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30912010 m. “Sveikatos mokslai” Nr.2
uþregistruotø N400 atsakø á neteisingus ir teisingus sakinius
kitimui pavaizduota 3 pav.
Apibendrinant galima teigti, kad MGT potencialiai gali turëti
teigiamà poveiká ðizofrenija sergantiems pacientams. Ðiai iðvadai
pagrásti reikia atlikti daugiau panaðiø tyrimø.
IÐVADOS1. MGT taikymas kartu su áprastu medikamentiniu
gydymu gali suðvelninti tiek negatyviàjà, tiek pozityviàjà
ðizofrenija serganèiøjø simptomatikà, sukurti prielaidas
efektyvesniam ir kokybiðkesniam jø santykiui su ap-linka, padëti
áveikti socialinæ ir emocinæ izoliacijà bei atsiribojimà.
2. Labai svarbu, kad uþsiëmimus vestø asmuo, þinantis ir
suprantantis serganèiøjø ðizofrenija problemas bei turintis
praktinio darbo su jais patirtá, prieðingu atveju nepavyktø
suformuoti pacientø motyvacijos darbui.
3. N400 potencialo tyrimas parodë, kad MGT gali turëti poveiká
pacientø reakcijai á semantiðkai teisingus sakinius.
Literatûra1. Kumar N, Debruille B. Semantics and N400: insights
for
schizophrenia. J Psychiatry Neurosci. 2004; 29(2):89-98.2. Kutas
M, Hillyard SA. Reading senseless sentences: Brain
potentials reflect semantic incongruity. Science. 1980;
207:203-5.3. Kutas M, Kluender R. What is who violating? A
reconsidera-
tion of Linguistic Violations in Light of Event-Related Brain
Potentials. In: H.-J. Heinze, T. F. Münte, and G. R. Mangun (Eds.).
Cognitive Electrophysiology, Birkhauser Boston. 1994; 183-210.
4. Kutas M, Van Petten CK. Psycholinguistics Electrified.
Event-Relates Brain Potential Investigations. In M. A. Gernsbacher
(Ed.), Handbook of psycholinguistics. San Diego, Academic Press,
1994; 83-143.
5. Maèiulis V., Marèënienë S., Banaitis V., Dapðys K., Utkuvienë
J. Metaglossotherapy in treatment of schizophrenia. Ab-stracts of
1st Eastern European Psychiatric Congress, Thessaloniki, September
21-23, 2007. Psychiatriki. 2007; 18(1):110.
6. Mathalon DH, Faustman WO, Ford JM. N400 and Automa-tic
Semantic Processing Abnormalities in Patients With Schizophrenia.
Arch Gen Psychiatry. 2002; 59:641-8.
7. Matulis AC. Language... a hope: an introduction to metag-
lossotherapy. 1977, National Research Institute for
Psychoanalysis and Psychology (Detroit), 113.
8. Matulis AC. A New-Foreign Language In The Treatment of
Schizophrenia: an Application Of Metaglossotherapy.
Metaglossothe-rapy: As presented in Rome Italy in 1984 to the
Lithuanian Catholic Academy of Sciences. National Research
Institute for Neurology and Psychology:
. 9. Sitnikova T, Salisbury DF, Kuperberg G, Holcomb PJ.
Elec-
trophysiological insights into language processing in
schizophrenia. Psychophysiology. 2002; 39:851-60.
METAGLOSSOTHERAPY IN TREATMENT OF SCHIZOPHRENIA Valentinas
Maèiulis, Sonata Marèënienë, Kastytis Dapðys, Valdas
Banaitis, Janina Utkuvienë, Akvilë JarmalavièiûtëSummaryKey
words: metaglossotherapy, schizophrenia, neurophysiology,
brain evoked potential N400.Metaglossotherapy (MGT) is the
method of treating schizophrenic
patients by teaching them a new foreign language. Training of
brain and establishing new associations during the course of MGT
treatment has a positive influence on schizophrenic patients.
The aim of the study was to evaluate the efficacy of MGT in
treating schizophrenic patients.
Methods. 7 long-stay male schizophrenic patients took part in
the program, which lasted 5 months, 5 sessions of MGT a week.
Patients were learning English. Evoked potential N400 was
registered at baseli-ne and after MGT in order to evaluate the
effectiveness of the therapy. Dynamics of mental state was
evaluated with help of PANSS.
Results. During MGT significant changes in motivation,
behaviour, non-verbal expressions and emotional state of patients
were observed. PANSS: negative and positive symptoms became milder,
changes are statistically significant. N400 responses of
schizophrenic patient do not depend on the congruity of sentence
endings. Compared with healthy subjects patients generate N400 with
smaller amplitude and larger latency.
Conclusions. Application of MGT can create possibilities for
schi-zophrenic patients for better relationships with the
environment, to help them overcome social and emotional isolation.
It is very important that activities would be led by the persons
who have practical experience to work with schizophrenic patients.
MGT may affect patient’s response to semantic congruent
sentences.
Correspondence to: [email protected]
Gauta 2009-12-06
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Raktaþodþiai: panikos sutrikimas, panikos priepuoliai, ðirdies
ir kraujagysliø ligos.
SantraukaPaskutiniuose tyrimuose vedamos paralelës tarp panikos
sutrikimo bei ðirdies ir kraujagysliø ligø. Panikos sutrikimø
raiðka populiacijoje – 4,7 %, o tarp serganèiøjø pirmine arterine
hipertenzija, 1999 m. atliktos studijos duomenimis, panikos
su-trikimo daþnumas yra didesnis, ðá teiginá patvirtina ir 2008 m.
M. Esler publikuotas straipsnis, kuriame teigiama, kad panikos
sutrikimas pasitaiko tris kartus daþniau tarp serganèiøjø pirmine
arterine hipertenzija nei bendroje populiacijoje. Abiejø bûkliø
metu stebimas kortizolio, adrenalinà sin-tezuojanèio hormono
koncentracijos didëjimas, simpatinë aktyvacija, suintensyvëjæs
adrenalino iðskyrimas ir sutrikusi noradrenalino reabsorbcija.
Gausëja árodymø, kad oksidacinis stresas ir uþde-giminis
komponentas svarbus panikos sutrikimo bei kardiovaskuliniø ligø
patogenezëje. Aukðtas nerimo lygis skatina reaktyviø deguonies
radika-lø susidarymà, dël jo didëja oksidacinio streso indeksas ir
ûmios fazës baltymø koncentracija. Kardiologø atliekamuose
tyrimuose oksidacinis stresas siejamas su miocitø gynybos
mechaniz-mø bei mitochondrijø paþeidimais, nustatyta, kad jis
sukelia endotelio disfunkcijà, lemdamas koronarinës ðirdies ligos
iðsivystymà. Lietuvoje, tiriant panikos sutrikimà, ávertinus jo
poveiká kardiovaskulinei sistemai ir gautus rezultatus pritaikius
gydymo praktikai, bûtø galima pasiekti þymiai geresniø gydymo
rezultatø.
ÁVADASPaskutiniuose tyrimuose vedamos paralelës tarp pani-
kos sutrikimo bei ðirdies ir kraujagysliø ligø, vis daþniau
prabylama apie panikos sutrikimo komorbidiðkumà su ðirdies
kraujagysliø ligomis, atrandama bendrø patogene-zës mechanizmø.
Panikos sutrikimas – nepriklausomas rizikos veiksnys, lemiantis
koronarinæ ðirdies ligà.
Darbo tikslas - árodyti didesná sergamumà panikos sutrikimu tarp
ðirdies kraujagysliø ligomis serganèiøjø bei ávertinti
pasikartojanèio ilgalaikio streso sukeliamus pakitimus.
METODIKAPanikos sutrikimo istorijos pradþia laikomas Da
Costa
sindromas, pavadintas pagal 1871 m. publikacijà, ap-raðanèià
Amerikos civiliniame kare dalyvavusiø kareiviø sveikatos
sutrikimus. Panaði bûsena vadinta neurocir-kuliacine astenija,
pastangø sindromu, dirglios ðirdies sindromu, kareivio ðirdimi,
kardiovaskuline neuroze [1]. 1895 m. Z. Freudas iðkyrë neurastenijà
– nuolatinio, vidutinio nerimo bûsenà ir epizodiðkai uþeinanèius
in-tensyvaus nerimo priepuolius (ûmi nerimo neurozë). T. Lewis 1933
m. raðë, kad sindromas nëra bûdingas vien sergantiems kareiviams ar
atletams, taèiau daþnai pasi-reiðkia nejudriems miestø gyventojams
[2]. J.L. Caughey 1939 m. apraðo kardiovaskulinæ neurozæ [1], kuri
suside-da ið sumiðusiø psichologiniø ir fiziologiniø komponentø ir
mëgdþioja organinës ligos sukeltus simptomus, taèiau negali bûti
paaiðkinta patologiniais kardiovaskulinio aparato pokyèiais.
Medicininëje nomenklatûroje ter-minas panikos sutrikimas pirmà
kartà pavartotas 1980 m. DSM-III redakcijoje, iðleistoje Jungtinëse
Amerikos Valstijose [3].
Panikos sutrikimas – sunki, varginanti ir daþna liga. Esminis
sutrikimo poþymis yra pasikartojantys stipraus nerimo priepuoliai,
nesusijæ su kokia nors specifine situ-acija ar aplinkybëmis,
psichoaktyviøjø medþiagø varto-jimu, todël jø negalima prognozuoti.
Panikos priepuolis prasideda netikëtai, staigiu autonominës nervø
sistemos simptomø augimu ir daþniausiai praeina savaime per 10-20
minuèiø. Panikos priepuolio metu kylantys simptomai ávairûs ir
intensyvûs – oro trûkumas, springimo jausmas, diskomfortas ðirdies
plote, pykinimas, tirpimas, galvos svaigimas, baimë prarasti
situacijos kontrolæ, iðprotëti ar numirti. Panikos sutrikimas
diagnozuojamas, kuomet panikos priepuoliai kartojasi, praëjus
iðlieka baimë, kad iðtiks kitas priepuolis ir, þinoma, atmetama
kita somatinë patologija ar psichikos liga.
PANIKOS SUTRIKIMAS IR JO RYÐYS SU ÐIRDIES IR KRAUJAGYSLIØ
LIGOMIS
INDRAJA VELIÈKIENË1, VITA DANILEVIÈIÛTË1, VALMANTAS BUDRYS21
Vilniaus universiteto Medicinos fakulteto Psichiatrijos
klinika,
2 Vilniaus universiteto Medicinos fakulteto Neurologijos ir
neurochirurgijos klinika
Adresas susiraðinëti: Indraja Velièkienë, el. p.:
[email protected]
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30932010 m. “Sveikatos mokslai” Nr.2
Panikos sutrikimo daþnis populiacijoje aiðkiai svyruo-ja nuo
1,4% iki 7,1%. Remiantis 1997 m. atliktais epide-miologiniais
tyrimais, JAV panikos sutrikimas nustatomas 3,4% gyventojø gyvenimo
laikotarpiu; Italijoje – 2,9%, o Taivane – tik 0,4% gyventojø [4].
R.C. Kessler 2005 m. atlikto tyrimo duomenimis, panikos sutrikimas
diagno-zuojamas 2,7% gyventojø per paskutinius 12 mënesiø, o
gyvenimo laikotarpiu – 4,7%. R.C. Kessler 2006 m. JAV atliktø
tyrimø rezultatai rodo, kad panikos sutrikimas be agorafobijos
vargina 3,7% gyventojø gyvenimo laikotar-piu ir 1,1% gyventojø
pasitaiko panikos sutrikimas su agorafobija [5], taèiau tyrinëtojø
pateikiami duomenys labai skiriasi, pavyzdþiui, 1993 m. D.A.
