{"id":4003,"date":"2021-06-23T14:36:07","date_gmt":"2021-06-23T14:36:07","guid":{"rendered":"https:\/\/curesz.org\/?page_id=4003"},"modified":"2023-08-15T15:07:22","modified_gmt":"2023-08-15T19:07:22","slug":"hope-in-a-needle","status":"publish","type":"page","link":"https:\/\/curesz.org\/pt_pt\/hope-in-a-needle\/","title":{"rendered":"Esperan\u00e7a em uma agulha"},"content":{"rendered":"

<\/span><\/div>

Dr. Craig Chepke, membro do Conselho de Administra\u00e7\u00e3o da The CURESZ Foundation, psiquiatra particular e professor assistente adjunto de psiquiatria da Escola de Medicina da Universidade da Carolina do Norte<\/strong><\/p>\n<\/div><\/div><\/div>

Antipsic\u00f3ticos injet\u00e1veis de a\u00e7\u00e3o prolongada: esperan\u00e7a em uma agulha<\/strong><\/p>\n

When the FDA authorized the first vaccines for COVID-19, they were called miracles of modern medicine and \u00a0saviors of society. Pictures of people weeping tears of joy while receiving the vaccine flooded the Internet. What stood out to me was that these were not people who were already sick with COVID\u2014 they were completely healthy. But they saw the vaccine as a symbol of hope and the first step in overcoming the oppression of living in fear of an uncertain future. It made me wonder, why do we have such a hard time believing that people living with schizophrenia could find hope in a needle too?<\/p>\n

Os antipsic\u00f3ticos injet\u00e1veis de a\u00e7\u00e3o prolongada (LAIs) oferecem in\u00fameras vantagens potenciais bem documentadas para o tratamento de adultos com esquizofrenia, mas menos de 15% os recebem1<\/sup>. Perhaps one reason they are so underutilized is that clinicians have assumed that patients would not be interested in receiving an injection every two to four weeks, as LAIs historically required. However, I can attest that even if the COVID vaccine needed to be taken every month to stay safe, I would still want to be the first in line!<\/p>\n

Furthermore, recent advances have allowed the interval between injections of certain LAIs to increase dramatically over the past decade. For instance, paliperidone palmitate was introduced as a once-a-month LAI in 2009, but a newer preparation given just every 3 months became available in 2015. Even more exciting, a version administered every six months was approved by the FDA in 2021. If this pace continues, perhaps there could be a once-a-year version in 2027!<\/p>\n

Considerable evidence suggests that schizophrenia is a neurodegenerative brain disorder, similar to Parkinson\u2019s or Alzheimer\u2019s disease. With schizophrenia, however, psychotic relapses drive the progressive loss of brain tissue2<\/sup>. Como tal, os m\u00e9dicos devem pensar na preven\u00e7\u00e3o de reca\u00eddas na esquizofrenia com a mesma urg\u00eancia com que atualmente tentamos evitar que algu\u00e9m tenha um segundo ou terceiro AVC.3<\/sup>. O uso mais amplo de LAIs pode ajudar bastante a minimizar a perda cerebral e o decl\u00ednio resultante na funcionalidade e na qualidade de vida que cada reca\u00edda traz. A pesquisa mostrou que os LAIs podem reduzir as taxas de reca\u00edda na esquizofrenia em 20% e o risco de mortalidade em 33% em compara\u00e7\u00e3o com o uso do mesmo antipsic\u00f3tico na forma oral4,5<\/sup>.<\/p>\n

Apesar desses benef\u00edcios substanciais, a maioria dos m\u00e9dicos parece reservar LAIs apenas para pacientes com doen\u00e7as mais graves ou cr\u00f4nicas6<\/sup>. Em contraste, os m\u00e9dicos normalmente prescrevem medicamentos que retardam o decl\u00ednio da doen\u00e7a de Alzheimer no in\u00edcio da doen\u00e7a para proteger o funcionamento mental da pessoa em um n\u00edvel mais alto, em vez de esperar at\u00e9 que haja menos qualidade de vida para preservar. Dada a evid\u00eancia de que cada reca\u00edda acelera o decl\u00ednio cognitivo e funcional de pessoas com esquizofrenia, os LAIs devem ser considerados uma op\u00e7\u00e3o precoce, n\u00e3o uma interven\u00e7\u00e3o de \u00faltimo recurso. N\u00e3o h\u00e1 per\u00edodo de car\u00eancia para os efeitos destrutivos que a esquizofrenia tem no c\u00e9rebro.<\/p>\n

