Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?

ANIL YAĞCIOĞLU, AYŞE ELİF

Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?

AYŞE ELİF ANIL YAĞCIOĞLU (Hacettepe Üniversitesi, Tıp Fakültesi, Psikiyatri Anabilim Dalı, Ankara, Türkiye)

Türk Psikiyatri Dergisi

46 7

Yıl: 2007 Cilt: 18 Sayı: 4 Sayfa Aralığı: 364 - 374 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?

Öz:

Bu gözden geçirmede şizofreni tedavisinde ilaç seçimine yön vermek üzere öncelikle tipik (TAP) ve atipik antipsikotiklerin (AAP) etki mekanizmaları üzerinde durulacak, özellikle de şizofreni tedavisi bağlamında TAP ve AAP?lerin farklılığının farmakolojik temeline odaklanılacaktır. İlk olarak ?atipiklik? kavramıyla ilgili görüşler ele alınacak ve bu kavramı açıklamada en sık kabul gören yüksek serotonin 5HT2A/dopamin D2 reseptör antagonizması oranı ve D2 reseptörleri ile mezolimbik seçicilik veya daha ? zayıf blokaj ile farklı etkileşim varsayımları desteklenen ve eleştirilen yönleriyle tartışılacaktır. İzleyen bölümde TAP ve AAP?lerin etki mekanizmaları reseptör düzeyinde incelenecektir. Atipik AP?lerin D2 reseptörleri dışında, ilgili güncel bulguların önemi ve tutarlılığı nedeniyle 5HT2A, 5HT2C, 5HT1A, adrenerjik ?1 ve ?2 reseptör etkinlikleri gözden geçirilecek, glutamat modülasyonu ve prefrontal korteksten asetilkolin salınımı gibi diğer etki mekanizmalarına da değinilecektir. Son bölümde klozapinin şizofreni tedavisindeki üstünlüğüyle ilişkili olabilecek özgül bazı etki mekanizmaları ele alınacaktır. Atipik AP?ler, TAP?lere göre etki mekanizması çeşitliliği sağlamakta ve bu çeşitlilik bağlamında pozitif belirtiler dışındaki belirti kümeleri üzerinde de etkili olmaları olası görülmektedir. Klinik uygulamada klozapin dışındaki AAP?lerin TAP?lere göre gerçek bir üstünlüğünün olup olmadığı halen kanıtlanması gereken bir konudur.

Anahtar Kelime: Şizofreni Antipsikotik ajanlar

Konular: Psikiyatri

The mechanisms of action of antipsychotic drugs: is atypicality superior in schizophrenia treatment?

Öz:

This review presents the mechanisms of action of typical and atypical antipsychotic drugs, emphasizing the differences in the pharmacology of these drugs used in the treatment of schizophrenia. Initially, the concept of atypicality will be examined through the 2 most widely accepted hypotheses. Hypotheses concerning a high serotonin 5HT2A/dopamine D2 receptor antagonism ratio and a special interaction with D2 receptors via mesolimbic selectivity or a weaker blockade will be discussed. Next, the mechanisms of action of typical and atypical antipsychotics will be explored at the receptor level. Receptor activity of atypical antipsychotics other than D2 receptors at 5HT2A, 5HT2C, 5HT1A, and adrenergic ?1 and ?2, along with relevant, currently important, and consistent findings, and other mechanisms of action, such as glutamate modulation and increased prefrontal cortical acetylcholine release will be reviewed. In the final section, some specific mechanisms of action, which might be related to clozapine?s superiority in schizophrenia treatment, will be examined. Atypical antipsychotics provide a variety of mechanisms of action as compared to typical antipsychotics, and they might be efficacious in treating symptom domains other than positive symptoms. In clinical practice, the superiority of atypical antipsychotics other than clozapine remains an issue that needs to be proven.

Anahtar Kelime: Schizophrenia Antipsychotic Agents

Konular: Psikiyatri

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

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APA	ANIL YAĞCIOĞLU A (2007). Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?. , 364 - 374.
Chicago	ANIL YAĞCIOĞLU AYŞE ELİF Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?. (2007): 364 - 374.
MLA	ANIL YAĞCIOĞLU AYŞE ELİF Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?. , 2007, ss.364 - 374.
AMA	ANIL YAĞCIOĞLU A Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?. . 2007; 364 - 374.
Vancouver	ANIL YAĞCIOĞLU A Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?. . 2007; 364 - 374.
IEEE	ANIL YAĞCIOĞLU A "Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?." , ss.364 - 374, 2007.
ISNAD	ANIL YAĞCIOĞLU, AYŞE ELİF. "Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?". (2007), 364-374.

APA	ANIL YAĞCIOĞLU A (2007). Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?. Türk Psikiyatri Dergisi, 18(4), 364 - 374.
Chicago	ANIL YAĞCIOĞLU AYŞE ELİF Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?. Türk Psikiyatri Dergisi 18, no.4 (2007): 364 - 374.
MLA	ANIL YAĞCIOĞLU AYŞE ELİF Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?. Türk Psikiyatri Dergisi, vol.18, no.4, 2007, ss.364 - 374.
AMA	ANIL YAĞCIOĞLU A Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?. Türk Psikiyatri Dergisi. 2007; 18(4): 364 - 374.
Vancouver	ANIL YAĞCIOĞLU A Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?. Türk Psikiyatri Dergisi. 2007; 18(4): 364 - 374.
IEEE	ANIL YAĞCIOĞLU A "Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?." Türk Psikiyatri Dergisi, 18, ss.364 - 374, 2007.
ISNAD	ANIL YAĞCIOĞLU, AYŞE ELİF. "Antipsikotik ilaçların etki mekanizmaları: şizofreni tedavisinde ''Atipiklik'' bir üstünlük mü?". Türk Psikiyatri Dergisi 18/4 (2007), 364-374.