Katerndahl ir J.P. Realini tyrime apraðoma, kad net 15% amerikieèiø
savo gyvenime yra patyræ panikos priepuoliø ar sirgæ panikos
sutrikimu. Tokius skirtingus duomenis galëtø paaiðkinti tyrimø
metodikos ypatumai ir kartu tai rodo, kad tikslinga tobulinti
metodikas ir diagnostikà. Lyginant serganèiøjø panikos sutrikimu
lyèiø skirtumus K.A. Yonkers 1998 m. atliktoje studijoje nustatyta,
kad moterys serga 2,5-3 kartus daþniau nei vyrai ir joms
priepuoliai po pasiektos remisijos pasikartoja daþniau. Tà
patvirtina ir japonø H. Kaiya su bendraautoriais 2005 m. atliktas
tyrimas, kurio duomenimis, moterys du kartus daþniau serga panikos
sutrikimu ar patiria panikos priepuoliø, tai ypaè iðryðkëja
vyresniame amþiuje apie penkiasdeðimtuosius gyvenimo metus [6].
Panikos sutrikimo patogenezëje iðskiriamos trys pagrindinës
teorijos: psichodinaminë, kognityvinë bei neurobiologinë.
Psichodinaminë teorija panikos sutriki-mà paaiðkina uþslopintais
intensyviais jausmais, tokiais kaip pyktis (B. Milrod ir M.K.
Shear, 1991). Patogenezëje svarbûs veiksniai gali bûti iðsiskyrimas
su tëvais, jø, ypaè motinos netektis [7].
Kognityvinë teorija teigia, kad pacientams, linku-siems
susitelkti ties kylanèiais vidiniais pojûèiais (D.M.A. Clark, 1986
m.)[8], bûdinga iðreikðta baimë susirgti sunkia fizine ar psichine
liga, o panikos priepuolio metu prasidedantys fiziniai simptomai
sukelia dar didesná ne-rimà, sustiprina baimæ sirgti sunkia liga.
Neurobiologinëteorija paremta tuo, kad panikos priepuolá galima
sukelti eksperimentiniu bûdu (ypaè pacientams, linkusiems sirgti
panikos sutrikimu [9]) ir slopinti panikos prie-puolá
medikamentais. Panikos priepuoliai sukeliami eksperimentais,
naudojant anglies dioksidà (CO2), laktatà, kofeinà,
cholecistokinino tetrapeptidà (CCK-4), isoproterenolá, johimbinà,
kortizolá, 5-hidroksitriptamino receptoriø, agonistus ir kt.
medþiagas.
D.F. Klein 1993 m. pateikë uþdusimo pavojaus teo-rijà, pagal
kurià pacientai jautriai reaguoja á didëjanèià
anglies dioksido koncentracijà kraujyje, taèiau atlikus tyrimus
paaiðkëjo, kad pacientai jautriai reaguoja ir á anglies dioksido
koncentracijos padidëjimà, ir á hiper-ventiliacijà (anglies
dioksido koncentracijos sumaþëji-mà) [10]. Vertinant panikos
sutrikimu serganèiø pacientø CO2 koncentracijà, kvëpavimo daþná,
kvëpuojamàjá oro tûrá bei minutiná kvëpavimo tûrá, iðryðkëjo
kvëpavimo rodikliø kitimai ir tai gali bûti kvëpavimo funkcijos
ne-stabilumo þymuo [9]. 2004 m. E. Berzak ir bendraautoriø atlikto
tyrimo duomenimis, pacientai, sergantys panikos sutrikimu,
intensyviau reagavo á padidëjusià CO2 kon-centracijà ákvepiamame
ore, atsiradusius simptomus buvo linkæ vertinti kaip panikos
priepuolá; vienà kartà gyvenime patyræ panikos priepuolá á CO2
koncentraci-jos pokyèius nereagavo. Tokiø tyrimø jautrumas 41%;
specifiðkumas 100%, tad jie gali bûti taikomi praktikoje
diferencijuojant vienà kartà gyvenime buvusá panikos priepuolá su
panikos sutrikimu ir polinkiu priepuoliams kartotis [11]. Matuoti
CO2 koncentracijà panikos prie-puolio metu sunkiau, tad
naudingesnis laktatø tyrimas. Laktatai parodo kompensaciná
metaboliná atsakà, atsi-radusá dël respiracinës alkalozës, atvykus
po panikos priepuolio [6, 35].
Kita svarbi anksèiau minëta medþiaga – cholecis-tokinino
tetrapeptidas (CCK-4) – dalyvauja ávairiuose fiziologiniuose
procesuose, pvz., po valgio sukelia hiperemijà þarnyne, veikia
þarnyno motorikà, didina smegenø barjero pralaidumà leptinui, per
vidurines smegenis, pagumburá veikia kardiovaskulinæ sistemà,
skatindamas stresiniø hormonø iðsiskyrimà. Ðis peptidas svarbus
ûmiam kardiovaskuliniam atsakui ir elgesio po-kyèiams á
iðskirtinius fizinius bei psichologinius iððûkius, taèiau ilgai
trunkantis CCK -4 sistemos stimuliavimas sukelia panikos sutrikimà
ar lëtiná skausmà, iðreikðtà autonominës aktyvacijos bûklæ. CCK-4
sukelia eksperi-mentinius panikos priepuolius, jø metu didëja
arterinis kraujo spaudimas, intensyvëja adrenokortikotropinio
hormono, prolaktino bei augimo veiksnio iðskyrimas, ðie pokyèiai
akivaizdesni sergantiesiems panikos sutrikimu [12]; remiantis 2008
m. D. Eser su bendraautoriais atliktu tyrimu, galima daryti
prielaidà, kad CCK-4 sukeltø pani-kos priepuoliø metu labiau
intensyvëja neurobiologiniai nei psichologiniai veiksniai.
REZULTATAIIeðkant biologiniø árodymø dar 1999 m. atliktoje
studijoje nurodomas didesnis panikos sutrikimo daþnis tarp
serganèiøjø pirmine arterine hipertenzija, ðá tei-giná patvirtina
ir 2008 m. M. Esler su bendraautoriais publikuotas straipsnis,
kuriame teigiama, kad panikos
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sutrikimas pasitaiko tris kartus daþniau tarp serganèiøjø
pirmine arterine hipertenzija nei bendroje populiaci-joje [13].
Panikos sutrikimo patogenezëje iðryðkëjantis plazmos kortizolio
koncentracijos padidëjimas, adrena-linà sintezuojanèio hormono
koncentracijos didëjimas, simpatinë aktyvacija, suintensyvëjæs
adrenalino iðsky-rimas ir sutrikusi noradrenalino reabsorbcija
inicijuoja morfologinius pokyèius, bûdingus kardiovaskulinëms
ligoms [13]. M. Esler atlikto tyrimo rezultatai rodo, kad
kortizolio koncentracija buvo didesnë ir pirmine arterine
hipertenzija, ir panikos sutrikimu serganèiøjø grupëse, panaðûs
duomenys gauti M. Hamer su bendraautoriais [14] ir G.G. Manfro su
bendraautoriais atliktø tyrimø metu [15]. Prieðtaringus duomenis
pateikia K. Petrowski su bendraautoriais, tyræ kortizolio
koncentracijà seilëse. Ðiø tyrimø duomenimis, ir serganèiø panikos
sutrikimu, ir sveikø tiriamøjø kortizolio koncentracija seilëse
buvo panaði prieð taikant laboratorinio streso protokolà (Trier‘o
socialinio streso testà), taèiau po testo ðirdies susitrau-kimø
padaþnëjimas buvo bûdingas abiems grupëms, o kortizolio
koncentracija seilëse skyrësi: kontrolinëje grupëje kortizolio
koncentracija didëjo, o panikos sutri-kimu sergantiems, kortizolio
koncentracijos padidëjimo nustatyta nebuvo [16]. Panikos priepuolio
metu iðsiskiria katecholaminai, sukeliantys hipertenzijà, ir
suaktyvëja lipoproteinlipazë, kuri sukelia hiperlipidemijà [17], ir
tai yra vienas paaiðkinimø, kodël panikos priepuoliai
patogenetiðkai siejami su ðirdies kraujagysliø ligomis.
Paroksizminë hipertenzija bûdinga panikos sutrikimu sergantiems
pacientams, atmetus kitas galimas prieþastis, pateikiamos
rekomendacijos gydyti ir kardiologui, ir psichiatrui [18].
Pacientams, kurie serga arterine hiper-tenzija, panikos priepuoliø
metu labiau iðryðkëja auto-nominë disfunkcija – prakaitavimas,
veido paraudimas, ðirdies ritmo sutankëjimas, nei normotenziniø
pacientø grupëje [19], tokie duomenys pabrëþia hipertenzijos ir
panikos priepuoliø ryðá. Pirmine arterine hipertenzija
sergantiesiems yra bûdingas noradrenalino reabsorbcijos sutrikimas
[20], stipriau pasireiðkiantis normosteninio kûno sudëjimo
pacientams nei turintiems antsvorá. 2004 m. tyrimo duomenimis,
sergantiesiems panikos sutrikimu daþniau pasitaiko arterinio kraujo
spaudimo padidëji-mas, ir tai gali bûti viena ið padidëjusio
mirtingumo dël kardiovaskulinës patologijos prieþasèiø [21].
Panikos priepuolio metu simpatiniuose nervuose pa-stebima staigi
aktyvacija, uþraðoma atliekant klinikinæ mikroneurografijà, ir
nustatomas noradrenalino pertek-lius, sutrikusi reabsorbcija.
Stipri simpatinë aktyvacija kitø bûkliø metu, pvz., ðirdies
nepakankamumo atveju, lemia padidëjusià kardiovaskulinæ rizikà
[22]. Taip pat
svarbus simpatiniø nervø kotransmiteris neuropeptidas Y,
iðsiskiriantis panikos priepuolio metu ir lemiantis koronariniø
arterijø spazmà [22]. Streso metu padidëjæs neuropeptido Y
iðskyrimas skatina vazokonstricijà bei sukelia kraujagysliø
paþeidimus, bûdingus ateroskle-rozei [22-24].
D.A. Katherndahl 2005 m. apþvelgia panikos sutri-kimo ir ðirdies
kraujagysliø ligø komorbidiðkumà (nuo 8% iki 21%), iðskirdamas
teiginius, kad sergantiesiems ðirdies kraujagysliø ligomis
gretutinis panikos sutrikimas gali lemti pagalbos ieðkojimà, taip
pat ir kardiologiná ávyká [25]. Panikos sutrikimas – nepriklausomas
rizikos veiksnys susirgti ûmiu miokardo infarktu, metø laiko-tarpiu
diagnozavus panikos sutrikimà: 4,77% pacientø ávyko miokardo
infarktas, kontrolinëje grupëje – 2,73%, tad statistiðkai patikimai
rizika didesnë 1,75 karto [26].
Paskutiniuose psichiatrijos ir kardiologijos mokslo tyrimuose
minimas oksidacinis stresas, kuris susijæs su vëþiu,
kardiovaskulinëmis ligomis, nerimo sutrikimais. Aukðtas nerimo
lygis skatina reaktyviø deguonies radi-kalø susidarymà
periferiniame kraujyje: limfocituose, granuliocituose bei
monocituose [27]. G.G. Manfro apraðo serganèiøjø panikos sutrikimu
imunologinius pokyèius, IL-2 koncentracijos padidëjimà bei
limfocitø pavirðiaus molekuliø (L-selektinø) ekspresijà [15].
