{"id":4044,"date":"2021-07-19T23:23:26","date_gmt":"2021-07-19T23:23:26","guid":{"rendered":"https:\/\/curesz.org\/?page_id=4044"},"modified":"2023-08-14T11:39:55","modified_gmt":"2023-08-14T15:39:55","slug":"tardive-dyskinesia-be-your-own-advocate","status":"publish","type":"page","link":"https:\/\/curesz.org\/pt_pt\/tardive-dyskinesia-be-your-own-advocate\/","title":{"rendered":"Discinesia tardia: seja seu pr\u00f3prio advogado"},"content":{"rendered":"

<\/span><\/div>

Dr. Craig Chepke<\/a>, Psiquiatra de consult\u00f3rio particular e Professor assistente adjunto de Psiquiatria, Escola de Medicina da Universidade da Carolina do Norte, Membro do Conselho da CURESZ<\/p>\n<\/div><\/div><\/div>

A discinesia tardia (DT) \u00e9 uma s\u00edndrome neurol\u00f3gica de in\u00edcio tardio que pode ocorrer como efeito colateral do uso prolongado de medicamentos antipsic\u00f3ticos. As pessoas que desenvolvem DT podem ter movimentos involunt\u00e1rios repetitivos que geralmente s\u00e3o lentos e contorcidos, ou de natureza dan\u00e7ante. Os movimentos ocorrem mais comumente nos m\u00fasculos da face, boca e l\u00edngua, mas tamb\u00e9m podem aparecer nos bra\u00e7os, pernas ou tronco. As estimativas da frequ\u00eancia de DT diferem, mas variam de 7%-30% de pessoas que tomam antipsic\u00f3ticos por um per\u00edodo prolongado.1<\/sup>\u00a0O tempo de exposi\u00e7\u00e3o necess\u00e1rio para desenvolver DT \u00e9 vari\u00e1vel, mas pode ocorrer meses ou mesmo anos ap\u00f3s o in\u00edcio do tratamento com um antipsic\u00f3tico. Uma vez que a TD se manifesta, ela pode se tornar irrevers\u00edvel. Portanto, a detec\u00e7\u00e3o precoce e o tratamento da discinesia tardia s\u00e3o cr\u00edticos.<\/em><\/p>\n

Sinto-me honrado em fazer parte do CURESZ\u00a0Painel de especialistas em discinesia tardia<\/a>, mas nem sempre fui h\u00e1bil a diagnosticar a TD. Durante anos, ningu\u00e9m no meu consult\u00f3rio atual parecia apresentar sintomas \u201cevidentes\u201d de TD, pelo que acabei por assumir que se tratava mais de um problema hist\u00f3rico associado aos antipsic\u00f3ticos de primeira gera\u00e7\u00e3o, mais antigos, que raramente prescrevo. Em 2016, no entanto, comecei a acompanhar um jovem com esquizofrenia cuja DT era inconfund\u00edvel. Na altura, sem medicamentos aprovados pela FDA, o melhor que pude oferecer foi suspender ou reduzir um dos dois antipsic\u00f3ticos que ele tomava. Ele e o pai recusavam-se a considerar qualquer altera\u00e7\u00e3o, porque aquela combina\u00e7\u00e3o era a \u00fanica que alguma vez tinha funcionado para ele. Quando o pai faleceu repentinamente meses mais tarde, o luto dele inspirou-me a aprender o m\u00e1ximo poss\u00edvel sobre o tratamento da DT. N\u00e3o podia devolver-lhe o pai, mas podia, pelo menos, tentar dar-lhe a dignidade de controlar o seu pr\u00f3prio corpo.<\/p>\n

Estudei revistas e livros de neurologia durante meses e percebi que, inconscientemente, tinha definido o meu crit\u00e9rio para diagnosticar a TD apenas ao n\u00edvel de gravidade mais elevado. Sem dar por isso, tinha-me tornado incapaz de detetar a TD de gravidade ligeira a moderada. Ao ler sobre os in\u00fameros ensaios cl\u00ednicos mal sucedidos com medicamentos e suplementos para o tratamento da TD, compreendi melhor o sentimento de impot\u00eancia que os m\u00e9dicos tinham sentido ao longo de d\u00e9cadas ao tentarem trat\u00e1-la. Parecia que o reconhecimento da TD tinha sido gradualmente ofuscado pelo aumento dos exames de rastreio de outros potenciais efeitos secund\u00e1rios dos antipsic\u00f3ticos, tais como o aumento dos n\u00edveis de a\u00e7\u00facar no sangue e do colesterol \u2014 talvez porque estes \u00faltimos s\u00e3o problemas para os quais h\u00e1 muito que dispomos de boas op\u00e7\u00f5es de tratamento. Em 2017, a FDA aprovou os dois primeiros medicamentos para a TD, e o tratamento do meu doente com um deles trouxe-lhe benef\u00edcios profundos que eu n\u00e3o esperava.<\/p>\n

Todos os profissionais de sa\u00fade mental receberam forma\u00e7\u00e3o numa \u00e9poca em que pouco ou nada pod\u00edamos fazer para tratar a TD, pelo que muitos n\u00e3o davam a devida prioridade \u00e0 sua dete\u00e7\u00e3o. As nossas compet\u00eancias de diagn\u00f3stico enfraqueceram e muitos cl\u00ednicos mais recentes nunca chegaram a adquirir profici\u00eancia nesta \u00e1rea. Agora que existem tratamentos aprovados, a \u00e1rea da sa\u00fade mental acabar\u00e1 por melhorar o seu reconhecimento da DT, mas se eu n\u00e3o tivesse tido esta experi\u00eancia \u00fanica na altura em que a tive, talvez tivessem passado anos at\u00e9 eu intensificar o meu rastreio. At\u00e9 que todos os profissionais tornem o exame exaustivo da DT uma parte padr\u00e3o das suas consultas, exorto todas as pessoas que tomam antipsic\u00f3ticos, especialmente aquelas que apresentam problemas de movimento invulgares ou inesperados, a defenderem os seus pr\u00f3prios interesses e a tomarem a iniciativa de discutir o tratamento da discinesia tardia com o seu m\u00e9dico.<\/p>\n

Refer\u00eancia: 1. Carbon et al. J Clin Psychiatry 2017;78(3):e264\u2013e278.<\/p>\n

<\/h2>\n<\/div><\/div><\/div><\/div><\/div>
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