Algumas diretrizes de pr\u00e1tica cl\u00ednica come\u00e7aram a recomendar o uso de LAIs no primeiro epis\u00f3dio psic\u00f3tico, e adotei essa abordagem em minha pr\u00e1tica7<\/sup>. Eu explico isso aos pacientes com a analogia de que, se eu pulasse de um avi\u00e3o, preferiria abrir meu paraquedas a 50.000 p\u00e9s acima do solo, n\u00e3o a 50 p\u00e9s. Na luta para alcan\u00e7ar uma vida mais rica, plena e longa, os LAIs s\u00e3o uma ferramenta muito poderosa para serem t\u00e3o subutilizados quanto s\u00e3o. O tratamento agressivo precoce do primeiro epis\u00f3dio psic\u00f3tico e as reca\u00eddas subsequentes com LAIs podem melhorar drasticamente os resultados a longo prazo.<\/p>\n

Descobri que os LAIs podem ser uma fonte not\u00e1vel de positividade na vida de pessoas com esquizofrenia. Com a confian\u00e7a de que a consist\u00eancia da medica\u00e7\u00e3o \u00e9 ideal e a estabilidade aprimorada que os LAIs geralmente trazem, tanto o cl\u00ednico quanto o paciente podem se concentrar em outras quest\u00f5es, como aprofundar sua alian\u00e7a terap\u00eautica ou trabalhar em habilidades de enfrentamento. O pr\u00f3ximo passo pode ser promover o engajamento necess\u00e1rio para perseguir com sucesso objetivos ainda mais elevados, como voltar a estudar, conseguir um emprego ou encontrar um relacionamento. LAIs podem ser interven\u00e7\u00f5es que salvam vidas, mas apenas se os m\u00e9dicos fizerem sua parte, oferecendo e educando sobre eles. Precisamos fazer tudo o que pudermos para transformar o primeiro epis\u00f3dio de esquizofrenia de uma pessoa em seu \u00faltimo epis\u00f3dio - e para alguns podemos come\u00e7ar ajudando-os a encontrar esperan\u00e7a em uma agulha.<\/p>\n

    \n
  1. Offord, S, et al. \u201cUso de recursos de sa\u00fade de pacientes com esquizofrenia iniciando antipsic\u00f3ticos injet\u00e1veis de a\u00e7\u00e3o prolongada versus orais.\u201d\u00a0Revista de Economia M\u00e9dica<\/em>2 (2013): 231-239.<\/li>\n
  2. Andreasen, N., et ai. \u201cDura\u00e7\u00e3o da reca\u00edda, intensidade do tratamento e perda de tecido cerebral na esquizofrenia: um estudo longitudinal prospectivo de resson\u00e2ncia magn\u00e9tica.\u201d\u00a0Jornal Americano de Psiquiatria<\/em>6 (2013): 609-615.<\/li>\n
  3. Nasrallah HA. R\u00c1PIDO e R\u00c1PIDO: siglas para prevenir danos cerebrais em acidente vascular cerebral e psicose. Psiquiatria Atual. 2018;17(8):6-8.<\/li>\n
  4. Kishimoto, T, e outros. \u201cAntipsic\u00f3ticos injet\u00e1veis de a\u00e7\u00e3o prolongada versus antipsic\u00f3ticos orais para o tratamento de manuten\u00e7\u00e3o da esquizofrenia: uma revis\u00e3o sistem\u00e1tica e meta-an\u00e1lise comparativa de estudos randomizados, de coorte e pr\u00e9-p\u00f3s\u201d.\u00a0The Lancet Psiquiatria<\/em>(2021).<\/li>\n
  5. Taipale, H, et al. \u201cAntipsic\u00f3ticos e mortalidade em uma coorte nacional de 29.823 pacientes com esquizofrenia.\u201d Schizophrenia Research 197 (2018): 274-280.<\/li>\n
  6. Kishimoto, T, e outros. "Efic\u00e1cia de antipsic\u00f3ticos injet\u00e1veis de a\u00e7\u00e3o prolongada versus antipsic\u00f3ticos orais em pacientes com esquizofrenia: uma meta-an\u00e1lise de estudos de coorte prospectivos e retrospectivos." Boletim de esquizofrenia 44.3 (2018): 603-619.<\/li>\n
  7. Florida Medicaid Drug Therapy Management Program. Diretrizes de Medica\u00e7\u00e3o Psicoterap\u00eautica das Melhores Pr\u00e1ticas da Fl\u00f3rida 2019\u20132020 para Adultos.<\/li>\n<\/ol>\n<\/div><\/div><\/div><\/div><\/div>
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