2008 m. M.A. Ersoy ir bendraautoriø atliktame tyri-me nustatytas
oksidacinio streso indekso ir ûmios fazës baltymø koncentracijos
padidëjimas sergantiesiems panikos sutrikimu lyginant su kontroline
sveikø þmoniø grupe [28]. L. de la Fontain 2009 metais atlikto
tyrimo duomenimis, sergantiems panikos sutrikimu pacientams
nustatomas IL-6 koncentracijos padidëjimas, ryðkiausias praëjus
dviem valandoms po eksperimentiniu bûdu sukelto panikos priepuolio
[29]. IL-6 koncentracijos padidëjimas nustatytas ir pacientams,
persirgusiems miokardo infarktu (praëjus 3-9 mënesiams po ávykio),
taip pat vertintos fibrinogeno ir C reaktyvaus baltymo
koncentracijos, nustatyti jø padidëjimai [30].
Kardiologø atliekamuose tyrimuose akcentuojama oksidacinio
streso sukeliami miocitø gynybos mechaniz-mø bei mitochondrijø
paþeidimai. Ûmus bei lëtinis stre-sas sutrikdo pusiausvyrà pro- bei
prieð- ateroskleroziniø veiksniø, kurie sukelia kraujagysliø
endotelio disfunkcijà ir veda link koronarinës ðirdies ligos bei
miokardo in-farktà [31]. Paskutiniø metø Minamino T., Kitakaze M.
atliktuose tyrimuose atkreipiamas dëmesys á oksidacinio streso
poveiká làsteliø endoplazminiam tinklui, kurio paþeidimai sutrikdo
baltymø sintezæ ir net gali sukelti kai kuriø làsteliø apoptozæ,
ðie mechanizmai dalyvauja
BIOMEDICINA
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30952010 m. “Sveikatos mokslai” Nr.2
kardiovaskuliniø ligø, aterosklerozës patogenezëje[17]. B.
Bringager su bendraautoriais vertino panikos su-
trikimo átakà mirtingumui, sergamumui bei gyvenimo kokybei –
ryðkesniø skirtumø mirtingumui tarp tiriamøjø ir kontrolinës grupës
neiðryðkëjo, taèiau gyvenimo koky-bë buvo pablogëjusi, vargino
gretutinës ligos bei sutrikæs funkcionavimas [32]. 2005 m. R. Fleet
su bendraauto-riais tyrë pacientus, kuriems diagnozuotas panikos
su-trikimas, panikos priepuolio metu, nepaisant gydymo, iðryðkëjo
ðirdies raumens perfuzijos sutrikimas, autoriø pateikiamos iðvados
– panikos sutrikimas kenksmingas ðirdþiai [33].
2008 metais Jungtinëje Karalystëje buvo atliktas vienas
didþiausiø tyrimø: „Panikos sutrikimas ir naujai prasidëjusios
koronarinës ðirdies ligos, ûmaus miokardo infarkto ir mirtingumo
dël kardiologinës patologijos rizika: kohortinis tyrimas, atliktas
naudojant bendrosios praktikos tyrimø duomenø bazæ“ (angl. Panic
disorder and risk of new onset coronary heart disease, acute
miocardial infarction and cardiac mortality: cohort study using the
general practice research database), kuriame dalyvavo daugiau nei
400 tûkst. tiriamøjø. Lygintos grupës: 57615 pacientø, kuriems
diagnozuota panikos sutrikimas/priepuoliai, bei 347039 asmenø
kontrolinë grupë. Tyrimo metu paaiðkëjo, kad diagnozuotas panikos
sutrikimas/priepuoliai jaunesniems nei 50 metø amþiaus grupës
tiriamiesiems këlë þymiai didesnæ rizikà susirgti miokardo infarktu
nei vyresniøjø grupës tiriamiesiems ir, nepriklausomai nuo amþiaus,
pacientai, kuriems buvo diagnozuotas panikos
sutrikimas/priepuoliai, daþniau sirgo koronarine ðirdies liga.
Mirtingumas dël kardiovaskulinës patologijos buvo sumaþëjæs panikos
sutrikimà/priepuolius patirianèioje grupëje [34]. Tokius duomenis
galima bûtø paaiðkinti intensyvesniu pacientø, kuriems diagnozuotas
panikos sutrikimas stebëjimu, kompleksiniu gydymu.
IÐVADOSPanikos sutrikimas diagnozuojamas 4,7% þmoniø
bendroje populiacijoje ir net tris kartus daþniau nu-statomas
sergantiesiems ðirdies ir kraujagysliø ligomis. Gausëja árodymø,
kad oksidacinis stresas ir uþdegiminis komponentas svarbus panikos
sutrikimo bei kardiovas-kuliniø ligø patogenezëje, panikos
sutrikimas vertinamas kaip nepriklausomas rizikos veiksnys susirgti
koronarine ðirdies liga. Lietuvoje, tiriant panikos sutrikimà,
ávertinus jo poveiká kardiovaskulinei sistemai ir gautus rezultatus
pritaikius gydymo praktikai, bûtø galima pasiekti þymiai geresniø
gydymo rezultatø.
Literatûra1. Caughey JL. Cardiovascular Neurosis. Psychosomatic
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dicine. 1939; 1(2):311-324.2. Wooley ChF. Where are the Diseases
of Yesteryear? Circu-
lation. 1976; 53:749-751. 3. American Psychiatric Association
(APA). Diagnostic and
Statistical Manual of Mental disorders (3rd ed.). Washington,
DC, American Psychiatric Association, 1980.
4. Weissman M, Bland RC, Canino GJ. et al. The Cross-na-tional
Epidemiology of Panic Disorder. Arch Gen Psychiatry. 1997;
54(4):305-309.
5. Kessler RC. The Epidemiology of Panic Attacks, Panic
Disor-der, and Agoraphobia in the National Comorbidity Survey
Replication. Arch Gen Psychiatry. 2006; 63(4):415-424.
6. Kaiya H, Umekage T, Ðarada S. et al. Factors Associated with
the Development of Panic Attack and Panic Disorder: Survey in
Japanese population. Psychiatry and Clinical Neurosciences. 2005;
59:177-182.
7. Gabbard GO. Psychodynamics of panic disorder and social
phobia. Bulletin of The Menninger Clinic. 1992; 56:2A.
8. Clark DMA. cognitive approch to panic. Behav Res Ther. 1986;
24(4):461-70.
9. Niccolai V, Duinen MA, Gertz EJ. et al. Respiratory Patterns
in Panic Disorder Reviewed: a Focus on Biological Challenge Tests.
Acta Psychiatrica Scandinavica. 2009; 120(3):167-77.
10. Schmidt NB, Telch MJ, Jaimez TL. Biological challenge
manipulation of PCO2 levels: a testo f Klein‘s (1993) suffocation
alarm theory of panic. Journal of Abnormal Psychology. 1996;
105(3):446-54.
11. Berzak E, Reznik M, Narsia O, Benjamin J. Sensitivity to
Carbon Dioxide in Subjects with a Single Lifetime Panic Attack:
Pos-sible Clinical „Bedside“ Predictive Test for Panic Disorder
after a First Panic Attack. Depression and Anxiety. 2005;
20:48-50.
12. Koszycki D, Zacharko MR, Melledo JM, Bradwejn J. et al.
Behavioral, Cardiovascular, and Neuroendocrine Profiles Following
CCK-4 Challenge in Healthy Volunteers: a Comparison of Panickers
and Non Panickers. Depression and Anxiety. 1998; 8(1):1-7.
13. Esler M, Eikelis N, Schlaich M. et al. Chronic Mental Stress
is a Cause of Essential Hypertension: Presence of Biological
Markers of Stress. Clinical and Experimental Pharmacology and
Physiology. 2008; 35(4):498-502.
14. Hamer M, O‘Donnell K, Lahiri A, Steptoe A. Salivatory
cortisol responses to mental stress are associated with coronary
artery calcification in healthy men and women. European Heart
Journal. PMID:19744954, 2009; 10.
15. Manfro GG, Pollack MH, Otto MW. et al. Cell-surface
expression of L-selectin(CD62L) by blood lymphocytes: correlates
with affective parameters and severity of panic disorder.
Depression and Anxiety. 2000; 11:31-37.
16. Petrowski K, Herold U, Joraschky P. et al. Astriking pattern
of cortisol non-responsiveness to psychosocial stress in patients
with panic disorder with concurrent normal cortisol awakening
responses. Psychoneuroendocrinology. PMID19913360, 2009.
17. Minamino T, Kitakaze M. ER stress in cardiovascular
dis-sease. J Mol Cell Cardiol. PMID: 19913545, 2009.
18. Pickering TG, Clemow L. Paroxysmal hypertension: the role of
stress and psychological factors. Journal of Clinical Hypertension.
2008;10(7):575-81.
19. Davies SJ, Jackson PR, Lewis G. et al. Is the association of
hypertension and panic disorder explained by clustering of
autonomic panic symptoms in hypertensive patients? J Affective
Disorders. 2008; 111(2-3):344-50.
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20. Rumantir MS, Kaye DM, Jennings GL. et al. Phenotypic
Evidence of Faulty Neuronal Norepinephrine Reuptake in Essential
Hypertension. Hypertension. 2000;36:824-829.
21. Yeragani VK, Mallavarapu M, Radhakrishna RK, Tancer M, Uhde
T. Depression and Anxiety. 2004; 19(2):85-95.
22. Esler M, Alvarenga M, Lambert G. Cardiac Sympathetic Nerve
Biology and Brain Monogamine Turnover in Panic Disorder. Annuals
N.Y. Academy of Sciences. 2004; 1018: 505-514.
23. Kuo EL, Zukowska Z. Stress, NPY and vascular remodeling:
implications for stress-related diseases. Peptides. 2007;
28(2):435-440.
24. Hass M. Neuropeptide Y: a cardiac sympathetic
cotransmit-ter? Catecholamines – Bridging basic Science With
Clinical Medicine. Academic Press, 1998; 129-132.
25. Katherndahl DA. The association between panic disorder and
coronary artery disease among primary care patients presenting with
chest pain: an updated literature review. Journal of Clinical
Psy-chiatry. 2008;10(4):278-282.
26. Chen YH, Tsai SY, Lee HC, Lin HC. Increased risk of acute
myocardial infarction for patients with panic disorder: a nation
wide population-based study. Psychosomatic Medicine. 2009;
71(7):798-804.
27. Rammal H, Bouaved J, Younos C, Soulimani R. The impact of
high anxiety level on the oxidative status of mouse peripheral
blood lymphocytes, granulocytes and monocytes. Eur J Pharmacol.
2008; 589(1-3):173-5.
28. Ersoy MA, Selek S, Celik H. et al. Role of oxidative and
antioxidative parameters in ethiopathogenesis and prognosis of
panic disorder. Int J Neurosci. 2008; 118(7):1025-37.
29. Fontain L, Schwarz MJ. Eser D. et al. Effects of
experimen-tally induced panic attacks on neuroimmunological
markers. J Neural Transm. 2009; 116:699-702.
30. Lowe GD, Woodward M, Rumley A. Associations of plazma
fibrinogen assays, C- reactive protein and interleukin-6 with
previuos myocardial infarction. J Thromb Haemost. 2003;
1(11):2312-6.
31. Nickel T, Deutschmann A, Hanssen H. et al. Modification of
endothelial biology by acute and chronic stress hormones. Microvasc
Res. 2009; 78(3):364-9.
