{"id":4048,"date":"2021-07-19T23:40:54","date_gmt":"2021-07-19T23:40:54","guid":{"rendered":"https:\/\/curesz.org\/?page_id=4048"},"modified":"2023-11-15T14:18:23","modified_gmt":"2023-11-15T19:18:23","slug":"tardive-dyskinesia-more-than-a-side-effect-2","status":"publish","type":"page","link":"https:\/\/curesz.org\/pt_pt\/tardive-dyskinesia-more-than-a-side-effect-2\/","title":{"rendered":"Discinesia tardia: mais do que um efeito colateral"},"content":{"rendered":"

<\/span><\/div>

Dr. Craig Chepke<\/a>, Membro, Conselho de Administra\u00e7\u00e3o, Funda\u00e7\u00e3o CURESZ, Psiquiatra de Pr\u00e1tica Privada e Professor Assistente Adjunto de Psiquiatria, Faculdade de Medicina da Universidade da Carolina do Norte<\/p>\n<\/div><\/div><\/div>

Tardive Dyskinesia (TD) was \ufb01rst described in the early 1960s, but we don\u2019t have a clear understanding of why it happens despite nearly 60 years of research. TD does seem to have a clear relationship with dopamine, which regulates a vast number of functions in our bodies, including attention, pleasure- seeking, and motor function. Some psychiatric disorders, including disturbances of mood, sensory perception, and thought processes are believed to be associated with an excess of dopamine stimulation in certain pathways, or \u201ccircuits\u201d of the brain.<\/p>\n

Costumamos usar medicamentos antipsic\u00f3ticos para esses sintomas porque s\u00e3o bloqueadores dos receptores de dopamina (DRBs) e, portanto, impedem que a dopamina complete o circuito. Em circuitos de dopamina hiperativos, isso normaliza a fun\u00e7\u00e3o, mas os DRBs s\u00e3o incapazes de discriminar entre vias de dopamina hiperativas e normais. \u00c0s vezes, o bloqueio da dopamina pode reduzir a fun\u00e7\u00e3o em vias que n\u00e3o deveriam e causar consequ\u00eancias n\u00e3o intencionais.<\/p>\n

Os g\u00e2nglios da base s\u00e3o a parte do c\u00e9rebro respons\u00e1vel pelo controle dos movimentos e tamb\u00e9m dependem da dopamina para conduzir sua sinaliza\u00e7\u00e3o. O uso prolongado de DRBs pode estimular os g\u00e2nglios da base a produzir muitos receptores de dopamina altamente sens\u00edveis. Em uma tentativa de reequilibrar seus sinais de dopamina diminu\u00eddos, o processo pode compensar alguns. O sistema motor torna-se hipersens\u00edvel e a dopamina passa a superestimul\u00e1-lo, resultando em movimentos involunt\u00e1rios ou \u201cdiscinesia\u201d que d\u00e3o o nome de TD. \u201cTardive\u201d vem da palavra francesa para \u201ctarde\u201d porque geralmente leva meses ou anos de exposi\u00e7\u00e3o a um DRB antes que os sintomas se desenvolvam.<\/p>\n

Imagine que voc\u00ea est\u00e1 ouvindo m\u00fasica com um amigo e acha que o n\u00edvel de volume est\u00e1 normal, mas est\u00e1 alto demais para ele. Ele tira tamp\u00f5es de ouvido, mas os coloca em seus ouvidos, assim como nos dele. Agora voc\u00ea n\u00e3o consegue mais ouvir a m\u00fasica e percebe que os protetores de ouvido n\u00e3o saem, ent\u00e3o voc\u00ea aumenta o volume para compensar. Eventualmente, os tamp\u00f5es de ouvido podem funcionar mal e cair, e a m\u00fasica soa insuportavelmente alta. Infelizmente, voc\u00ea descobre que o bot\u00e3o de volume est\u00e1 quebrado e n\u00e3o consegue abaix\u00e1-lo.<\/p>\n

The real problem with TD isn\u2019t that it can develop long after the start of a DRB, it’s that\u00a0it\u2019s generally irreversible. Not everyone taking a DRB gets TD, but those who do can\u2019t get rid of it by stopping the medication. While some risk factors are known, we don\u2019t yet have a very good way of predicting who is going to get it before it happens. Or in the terms of the analogy above, we don\u2019t know whose earplugs are going to malfunction.<\/p>\n

Therefore, we shouldn\u2019t consider TD a \u201cside effect\u201d of DRBs, because side effects go away if you remove the medication that cause them. Rather, we should think of TD as its own syndrome that is caused by exposure to DRBs in vulnerable people. Just like cigarette smoking causes lung cancer in some people \u2013 those who get cancer don\u2019t go into remission just because they stop smoking. Improving tardive dyskinesia at that point requires its own additional treatment, which I\u2019ll discuss in my\u00a0pr\u00f3xima coluna<\/a>.<\/p>\n

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