobva
Muzhinji, mishonga haisi iyo inonyanya, iyo nzira yekurapa kwechirwere chekudya. Mishonga inogona kubatsira kana inowanikwa ku-psychotherapy kana kana psychotherapy isingawanikwi. Uyezve, mishonga inowanzoshandiswa apo varwere vanewo zviratidzo zvekuzvidya mwoyo uye kuora mwoyo kubatsira nemiratidzo iyi.
Zvisinei, mishonga inogona kutakura mungozi yemigumisiro iyo isingawaniki nemishonga yepfungwa. Pakupedzisira, "mishonga" yekusarudzwa kwekudya kwekudya ndiko kudya uye zvinowanzodya.
Kune marapirwo akasiyana-siyana ekusawirirana kwezvokudya izvo zvinoonekwa sekubudirira, kusanganisira cognitive behavioral therapy uye mhuri-based treatment .
> Sources:
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> Berkman, ND, Brownley, KA, Peat, CM, Lohr, KN, Cullen, KE, Morgan,. . . Bulik, CM (2015). Kutungamira uye zvinokonzerwa nekudha-kudya chirwere [Executive summary].
> "Bulimia Nervosa muAdults: Pharmacotherapy." Crow, Scott. 2013 UpToDate. http://ultra-medica.net/Uptodate21.6/contents/UTD.htm?6/62/7145?source=related_link.
> Davis, Haley, naEvelyn Attia. 2017. "Pharmacotherapy yeDambudziko rekudya." Mhirizhonga Yemazuva Ano muPyychiatry 30 (6): 452-57. doi: 10.1097 / YCO.0000000000000358.
> Gorla, Kiranmai, naMaju Mathews. 2005. "Kurapa Kwemishonga Yezvokudya Zvokudya." Psychiatry (Edgmont) 2 (6): 43-48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000192/.
> Sysko, Robyn, Nanshi Sha, Yuanjia Wang, Naihua Duan, naB. Timothy Walsh. 2010. "Kupindura Kwokutanga kuAnode Depressant Treatment muBulimia Nervosa." Psychological Medicine 40 (6). doi: 10.1017 / S0033291709991218.