32. Bringager BC, Arnesen H, Friis S. et al. A long-term
follow-up study of chest pain patients: effect of panic disorder on
mortality, morbidity, and Quality of life. Cardiology. 2008;
110(1):8-14.
33. Fleet R, Lesperance F, Arsenault A. et al. Myocardial
per-fusion study of panic attacks in patients with coronary artery
disease. American Journal of Cardiology. 2005; 96(8):1064-8.
34. Salters K, Rait G, Petersen I, Williams R, Nazareth I. Panic
disorder and risk of new onset coronary heart disease, acute
miocardial infarction and cardiac mortality: cohort study using the
general practice research database. European Heart Journal. 2008;
29:2981–2988.
35. Ueda Y, Aizawa M, Takahashi A. Exaggerated compensatory
response to acute respiratory alcalosis in panic disorder is
induced by increased lactic acid production. Nephrol Dial
Transplant. 2009; 24(3):825-8.
THE LINK BETWEEN PANIC DISORDER AND CARDIOVASCU-LAR DISEASES
Indraja Velièkienë, Vita Danilevièiûtë, Valmantas
BudrysSummaryKey words: panic disorder, panic attacks,
cardiovascular diseases.
At the present time, the question of chronic mental stress links
with vari-ous kinds of somatic diseases and parallels between panic
disorder and cardiac diseases especially, arises. It is being
emphasized that panic disorder is one of the states which provide a
clinical model of recurring stress responses. There is 4,7 percent
prevalence of panic disorder in general population. The rate of
panic disorder among cardiac patients is three times more frequent
in comparison to general population. The aim of the paper is to
discuss biological and psychological peculiarities of the stress
response and to define the link between cardiovascular diseases and
panic disorder. In the both conditions there is the arousal of the
sympathetic nervous system, increase of CO2; lactate; cortisol;
adrenalin synthesizing hormone concentrations in blood. The mental
stress initiates an increase in oxidative stress parameters and
alters the defence mechanisms in myocytes, the malfunction of
endothelium leading to cardiovascular events. There is evidence
that the inflam-matory component as well as oxidative parameters
plays an important role in panic disorder and cardiovascular
diseases pathogenesis. As far as panic disorder is seldom
discussed, it is important to diagnose, estimate the high risk
groups and use the preventive means and treat-ment methods.
Correspondence to: [email protected]
Gauta 2009-12-08
BIOMEDICINA
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30972010 m. “Sveikatos mokslai” Nr.2 APÞVALGA
Raktaþodþiai: Catha edulis, katas, katinas, katinonas,
amfetaminai, Salvia divinorum, Salvinorinas A, psi-choaktyvûs
augalai, haliucinogenai.
Santrauka Piktnaudþiavimas stimuliaciniais preparatais -
didþiulë problema pasaulyje. Psichostimuliaciniø savybiø turinèiø
ávairiø þoliniø preparatø prieinamumas lengvëja, vartojimas didëja.
Populiariuose interneto puslapiuose jie siûlomi pirkti tarsi legali
þolinë alternatyva nelegaliems haliucino-genams. Ðiame
apþvalginiame straipsnyje aptariami nauji psichoaktyvûs þoliniai
preparatai: katas (Catha edulis), daugiametë mëtø ðeimos þolë –
kvaitulinis ðalavijas (Salvia divinorum), keletas Pietø Afrikos
augalø rûðiø („Kanna þolelës“, gyslotojo vyklio sëklos, „Spice“
þoliø miðiniai). Bendriausia piktnaudþiavimo vaistais forma Rytø
Afrikoje yra kato (Catha edulis) lapø ir ûgliø kramtymas ir seiliø
nurijimas. Þolininkai katu gydo depresijà, nuovargá, nutukimà ir
skrandþio opas. Kato augale yra du aktyvûs alkaloidai: katinas ir
katinonas. Pastarasis yra veiklesnis psichostimuliatorius.
Kvaitu-linis ðalavijas dël savo psichoaktyvaus poveikio buvo
vartojamas daugelá ðimtmeèiø. Aktyvusis komponentas yra
salvinorinas A – beazotinis, nealkaloidinis selekty-vus kappa
opioidiniø receptoriø agonistas. Jis sukelia ryðkias, trumpalaikes
haliucinacijas. Straipsnyje aptar-iama ðiø augalø, kaip
psichostimuliatoriø, vartojimas, epidemiologija, vartojimo bûdas,
farmakokinetika, toksikologija, diagnostikos metodai, pateikiamos
þinios apie jø vartojimo legalumà.
ÁVADASGyvenimo tempas, begalë rûpesèiø, socialinës,
ekonominës, ðeimyninës problemos lemia daþnëjantá nuovargio
jausmà, adaptacijos sutrikimus. Visi nori jaus-tis þvalûs,
energingi, sveiki, lengvai bendrauti, maþiau galvoti apie
kasdienybæ. Todël, ypaè nuo XX a., iðplito ir toliau plinta ávairiø
psichostimuliatoriø vartojimas. Sintezuoti (amfetaminai ir kt.) bei
augaliniai alkaloidai
(kokainas, efedrinas ir kt.) visuomenei jau tapo þinomi kaip
draudþiami, nelegalûs, kenksmingi [1]. Kaip al-ternatyva jiems
padaþnëjo naujø augaliniø preparatø, neretai vertinamø kaip
legaliø, tiek reklamavimas, tiek vartojimas. Supaþindiname su
keletu jø.
Katas Katas (khat, qut, kat, chaat, Kus es Salahin, Tchaad,
Gat) tai psichostimuliacinis augalas Catha edulis,
pri-klausantis Celastaceae ðeimai. Já apraðë ir pavadino (arabiðkà
pavadinimà khat pakeitæs á panaðø Catha) botanikas Peter Forsskal,
þuvæs Jemene 1763 m. [2].
Catha edulis amþinai þaliuojantis krûmas (dabar ir
kultivuojamas), augantis virð jûros lygio rytinëje ir pietø
Afrikoje, Afganistane, Jemene ir Madagaskare [2-7].
Ðio krûmo þali lapai ir ûgliai dël malonaus euforinio, nuovargá
ðalinanèio poveikio vartojami jau daugiau nei 600 metø [2, 12],
paprastai Rytø Afrikoje, Vidurio Rytuo-se, Arabø pusiasalyje [12].
Vien Rytø Afrikoje juos vartoja apie 10 mln. þmoniø, o visame
regione – apie 20 mln. [5-11]. Kato lapø kramtymas tiesiog tapæs tø
gyventojø tradiciniu áproèiu. Lapai kramtomi ávairiose þmoniø
sueigose, religinëse ceremonijose, ypaè savaitgaliais ar dienà po
pietø iki vakarinës maldos. Arbatos parduo-tuvëse kato galima
ásigyti visà parà. Minëtame regione piktnaudþiavimas katu, kaip
psichoaktyvia medþiaga, uþima I-à vietà [7]. Daþniau já vartoja
vyrai, bet kramto ir moterys, net nëðtumo ir laktacijos metu. Vien
Jemene já nors kartà yra vartojæ 81,6% vyrø ir 43,3% moterø [2].
Kato lapø kramtymas ypaè padaþnëja ávairiø religiniø, politiniø
konfliktø metu. Pvz., Somalyje já vartoja per 80% vyrø [5], apie
70,1% kareiviø [8].
Katà vartoja ne tik kaip centrinës nervø sistemos stimuliantà,
bet vietiniai þolininkai juo gydo depresijà, nuovargá, skrandþio
opà [12].
Ilgus metus katas buvo paplitæs tik minëtame regione, dabar, dël
pagerëjusiø transportavimo sàlygø, didëjanèio imigrantø skaièiaus
ið tø srièiø, jau keli deðimtmeèiai plinta ir Vakaruose [7, 8, 11].
Jo kramtymas uþdraus-tas Kanadoje, Amerikoje, Europos Sàjungoje
(iðskyrus Jungtinæ Karalystæ ir Olandijà) [5]. Dël to dabar visame
pasaulyje kasdien sukramtoma 6 mln. kato porcijø (8).
ÁVAIRIØ ÞOLINIØ PREPARATØ PSICHOSTIMULIACINIS POVEIKIS DAGMARA
REINGARDIENË1, JOLITA VILÈINSKAITË2
1 Kauno medicinos universiteto Intensyviosios terapijos klinika,
2 Kauno medicinos universiteto klinikø
Centrinës reanimacijos ir intensyviosios terapijos skyrius
Adresas susiraðinëti: Dagmara Reingardienë, el. p.:
[email protected]
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“Sveikatos mokslai” Nr.2 2010 m.3098 APÞVALGA
Vartojimo bûdas. Smulkûs ryðulëliai ið catha edulis lapø ir
plonø ûgliø parduodami vietinëse parduotuvë-se. Pagrindinis kato
vartojimo bûdas yra jo kramtymas. Kramtoma laikant lapus vienoje
burnos pusëje. Susi-daranèios seilës praryjamos. Rutuliuko formos
likutis laikomas uþ skruosto ir iðspjaunamas tik sueigos,
ce-remonijos pabaigoje. Retai ið lapø ir ûgliø verdama ir geriama
arbata [7, 12].
Toksinës catha edulis sudëtinës dalys. Augalo sudë-tyje yra du
bioaktyvûs alkaloidai, netiesiogiai veikiantys simpatomimetikai,
savo chemine struktûra ir poveikiu panaðûs á amfetaminà. Todël
literatûroje paprastai minimi ir nagrinëjami amfetaminø ir jø
derivatø grupëje [1, 13]. Tai katinas (cathine –
norpseudoephedrine) ir katinonas (cathinone – fenilalkilaminas α –
aminopropiophenone). Pastarasis, kaip stimuliantas, yra veiklesnis.
Katinonas randamas tik ðvieþiuose lapuose. Jis reliatyviai
nestabilus ir greit metabolizuojamas á katinà ir norefedrinà. Todël
kato lapai vartojami ðvieþi, o nuskinti turi bûti sunaudoti per
savaitæ. Iðdþiovintuose lapuose ir stiebuose yra jau tik 0,1 – 0,2%
katino, kuris turi tik apie 1/10 D-amfetamino stimuliacinio
poveikio. Dþiovinti lapai yra nepopuliarûs ir retai vartojami [2,
7, 9, 10, 12-15]. Ðvieþiø lapø su-dedamoji dalis katinonas yra
vadinamas ir natûraliu ar þoliniu ekstaziu [11]. Kato lapuose dar
yra ir kitø alka-loidiniø junginiø (fenilpentenilaminai,
katedulinai). Jie gali irgi prisidëti prie kato poveikio [10].
Catha edulis lapai turi ir taninø, askorbininës rûgðties, maþà
kieká esminiø riebaliniø rûgðèiø, sterolø, triterpenø, tiamino,
riboflavino, niacino, geleþies ir amino rûgðèiø [7]. Kramtant katà
per 90% jo alkaloidinës sudëties yra ekstraguojama á seiles ir
didþioji jø dalis absorbuojama jau per burnos gleivinæ [3, 10].
Katinono metilinis derivatas methcathinone che-miðkai
sintezuojamas ið efedrino. Jo poveikis panaðus á metamfetamino.
Ðiuo preparatu daugelá metø piktnau-dþiauta Rusijoje ir kitose
Tarybø Sàjungos ðalyse. Piktnau-dþiavimas juo pirmà kartà apraðytas
1990 m. Mièigane. Methcathinone vadinamas dar ir efedronu
(ephedrone), o gatvëse perkamas pavadinimais „cat“ ar „Jeff“
[15].
Ðalutiniai kato poveikiai. Katinonas labiausiai tok-siðkas
centrinei nervø sistemai ir ðirdþiai, taèiau jo su-keltos
adrenerginës komplikacijos yra daug retesnës ir ðvelnesnës nei nuo
amfetaminø.
Centrinë nervø sistema [10, 11, 15-17]. Pradinis efektas:
euforija, padidëjæs budrumas, hiperaktyvumas, nerimas, nemiga.
Vëliau atsiranda psichologinë priklau-somybë, stimuliacijos ar
sedacijos reiðkiniai. Daþnas ir gausus kato naudojimas susijæs su
psichozëmis, agresy-viu elgesiu, hipomanijomis. Odenwald M. ir
bendr. [8] ið Somalio vyrø nustatë ryðá tarp kato kramtymo kiekio
(didelis kiekis > 2 ryðulëliai/d) (p < 0,05), kramtymo
staþo
(p < 0,001) ir psichozës simptomø pradþios. Piktnaudþia-vimo
katu ryðá su protine negalia pastebi ir kiti [5, 18]. Taèiau
nurodoma, kad, jeigu kramtomi tik vidutiniai kato kiekiai, tai turi
tik socialiniø padariniø kaip ir alkoholio vartojimas [5, 18].
Pvz., Somalis viena ið neturtingiausiø ðaliø pasaulyje. 60% jo
þmoniø pragyvena maþiau nei uþ 1 dolerá per dienà. Per 80% Somalio
vyrø, kramtydami katà, tam iðleidþia 4 dolerius kasdien [5].
Þiurkëms katas sukelia ir stiprina agresyvø elgesá, galbût
maþindamas serotonino ir jo metabolitø kieká. Á ðá procesà gali
bûti átrauktas ir dopamino metabolizmas [6].
Retai [2] piktnaudþiavimo katu ryðys su psichiniu, psichologiniu
sergamumu yra neigiamas.
Kardiovaskulinë sistema. Kato kramtymas gali sukelti ávairias
aritmijas, hipertenzijà, krûtinës anginà ir net miokardo infarktà
[3, 10-13, 15, 16, 19]. Apraðytos dvi nëðèiosios [11], kurioms
vienkartinis kato kramtymas sukëlë aritmijas ir skausmus krûtinëje.
Savanoriams kato kramtymas padidina arteriná kraujospûdá, kurio
pa-didëjimas sutampa su katinono koncentracijos plazmoje padidëjimu
(kramtant po 1,5 – 3,5 val.) [14]. Katinono poveikis tirtas jûrø
kiaulytëms, jis sukëlë þenklià vaini-kiniø arterijø
vazokonstrikcijà [14]. Poveikis inotropinei ir chronotropinei
ðirdies funkcijoms, kaip parodë ekspe-rimentas, ávairus [14].
Kiti galimi ðalutiniai reiðkiniai. Kraujyje ir ðlapime kato
alkaloidai nustatomi skystos chromatografijos, masës
spektrometrijos metodu [3, 4, 10].
Katas (catha edulis) tik pastaraisiais metais, dël gau-sëjanèiø
imigrantø ið Afrikos, pradëjo patekti á Vakarø Europà, Amerikà,
kartà buvo patekæs ir á Lietuvà. Tai mû-suose galinti atsirasti
nauja psichostimuliacinë medþiaga, todël apie piktnaudþiavimà ja
reikia þinoti.
Kvaitulinis ðalavijas Kvaitulinis ðalavijas (Salvia divinorum,
S. divinorum)
– psichoaktyvus haliucinogeninis augalas. Nors jo, kaip
haliucinogeno, vartojimas pasaulyje pradëjo plisti tik nuo 1990 m.,
já jau nuo XVI a. vartojo indënai Meksikos ðiaurës rytø kalnø
regione. Vartojo tradicinëms religinëms apeigoms religiniø vizijø,
ateities numatymo, pranaðiðkø atsakymø apie draugus, prieðus,
gimines sukëlimui. Já naudojo ir vietiniai daktarai (hileriai)
galvos skausmø, reumato, diarëjos, ascito gydymui [20-22,
24-26].
Ðis daugiametis augalas yra mëtø (Lamiaceae) ðei-mos atstovas.
Nors ðalavijø rûðiø pasaulyje yra beveik 1000, S. divinorum dël
savo savybiø yra laikomas at-skiru augalu. Jis uþauga daugiau kaip
1 m aukðèio, turi didelius þalius lapus, tuðèiavidurá tiesø stiebà
ir baltus þiedus su purpurinëmis taurelëmis. Susidaro tik kelios,
retai sudygstanèios sëklos [24, 25]. Áprastai auga tik Meksikoje,
saulëto, ðvelnaus klimato sàlygomis. Dabar kultivuotas Kalifornijos
universitete ir botanikos kolek-
-
30992010 m. “Sveikatos mokslai” Nr.2 APÞVALGA
cijose yra maþiausiai keturios ðio ðalavijo atmainos. Pirmà
kartà literatûroje paminëtas 1939 m. JB John-
sono, studijavusio vietiná ðamanizmà. Jo þentas R.G. Weitlaneris
ðá augalà, kaip Marijos þolæ, apraðë 1952 m. 1962 m. R.G. Wassonas
ir A. Hoffmanas pirmàjá augalo pavyzdá gavo ið indënø ir apraðë já
kaip pakaitalà haliuci-nogeniniams grybams (tikslus augalo poveikis
iðaiðkintas tik 2002 m.). Ðá augalà minëti tyrëjai atveþë Amerikos
botanikams C. Eplingui ir M.C. Jativai. Jie 1962 m. su-klasifikavo
já kaip mëtø ðeimos atstovà ir C. Eplingas já pavadino S. divinorum
vardu [20, 23, 24, 27].
Vartojimo paplitimas, priklausomybës problemos. S. divinorum,
tarsi galimai legalaus ir alternatyvaus nelegaliems narkotikams
haliucinogeno, vartojimas pa-staruosius du deðimtmeèius plinta
[25]. Beveik visame pasaulyje jis parduodamas ávairiose maþose
parduotu-vëlëse ir já gali ásigyti tiek jauni, tiek seni [23].
Ilgalaikio augalo vartojimo poveikis netirtas [23], pripratimo,
tolerancijos padidëjimo jam ar vartojimo nutraukimo simptomai dar
neapraðyti [21, 23].
Farmakologija. Kvaitulinio ðalavijo psichoaktyvioji dalis –
salvinorinas A (C23 H28 O8). Jo koncentracija la-puose svyruoja nuo
0,89 iki 3,70 mg/g sauso svorio [24]. Tai neazotinis nealkaloidinis
diterpenoidas, savo struk-tûra nepanaðus á joká þinomà
haliucinogenà ir lengvai praeinantis per kraujo – smegenø barjerà
[20, 21, 28]. Salvinorinas A vienas ið stipriausiø natûraliøjø
haliuci-nogenø, labai selektyvus κ (kappa) opioidiniø receptoriø
agonistas (in vitro ir in vivo). κ receptoriai randami tiek galvos,
tiek nugaros smegenyse. Jø stimuliacija sukelia spinalinæ
analgezijà, miozæ, diurezæ, psichotomimezæ, disforijà,
supraspinalinæ analgezijà. Kvëpavimo neslo-pina. Haliucinacijø
biologinis mechanizmas neþinomas [20-22, 24, 25, 27, 28].
Salvinorinas A savo þymiu haliucinogeniniu poveikiu panaðus
sintetiniam haliuci-nogenui LSD (lizerginës rûgðties dietilamidui)
[26].
Farmakokinetika. Intraveninio salvinorino A poveikis netirtas,
nes ðis diterpenas vandenyje netirpsta [20, 21]. Geriamasis
salvinorinas A, net iðgërus jo 10 mg, jokio poveikio nesukelia.
Galvojama, kad já tuoj deaktyvuoja virðkinimo fermentai [20, 21,
25].
Kramtant lapus ir juos laikant burnoje apie 10 min. ak-tyvioji
jø dalis rezorbuojasi pro burnos gleivinæ ir povei-kis prasideda po
5-15 min., pasiekia maksimumà per 30 min.-1 val. ir tuomet silpnëja
per 1-2 val. [20, 21, 23, 25].
Rûkant dþiovintus lapus ar garinant lapø sultis ir jas
inhaliuojant poveikis gali atsirasti per keletà sekundþiø,
maksimaliai per 5-10 min. Efektas trunka iki 20-30 min. [20, 21,
25]. Apklausus 500 þmoniø, rûkiusiø ar inha-liavusiø S. divinorum,
25,8% jø nurodë, kad pagerëjusi nuotaika ir antidepresantinis
poveikis uþtruko 24 val. ar net ilgiau. Slenkstinë, haliucinacijas
sukelianti salvino-
rino A dozë rûkant já grynà ar inhaliuojant yra 200-500 µg [21,
23].
Metabolizmas gerai neiðtirtas, bet eksperimentas su beþdþionëmis
parodë, kad salvinorinas A iðskiriamas ir pro inkstus, ir pro
tulþies takus [27].
Iðtyrus 2 vyrus ir 2 moteris pasirodë, kad salvinorino A
pasiskirstymas ir eliminacija priklauso nuo lyties. Jie greièiau
veikia vyrus [20].
Kvaitulinio ðalavijo vartojimo bûdai: • Lapai gali bûti kramtomi
ir po to praryjami.
Kadangi salvinorinas A rezorbuojasi pro burnos gleivinæ, tai
kramtomus lapus reikia palaikyti burnoje kiek galima ilgiau, nors
tie lapai yra itin kartûs.
• Rûkomi dþiovinti lapai arba rûkomas, inhaliuo-jamas ið þaliø
sutraiðkytø lapø gautas ekstraktas.
• Minëtas ekstraktas sumaiðomas su vandeniu ir geriamas. Geriama
ir lapø arbata. Tik tuos gërimus reikia ilgiau palaikyti burnoje.
Ðiuo metu vartojamas ir iðgrynintas salvinorinas A [20, 23-25,
29].
Klinika. Ûminis kvaitulinio ðalavijo poveikis: haliu-cinacijos
ir sinestezijos (synesthesia – jausmas, jutimø maiðatis, girdëjimas
spalvø ar uþuodimas garsø, ðis po-veikis nëra specifinis).
Haliucinacijos ryðkios, gyvos. Gali bûti regëjimo, klausos ar
uoslës haliucinacijos. Spalvos matomos ðviesesnës, su ðvieèianèia
aureole apie daik-tus. Regëjimo haliucinacijos baigiasi, kai jas
pertraukia triukðmas, ðviesa. Sustiprëja intuicija, pagerëja
nuotaika, apima ramybë, mintys apie likimà, taip pat – plaukimo,
skraidymo jausmai, kelionës per laikà ar erdvæ jausmas, juntamas
ryðys su gamta, pasauliu. Gali padidëti prakai-tavimas, uþplûsti
ðilumos ir karðèio jausmas kûne, gali prasidëti galvos svaigimas,
pykinimas, koordinacijos sutrikimai, motorinës funkcijos
pablogëjimas, neaiðki kalba, suretëjæs ðirdies susitraukimø daþnis,
ðaltkrëtis [20,21,23-25,27,29].
Kokie nors grësmingi ðalutiniai reiðkiniai, pavartojus S.
divinorum neapraðyti. Tik viename tyrime 4,4% ið 500 vartotojø
apraðë uþtrukusius (24 val. ar ilgiau) neigiamus poveikius,
daþniausiai – nerimà.
Lëtinio vartojimo toksiðkumas taip pat neapraðytas. Tai rodo
kvaitulinio ðalavijo saugumà ar gydytojø ne-galëjimà paþinti
ilgalaikiø jo vartotojø [20, 21].
Laboratorinë S. divinorum vartojimo diagnostika. Ilgà laikà
salvinorino A ir B kiekiai þmogaus organizme nebuvo tiriami [25].
Ðiuo metu skystos chromatografijos ir spektrometrijos metodu
atlikti tik pavieniai kiekybiniai diterpenø tyrimai seilëse,
prakaite, ðlapime [20-22, 30].
Vartojimo legalumas. Kadangi ðio haliucinogeninio augalo
poveikis trumpas, neþinoma jo vartojimo rizika sveikatai, neþinomas
priklausomybës ir jos iðraiðkos iðsi-vystymas, todël daug kur S.
divinorum laikomas legaliu kanapiø pakaitalu. Internete pateikiamas
taip pat kaip
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“Sveikatos mokslai” Nr.2 2010 m.3100 APÞVALGA
legalus haliucinogenas, propaguojama prekyba jo ðvie-þiais ir
dþiovintais lapais, ávairaus stiprumo ekstraktais bei sëklomis,
ûgliais kvaitulinio ðalavijo auginimui. Visa tai nebrangu ir
lengvai gaunama. Jo vartotojø gretose vyrauja moterys (30 : 1) ir
paaugliai, nes salvinorinas A organizme praktiðkai netiriamas. JAV
kasmet já vartoja apie 1,8 mln. þmoniø (12 metø ar vyresni) ir apie
750000 per metus tai iðbando pirmà kartà. Taèiau, nepaisant jo
didelio prieinamumo, S. divinorum nëra vakarëliø, jaunimo
susibûrimø preparatas, nes já geriausiai vartoti vienam ar su
keliais gerais draugais, ramiame, tamsiame kambaryje [20, 21,
23-27, 31].
Taèiau paskutiniu metu kai kurios ðalys jo vartojimà yra
uþdraudusios ar tà vartojimà kontroliuoja. Tai kelios JAV
valstijos, Australija, Belgija, Danija, Estija, Suomija, Ðvedija,
Italija, Ispanija, Pietø Korëja [20, 21, 23-25]. 2008 05 Lietuvoje
kvaitulinis ðalavijas ir salvinorinas A átraukti á kontroliuojamø
vaistø sàraðà.
NAUJIEJI PSICHOTROPINIAI AUGALAI LIETUVOJE „Kanna“ þolelës
Iðgaunamos fermentuojant Sceletium tortuosum
(lot.). S. tortuosum yra pluoðtagëliniø (Aizoaceae) ðeimos
augalas, kilæs ið Pietø Afrikos, taip pat þinomas kaip Kan-na arba
Kauwgoed. Ðimtus metø jis buvo naudojamas kaip nuotaikos
stiprintojas, relaksantas ir empatogenas. S. tortuosum buvo
kramtoma, rûkoma bei uostoma, kas pirmiausia sukeldavo euforijà,
stimuliuodavo ir palaips-niui pereidavo á sedacijà [32, 33].
Kramtant, ji veikdavo kaip lengvas anestetikas ir kai kuriø Afrikos
genèiø buvo vartojama raunant dantis ar malðinant pilvo dieglius
vaikams. Ið S. tortuosum virta arbata buvo vartojama atpratinti
alkoholikus nuo alkoholio, taip pat apetito maþinimui. Augalas
pirmà kartà apraðytas 1662 metais Olandijos karo laivyno gydytojo
Jano van Rybeko (angl. Jan van Riebeck) [35].
S. tortuosum poveikis pagrástas alkaloidais, kuriø jis turi bent
9, pvz., mesembrino, mesembrenolio ir tortuo-samino (angl.
mesembrine, mesembrenol, tortuosamine) [32, 33]. Jie sàveikauja su
galvos smegenø dopamino ir serotonino receptoriais. Mesembrinas yra
pagrindinis alkaloidas, esantis S. tortuosum. Manoma, jog jis yra
serotonino reabsorbcijos inhibitorius [34]. S. tortuosum yra 1-1,5
% visø alkaloidø, apytiksliai 0,3 % mesembrino yra lapuose ir 0,86
% augalo stiebuose [32].
Paðalinis poveikis: lengvas galvos skausmas, apati-ja, apetito
stoka, pykinimas be vëmimo, viduriavimas, nemiga. Patariama
nevartoti kartu su raminamaisiais, migdomaisiais, antidepresantais,
antipsichotiniais bei ðirdá veikianèiais vaistais. Apie pripratimà
ir abstinencijà vartojant ilgai duomenø nëra, taip pat nurodoma,
kad au-
galas ne haliucinogenas. Nesenai buvo pradëtos gaminti S.
tortuosum tabletës bei kapsulës, kurios duoda puikiø rezultatø
gydant nerimà, lengvo ar vidutinio sunkumo depresijà, keliant
nuotaikà, maþinant stresà ir átampà, su-teikiant energijos [32].
Áprastais narkotikø testais kvaiðalas nerandamas. Legaliai
pardavinëjamas JAV, Australijoje, Nyderlanduose, Lenkijoje bei
Lietuvoje. Kaina Lietuvoje veikianèiose internetinëse parduotuvëse
– 5 g apie 35 Lt.
Gyslotojo vyklio sëklos Kitas labai populiarus produktas yra
gyslotojo vyklio
(lot. Argyreia nervosa, angl. Hawaiian Baby Woodrose, Elephant
creeper) sëklos. Gyslotasis vyklys yra vijokliniø (Convolvulaceae)
ðeimos augalas, kilæs ið Indijos, taèiau randamas ávairiose
vietovëse, pvz., Havajuose, Afriko-je, Karibø jûros regione. Jo
haliucinogeninës savybës atrastos palyginti neseniai – apie 1960
metus. Indijoje paprastai buvo vartojamos jo ðaknys bei lapai,
kurie neturi psichoaktyvaus poveikio, bet veikia antiseptiðkai bei
prieðuþdegimiðkai. Jo sëklose gausu alkaloidø, kurie struktûriðkai
panaðûs á LSD, todël sukeliamas efektas yra panaðus, tik
silpnesnis. Sukelia haliucinacijas, nuotaikos pakilimà,
mieguistumà, realistiðkus sapnus, nestabi-lumo jausmà, suaktyvina
pojûèius ir kt. Ðis produktas priskiriamas vadinamajai LSA, t.y.
d-lizerginës rûgðties amidø kategorijai [35, 36]. Preparatas veikia
apie 5-8 val., stipriausias poveikis bûna po 20-60 min. Paprastai,
efektui sukelti, vartojamos 5-8 sëklos [35]. Paðaliniai poveikiai:
nerimas, baimë, panika, delyras, pykinimas, vëmimas, pilvo diegliai
[35, 36]. Apie pripratimà ilgai vartojant duomenø nëra. Nurodoma,
jog standartiniais bei iðplëstais narkotikø testais kvaiðalas
nerandamas. Daugumoje pasaulio ðaliø ði medþiaga pardavinëjama
legaliai, t.y. JAV, Brazilijoje, Vokietijoje, Lenkijoje, Lietuvoje,
uþdrausta – Australijoje bei Italijoje. Kaina Lietuvoje
veikianèiose internetinëse parduotuvëse – 10 sëklø apie 25 Lt.
„SPICE“ miðiniaiManoma, jog ðiuo metu vieni stipriausiai
veikianèiø
ir populiariausiø yra rûkomieji „SPICE“ miðiniai, susi-dedantys
ið ávairø þoleliø. Pagal stiprumà jie skirstomi atitinkamai á
„SPICE silver/gold/diamond“). Ðiø ávairiø augalø miðinys veikia
panaðiai kaip kanapës. Ne visi miðinio ingredientai turi
psichoaktyvø veikimà – kai kurie veikia sinergistiðkai su kitais, o
kai kurie yra tik kvapnieji priedai. Paprastai rûkomas bongais
(vandens pypkëmis) arba maiðomas su tabaku. Veikimas prasideda po
keliø minuèiø, trunka apie 4-5 val.. Sukelia galvos sukimàsi,
juokà, euforijà, ekstazæ, nestabilumo jausmà, haliucinacijas
[37].
Sudëtis [37-39]: Jûrinë kardapupë (lot. Canavalia maritima,
angl. Bay Bean), taip pat þinoma kaip Mac-kenzie pupa. Tai paþemiui
augantis augalas, randamas
-
31012010 m. “Sveikatos mokslai” Nr.2 APÞVALGA
pietryèiø Floridos bei Meksikos paplûdimiuose ir smë-lynuose,
jos sëklos buvo naudojamos nuo 300 m. pr. Kr. Sukelia ramumo
jausmà, nors jos psichoaktyvios savybës neárodytos.
Mëlynasis lotosas (lot. Nymphaea caerulea, angl. Blue Lotus) –
tai lûgniniø (Nymphaeaceae) ðeimos augalas, naudotas senovës
Egipte, kaip geros sveikatos, sekso ir atgimimo raktas, taip pat –
afrodiziakas. Veikia tonizuo-jamai, maþina skausmà, stimuliuoja
kraujo cirkuliacijà, gali sukelti euforijà ir haliucinacijas.
Manoma, jog jame yra fitosterolio, bioflavonoidø bei
fosfodiesterazës.
Rieðutinis lotosas (lot. Nelumbo nucifera, angl. Pink lotus) –
tai lotosiniø (Nelumbonaceae) ðeimos augalas, nacionalinë ðventa
Indijos gëlë, uþimanti unikalià vietà Indijos mitologijoje.
Vartojant didesnëmis dozëmis gali sukelti euforijà, haliucinacijas,
sumaþinti arteriná kraujo spaudimà.
Maþoji kalpokë (lot. Scuttelaria nana, angl. Dwarf skullcap) –
notreliniø (Lamiaceae) ðeimos augalas, veikiantis atpalaiduojamai,
migdomai, gali bûti naudo-jamas sumaþinti nerimà. Nuo senovës buvo
vartojamas Ðiaurës Amerikos indënø genèiø gerinti miegui bei
maþinti baimei.
Tankiaþiedë glindë (lot. Pedicularis densiflora, angl. Indian
Warior) – dþiovekliniø (Orobanchaceae) ðeimos augalas. Tai
daugiametis vaistinis augalas, nuo senovës vartotas Ðiaurës
Amerikos indënø genèiø. Jis veikia ram-inamai, atpalaiduoja
raumenis, yra afrodiziakas.
Tikroji liûtausë (lot. Leonotis leonurus, angl Lion’s Tail) –
notreliniø (Lamiaceae) ðeimos augalas, nuo senoves Pietø Afrikoje
vartotas kaip vaistinis augalas, turintis nervø sistemà
atpalaiduojantá poveiká. Jo svar-biausias alkaloidas yra leonurinas
(angl. leonurine). Taip pat sukelia euforijà, svaigulá ir ramumo
jausmà. Naudotas nuo kosulio, perðalimo, diabeto, hipertenzi-jos,
egzemos, epilepsijos, þarnyno kirminams gydyti, obstipacijoms, kaip
prieðnuodis nuo vorø, gyvaèiø bei skorpionø ágëlimø.
Plaèialapë zornija (lot. Zornia latifolia, angl. Ma-conha Brava)
yra pupiniø (Fabaceae) ðeimos augalas, kilæs ið Pietø Amerikos. Tai
daugiametis vaistinis auga-las, kurio lapai ir sëklos Brazilijoje
buvo rûkomi vietoj kanapiø. Gali sukelti haliucinacijas.
Sibirinë sukatþolë (lot. Leonurus sibiricus, angl. Si-berian
Motherwort) yra notreliniø (Lamiaceae) ðeimos augalas, kilæs ið
centrinës Azijos. Jos preparatai ra-mina nervø sistemà, maþina
kraujospûdá, lëtina ðirdies ritmà.
Vaistinë svilaroþë (lot. Altheae officinalis, angl. Marshmallow)
– dedeðviniø (Malvaceae) ðeimos daugia-metis þolinis augalas.
Paprastai vartojamas kvëpavimo takø ligoms gydyti, atsikosëjimui
lengvinti, nes skystina bronchø sekretà, taip pat skatina diurezæ
bei veikia
antiuþdegimiðkai. Neturi psichoaktyvaus poveikio. Kiti nurodomi
ingredientai: raudonasis dobilas (lot.
Trifolium pratense, angl. Red Clover), roþës, vanilë bei medus.
Ðie preparatai neturi jokio psichoaktyvaus vei-kimo, naudojami kaip
skaninamieji priedai.
Tiksli „SPICE“ preparatø sudëtis yra ne visai tokia, kokià
nurodo gamintojai. Vokietijoje 2008 metø gruo-dþio mënesá atliktø
tyrimø duomenimis, „SPICE“ sudëtyje buvo rasta modifikuotø
sintetiniø kanabinoidø (JWH-018), kurie labai panaðûs á kanapëse
esantá tetrahidro-kanabinolá. Maþa to, jø analgezinis poveikis yra
nuo 5 iki 10 kartø, o afinitetas kanabinoidiniams receptoriams –
nuo 3 iki 28 kartø stipresnis nei tetrahidrokanabinolio. Vartojant
ðiuos preparatus kyla rizika priprasti ir perdo-zuoti. Áprastais
narkotikø testais kvaiðalas nerandamas [40]. Verta paminëti, jog
JAV ðis miðinys yra uþdraustas kaip Nyderlanduose, Vokietijoje,
Ðveicarijoje, Austrijoje. Legaliai pardavinëjamas Lietuvoje. Kaina
Lietuvoje vei-kianèiose internetinëse parduotuvëse – 1 g apie 50
Lt.
Apsinuodijimø kontrolës ir informacijos centro duo-menimis, ðiø
metø pradþioje Lietuvoje sudaryta darbo grupë, tirianti ðiø
internetinese parduotuvese paplitusiø kvaiðalø galimà átakà
sveikatai, jø prekybos apribojimà ar uþdraudimà.
Neabejojama, kad tai ne vieninteliai legaliai pri-einami
preparatai, pasiþymintys psichoaktyviu poveikiu ir nerandami
áprastais narkotikø testais. Panaðu, kad narkobiznio atstovai,
manipuliuodami ðiuo metu itin populiaria natûralumo koncepcija,
rado naujà niðà rin-koje. Dalis þmoniø gali pradëti vartoti minëtus
augalus net neþinodami apie jø poveiká sveikatai bei galimà
priklausomybæ jiems. Manoma, jog netrukus gali pasi-rodyti dar
daugiau tokio tipo preparatø, kurie neabejo-tinai sukels didelá
iððûká toksikologams bei teisësaugos struktûroms.
Literatûra 1. Reingardienë D., Vilèinskaitë J., Pilvfinis V.,
Stasiukynienë
V., Stonys A., Adomaitienë V. Apsinuodijimai narkotinëmis ir
psichot-ropinëmis medþiagomis. Kaunas, 2007; 1-148.
2. Numan N. Exploration of adverse psychological symptoms in
Yemeni khat users by the symptoms checklist – 90 (SCL-90).
Addiction 2004; 99 : 61-5.
3. Lukandu O.M., Costea D.E., Neppelberg E., Johannessen A.C.,
Vintermyr O.K. Khat (Catha edulis) induces reactive oxygen spe-cies
and apoptosis in normal human oral keratinocytes and fibroblasts.
Toxicological sciences 2008; 103 : 311-24.
4. Lukandu O.M., Costea D.E., Dimba E.A., Neppelberg E.,
Bredholt T. et al. Khat induces G1-phase arrest and increased
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45:1-6.
PSYCHOACTIVE PROPERTIES OF VARIOUS HERBAL PLANTS Dagmara
Reingardienë, Jolita Vilèinskaitë SummaryKey words: Catha edulis,
Khat, cathine, cathinone, amphetamines,
Salvia divinorum, Salvinorin A, psychoactive plants,
hallucinogens. Stimulant abuse is a major problem in the world.
There has been a
rise in the availability and recreational use of various herbal
plants as psychoactive agents. Numerous internet websites have
advertised it for sale as a legal herbal alternative to illegal
hallucinogens. In this review article there are discussed about new
psychoactive herbal plants : khat (Catha edulis), perennial herb of
the mint family Salvia divinorum, and several South African plant
species (Selectium tortuosum, Argyreia nervosa, “Spice” herbal
blends). A common form of drug abuse in East Africa involves
chewing the leaves and stems of the khat plant and swal-lowing the
juice. Khat is used by herbalist to treat depression, fatigue,
obesity, and gastric ulcers. The two active compounds alkaloids in
khat are cathine and cathinone, the more active stimulant. Salvia
divinorum has been used for its psychoactive effects for many
hundreds of years. The active component of Salvia divinorum is
Salvinorin A – non – ni-trogenous, non – alkaloid kappa opioid
receptor selective agonist. It produces intense, short – lived
hallucinations. We are discussed about recreational use of these
plants, the epidemiology and use patterns of them,
pharmacokinetics, toxicology, the diagnostic detection,
informa-tion about legality of users of these herbal plants.
Correspondence to: [email protected]
Gauta 2009-12-06
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31032010 m. “Sveikatos mokslai” Nr.2
Key words: adaptation/disadaptation, cross-cultural psychology,
M. K. Èiurlionis.
Summary Stressing the role of culture, tradition and lan-guage,
cross-cultural psychology may be better equipped to account for
migrants’ (dis)adaptation in the globalizing world. It may also
offer a more inquisitive assessment of M. K. Èiurlionis’ artistic
achievements seemingly clashing with his life history.
MATERIAL AND METHODSAs the title appropriates Hamlet’s famous
query “to
be or not to be”, the question is still topical, more so in our
times, for it indicates the issue whether to exist or not to exist
(or how to exist) in some unknown reality, place, country. The
problem of adaptation is old, though cross-cultural psychology is
fairly new.
In psychology, adaptation denotes outward behavior
serving/helping to secure the most basic needs of an individual. It
is usually linked with mass migration due to economic reasons. In
psychology and sociology, it denotes a shift in sociological or
cultural disposition. One is said to ‘adapt’ to a new environment
[10]. The phrase ‘cultural disposition’ indicates that there are
prob-ably other areas and other ways, and also other needs to be
taken into account when a certain adaptive norm or practice is
established. The situation changes when adaptation is to reach
innermost and personal problems, such as identity, accepted or
rejected universals, a sense of purpose in life, etc. In other
words, when it is not the problem of health after illness or
normality after medication. It is a psychological problem of a
different nature, of individual choices and consequences going well
beyond ‘normal functioning’ and everyday affairs, projecting on the
individual’s functioning in a foreign society, unknown culture and
strange linguistic milieu.
From time immemorial people used to travel, fight, fall in love,
marry and die on foreign soil, which were just a few reasons for
changing their place or country of origin. In our part of the world
migrating Lithuanians,
Poles, Italians, Irish have created their own nomadic his-tory
due to historical upheavals and individual decisions, in result
establishing influential Diasporas in various parts of the
world.
Old travelogues, accounts of voyages, diaries, let-ters, novels
and several eyewitness accounts, films and videos, magazines and
reports describing foreign places form an important part of
national, literary and popular traditions. Before and now people
used to be and still are faced with several choices – whether they
are aware of them or not – how/whether to fit into new
circumstances. All these have been happening before cross-cultural
psychology or any similar studies were launched. The catalogue of
queries modern societies, individuals and psychologists struggle
with are numerous:
• How does the idea of Diaspora combine with adaptation or
acculturation, homogeneity and globali-zation? Is there a norm (to
be) established?
• Why does migration almost always mean lowe-ring social status,
taking a job below one’s qualifications and a general worsening of
the quality of life (with the exception of some measurable economic
success)?
• What are the reasons for the generation gap between parents
and children in migrants’ families? Is this linked with the new
identity of the next generation of migrants?
• Why do migrants so often flare up against their adopted
country’s authorities? Why are the police of host countries accused
of unequal treatment of representati-ves of other races and
nationalities?
And, finally, the problems psychologists should not ignore:
• Why have there been so many suicides of com-monly known men of
letters and mental disorders other seemingly successful emigrant
artists (Jan Lechoñ, Ma-rek Hùasko, Jerzy Kosiñski and Mikalojus
Konstantinas Èiurlionis)?
• Why are there so few ‘success stories’ among emigrants? Does
it relate to adaptation or its absence? Does it stand for
adaptation if a successful migrant states: “The language is
beginning to invent another me” [4, 121]?
TO ADAPT OR NOT TO ADAPT – ISSUES IN CROSS-CULTURAL
PSYCHOLOGY
MARTA WISZNIOWSKA – MAJCHRZYK Cardinal Stefan Wyszyñski
University, Warsaw, Poland
Correspondence to: Marta Wiszniowska – Majchrzyk, e-mail:
[email protected]
INFORMACIJA
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“Sveikatos mokslai” Nr.2 2010 m.3104
Several attempts have been made to explain at least some of the
above. In the seventies John Berry provided an answer in his
acculturation model. The term accultu-ration has been defined in a
variety of ways, including the notion of cultural modification of
individuals or groups adapting or borrowing from another culture
but also merging with that culture. Some definitions state that it
is the culture of a given society acquired from infancy [1].
Berry’s model has been widely discussed and adopted [3] [Fig. 1].
Its main forte is accounting for several choices and consequences
that follow such choi-ces. Individuals may either participate in
another culture while maintaining his/her own and in result get
either assimilated or marginalized. The problem of marginali-zation
has become such a burning issue in various parts of the world,
worrying psychologists, psychiatrists, social workers,
criminologists, judges, teachers, representatives of various
religious denominations – almost all who try to organize, educate,
treat and … penalize.
So unsurprisingly, modern anthropology, sociology and recently
cross-cultural psychology have taken up psychological problems of
long-term residence in foreign countries. Yet, early studies mainly
concentrated on living conditions, environment, eventual success,
as-similation, or its absence. They devoted little attention to
cultural clash experienced by immigrants encountering foreign
customs, religion, language, living conditions, etc. It is only
recently that it has been accepted that hu-man behavior depends
very much on cultural traditions that human beings carry with
themselves. Indeed, the principle of “culture – bound nature of
most human behavior” [7, X] is comparatively new and the
relation-ship between psychology and culture dates back from WW
II.
Cross-cultural psychology has been defined in a variety of ways
[2, 1]. The basics of those definitions
necessitate following, scientific and systematic approach to how
human behaviours are shaped and influenced by social and cultural
forces, studying individuals from more than two cultures, finally,
how they are influenced by culture and how it leads to changes in
existing culture [Fig 2] (2,7).
The proposed goals and their topicality seem beyond doubt but
looking into the problem we may easily en-counter other
difficulties, namely how to make a set of coherent assumptions and
tools to study a discipline so vast, varied and of already
established methods, which may or may not be made compatible. Then,
what may cross-cultural psychology amount to; a chance, a
chal-lenge or a humbug? The gains seem obvious as the study aims at
covering both the individual and social level, taking into account
several variables, the approach seemingly open with few (if any)
preconceived ideas. The danger is that such a variety of
disciplines may lead to chaos and turn un-scientific, and the
difficulties in designing a coherent method of study
insurmountable.
Before the difficulties are ironed out, the problems individuals
and societies encounter when in new sur-roundings must be analyzed
from various theoretical and practical standpoints.
The earliest case of disadaptation in European culture is
probably the story of Odysseus as presented in Homer’s Odyssey
(VIII c. B.C.). When after the fall of Troy Odysseus was trying to
sail back to his native Ithaca and encountering various dangers and
adven-tures, he neither accepted nor wanted to adapt to new
circumstances offered to him but, if need be, he could pretend in
order to survive and successfully reach his kingdom, his wife,
Penelope, and his son, Telemachus. Thus, Odysseus’ tactics was
skin-deep adaptation, flex-ibility and cunning.
Leaving aside the ancient archetype of a modern migrant, one
encounters several cases for whom adap-tation or its absence cannot
be defined and who turn it into completely different uses. This is
the case of
Fig. 2 Cross-cultural psychology in relation to other
dis-ciplines [2,7]Fig. 1 John Berry’s acculturation model [3]
INFORMACIJA
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31052010 m. “Sveikatos mokslai” Nr.2
Mikalojus Konstantinas Èiurlionis. It might appear that Kæpiñski
had him in mind when dedicating his famous Schizophrenia:” To those
who feel more and understand differently and because of this suffer
more, and whom we often call schizophrenics.” [8]
The unquestionable greatness and uniqueness of Èiurlionis is
beyond discussion [11]. However, cross -cultural psychology may
offer a different view on his disorder, at that time diagnosed as
schizophrenia (thus stating the norm and pointing to pathology).
Èiurlionis’s disorder could very well be taken for an eruption of
free-dom and creative energy, for breaking away from artistic
constraints, a flight to happiness, a struggle against the norms
enslaving his inner world and his many-sided tal-ent. And yet, he
was a patient and an outsider, though well versed in languages and
cultures, in artistic trends of the epoch, he seemed to have
decided NOT to belong and NOT to conform.
Psychiatry and psychology can differentiate between what is
normal and what is not by conducting tests and assessing symptoms.
Èiurlionis did not match up, twist-ing and turning rules, which
shows in his music and his paintings (cf. Ramybe and Angelas
Preliudas). What can be said about the man who wrote to his
friend:
”Look among the snowy crowns of the mountains, spiry mountains.
Soaring almost up to the sky, stands a man. At his feet cloud has
covered the whole earth; down there earthly history proceeds,
muddle, din, babble, but the cloud has covered all. Silence. White,
strange crowns around. Strangely huge, strangely beautiful of opals
and pearls, of topaz and malachite, of crystal and diamonds.
Strangely magnificent, huge crowns and among them stands the man
and looks with his eyes, wide open, looks and waits. He promised
that at sunshine – the moment when the crowns are on fire, when
colors mingle and
rays dance – he would sing a hymn to the sun. A hymn to the sun!
“[ 9 ]
Standard methods of assessment fail to adequately describe his
art and him as an entity. Though interna-tionally recognized after
his death, he remains outside Berry’s diagram, various diagrams and
globalization/ ethnicity/ adaptation conflicting evidence.
Cross-cultural psychology can better account of the importance
of tradition and language and also tremen-dous efforts migrants
make in order to adapt to living in a new society, another country,
among complete strangers. Eva Hoffman, who immigrated to Canada in
her teens and made a career there as a Harvard gradu-ate and
university lecturer and, also a writer, is the case in point. The
manner she describes her personal road toward adaptation is
revealing and would justify cross-cultural studies, something well
beyond the norm and pathology issue:
“I think every migrant becomes a kind of amateur anthropologist
– you do notice things about the culture or the world that you come
into that people who grow up in it, who are embedded in it, simply
don’t notice/…/ At first you notice the surface things, the surface
differences. And gradually you start noticing the deeper
differences. And very gradually you start with understanding the
inner life of the culture, the life of those both large and very
intimate values.” [5 ]
Mikalojus Èiurlionis. Ramybë (Tranquility)
http://en.wiki-pedia.org/wiki/File:Mikalojus_Ciurlionis_-_Tranquility_(Ra-mybe).jpg
Mikalojus Èiurlionis. Angelas. Preliudas (Angel Prelude).
http://en.wikipedia.org/wiki/File:Angelas.Preliudas.jpg
INFORMACIJA
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“Sveikatos mokslai” Nr.2 2010 m.3106
Compared to putting on a new skin, adaptation was long and
painful, as the writer had to re-write herself in the new language,
as she states, “For I did not want to say ‘ Now I am American,
point, the end.’ For I had to go through the process of translating
myself. And it was really translating not chameleoning, though
there may have been some elements of it. I always wanted to save a
thread of myself in the process, trying to understand the new world
and enter it somehow.” [6]
The above cases support the need for some new ap-proach to the
study of adaptation to new surroundings, culture, language and
society. For adaptation is more than norm or pathology, it is more
than conforming or paying lip service to prevailing ideologies.
Numerous studies indicate how complex the problem is and how vital
in our times. To assess it must be personalized because some
extraordinary individuals can use their seclusion and loneliness,
illness, etc. to achieve unbe-lievable results struggling with
various constraints. So far, psychology was geared mainly to
pathological processes more than to welfare, to interpreting
statistical data in-stead of individual’s growth-oriented
functioning.
Cross- cultural psychology is more likely to assess gains and
losses of adaptation processes. Some gains are obvious, such as new
horizons, experiences, personal development, eventually
recognition, or fame. So are loses, such as lost or modified
identity, nostalgia, (a pass-ing) phase of shock, inability (or
refusal) to adapt, etc.
Besides, some re- assessment is needed to re-define the role of
language and tradition one carries with him/her as one’s most
personal trait. Perhaps cross-cultural psychology can help assess
the problem, offering a more complex view on how individuals adapt
in/to the changing world.
References1. Acculturation, def.
http://www.merriam-webster.com/dic-
tionary/acculturation 2. Berry J.W., Poortinga,Y.H., Segall,
M.H., Dasen, P.R. Cross-
Cultural Psychology. Research and Applications. CUP, Cambridge,
(1992) 1999.
3. Chika Assai E., Durham J., Halvorson A., Holte S. Counseling
and Student Affairs. Minnesota State University. HTML version:
w2.edutech.nodak.edu/ndca/conference/.../amyhalvorson.ppt
4. Hoffman E. Lost in Translation: A Life in a New Language.
Vintage Books, London,(1989)1998.
5. Hoffman E. Identity Theory Interview
http://www.identityt-heory.com/interviews/birnbaum157.php
6. Hoffman E. Nie Chcæ Ýyã w Wædrówce
http://free.art.pl/akcent_pismo/pliki/siec/hoffman.html (transl. by
MWM)
7. Jahoda G. Foreword in: Berry J.W. 1999. X-XII.8. Kepiñski A.
Schizofrenia. PZWL, Warszawa, 1972,.9. Okulicz-Kozaryn R. The
Language of Luminous Love:
M.K. Ciurlionis among Heirs to the King-Spirit
http://www.lituanus.org/2003/03_4_04.htm#foots
10. Reber A.S. The Penguin Dictionary of Psychology. Penguin
Books 1995.
11. Siedlecka J. Mikoùaj Konstanty Èiurlionis 1875-1911.
Pre-ludium Warszawskie. Wyd. AgArt Warszawa, 1996.
PRISITAIKYTI AR NEPRISITAIKYTI – TRANSKULTÛRINIAI IÐÐÛKIAI
Marta Wiszniowska – Majchrzyk SantraukaRaktaþodþiai:
adaptacija/disadaptacija, transkultûrinë psicholo-
gija, M.K.ÈiurlionisTranskultûrinë psichologija, kuri remiasi
kultûrø, tradicijø ir kalbos
vaidmeniu, turi didesnes galimybes paaiðkinti migrantø
(dis)adaptacijà ðiame globalëjanèiame pasaulyje. Ji gali suteikti
geresnës áþvalgos vertinant M.K.Èiurlionio meninius pasiekimus,
kurie tarsi prieðtarauja jo biografijos faktams.
Adresas susiraðinëti: [email protected]
Gauta 2009-12-05
INFORMACIJA
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31072010 m. “Sveikatos mokslai” Nr.2
Key words: effectiveness of therapy of the imprisoned offenders,
aggression, a sense of purpose in life, coping with stress
styles.
SummaryThe present paper discusses the effectiveness of therapy
of the imprisoned addicted offenders. The effectiveness of
specially designed therapeutic program for in-prison treatment is
evaluated by comparing the changes in behavioral aggression
indicators, a sense of purpose in life and coping with stress
styles and, in result, changes in social adaptation.
MATERIAL AND METODS Legal foundations for the treatment of
addicted
offenders in Polish penal system. Art. 96 § 1 Polish Penal Code
states (an unofficial translation): “Offenders with non-psychotic
disorders serve prison sentence in a therapeutic system, including
those sentenced upon art. 197-203 Polish Penal Code for offences
linked with disturbed sexual preferences, mental impairment,
alcohol or psychoactive drugs addiction, physical handicaps –
requiring specialist treatment, in particular psychological,
medical or rehabilitation.”
The next relevant paragraph states (unofficial
tran-slation):
“Executing the sentence in therapeutic system ac-counts for a
particular need to prevent further deepening of pathological
personality traits, regaining psychic ba-lance and helping develop
social relations and preparing for self-reliant life. “Art. 97 §
1
Imprisoned offenders undergo systematic therapy with individual
therapeutic programs that include:
• Kinds and forms of therapeutic activities (espe-cially
psychological, medical and rehabilitating)
• Activities included in systematic re-socializing and adapting
programs (General Prison Service, Direc-tive (19).
Such understanding of resocializing and therapy aim
at the following objectives:Minimal aim: such state of the
prisoner’s personality
that allows functioning in society (after release) without
re-offending
Maximal aim: the state of the prisoner’s personality, which
allows functioning in society without re-offending and with
respecting several significant social norms.
Effectiveness of therapeutic activities in prison con-ditions.
Those dealing with the problems of resocializing and therapy in
prison condition reveal certain skepticism toward its
effectiveness. It is often maintained that on release offenders are
far worse than before they served their term. J. Pinatel (13)
assumes that no prison can be-come a proper place for corrective
actions. H.J.Schneider (16) talked about the failure of any
activity due to the artificiality and isolation in prison.
K.Pospiszyl (14,15) believes that therapy of psychopaths is only
apparent and utterly ineffective, and the process of change and
psychotherapy effectiveness comes from a desire to show off and is
a manipulative action to achieve per-sonal goals.
There are few researches that point to positive results of
therapy on the offenders’ functioning. Z. Lenartowicz and W.
Piekarski (10) point to the following positive results of in-prison
therapy such as better adaptation to prison conditions, lowering
anxiety and hostility. K. Pospiszyl (15) maintains that group
therapy is the best resocialization method for psychopaths.
Conducting in-prison addiction therapy, J.Górski (7), J.Górny
(6), K. Linowski and J.Nowicka (11) point to the effectiveness of
therapy in small prisons. There, therapy can be of motoric,
individual, occupational and artistic. The patient’s attitude, his
will to change attitudes and offensive p