{"id":2786,"date":"2019-11-20T16:58:21","date_gmt":"2019-11-20T16:58:21","guid":{"rendered":"https:\/\/curesz.org\/?p=2786"},"modified":"2020-05-13T15:30:49","modified_gmt":"2020-05-13T15:30:49","slug":"tardive-dyskinesia-more-than-a-side-effect","status":"publish","type":"post","link":"https:\/\/curesz.org\/pt_pt\/2019\/11\/20\/tardive-dyskinesia-more-than-a-side-effect\/","title":{"rendered":"Discinesia tardia: mais do que um efeito colateral"},"content":{"rendered":"
\"\"

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

A discinesia tardia (TD) foi descrita pela primeira vez no in\u00edcio dos anos 1960, mas n\u00e3o temos uma compreens\u00e3o clara de por que isso acontece, apesar de quase 60 anos de pesquisa. A TD parece ter uma rela\u00e7\u00e3o clara com a dopamina, que regula um grande n\u00famero de fun\u00e7\u00f5es em nossos corpos, incluindo aten\u00e7\u00e3o, busca por prazer e fun\u00e7\u00e3o motora. Acredita-se que alguns dist\u00farbios psiqui\u00e1tricos, incluindo dist\u00farbios de humor, percep\u00e7\u00e3o sensorial e processo de pensamento, estejam associados a um excesso de estimula\u00e7\u00e3o de dopamina em certas vias ou \u201ccircuitos\u201d do c\u00e9rebro.<\/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

O problema real com TD n\u00e3o \u00e9 que ele \u00e9 atrasado ap\u00f3s o in\u00edcio de um DRB, \u00e9 que geralmente \u00e9 irrevers\u00edvel. Nem todo mundo que toma um DRB fica com TD, mas aqueles que o fazem n\u00e3o conseguem se livrar disso interrompendo a medica\u00e7\u00e3o. Embora alguns fatores de risco sejam conhecidos, ainda n\u00e3o temos uma maneira muito boa de prever quem vai contrair antes que aconte\u00e7a. Ou, nos termos da analogia acima, n\u00e3o sabemos de quem s\u00e3o os tamp\u00f5es de ouvido que v\u00e3o apresentar defeito.<\/p>\n

Portanto, n\u00e3o devemos considerar a DT um \u201cefeito colateral\u201d das DRBs, pois os efeitos colaterais desaparecem se voc\u00ea retirar a medica\u00e7\u00e3o que os causa. Em vez disso, devemos pensar em TD como sua pr\u00f3pria s\u00edndrome causada pela exposi\u00e7\u00e3o a DRBs em pessoas vulner\u00e1veis. Assim como fumar cigarros causa c\u00e2ncer de pulm\u00e3o em algumas pessoas \u2013 aqueles que t\u00eam c\u00e2ncer n\u00e3o entram em remiss\u00e3o s\u00f3 porque param de fumar. Melhorar a discinesia tardia nesse ponto requer seu pr\u00f3prio tratamento adicional, que discutirei em meu pr\u00f3xima coluna<\/a>.<\/p>","protected":false},"excerpt":{"rendered":"

Tardive Dyskinesia (TD) was \ufb01rst described in the early 1960s, […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2786","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"acf":[],"yoast_head":"\nTardive Dyskinesia: More than a Side Effect - CURESZ Foundation<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/curesz.org\/pt_pt\/2019\/11\/20\/tardive-dyskinesia-more-than-a-side-effect\/\" \/>\n<meta property=\"og:locale\" content=\"pt_PT\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Tardive Dyskinesia: More than a Side Effect - CURESZ Foundation\" \/>\n<meta property=\"og:description\" content=\"Tardive Dyskinesia (TD) was \ufb01rst described in the early 1960s, [...]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/curesz.org\/pt_pt\/2019\/11\/20\/tardive-dyskinesia-more-than-a-side-effect\/\" \/>\n<meta property=\"og:site_name\" content=\"CURESZ Foundation\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Cureszorg\/\" \/>\n<meta property=\"article:published_time\" content=\"2019-11-20T16:58:21+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2020-05-13T15:30:49+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/curesz.org\/wp-content\/uploads\/2019\/09\/Dr-Chepke-225x300.jpg\" \/>\n<meta name=\"author\" content=\"Bethany Yeiser\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@cureszorg\" \/>\n<meta name=\"twitter:site\" content=\"@cureszorg\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Bethany Yeiser\" \/>\n\t<meta name=\"twitter:label2\" content=\"Tempo estimado de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/curesz.org\\\/2019\\\/11\\\/20\\\/tardive-dyskinesia-more-than-a-side-effect\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/curesz.org\\\/2019\\\/11\\\/20\\\/tardive-dyskinesia-more-than-a-side-effect\\\/\"},\"author\":{\"name\":\"Bethany Yeiser\",\"@id\":\"https:\\\/\\\/curesz.org\\\/#\\\/schema\\\/person\\\/817f48ff6a883819905fd8ad4d968994\"},\"headline\":\"Tardive Dyskinesia: More than a Side Effect\",\"datePublished\":\"2019-11-20T16:58:21+00:00\",\"dateModified\":\"2020-05-13T15:30:49+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/curesz.org\\\/2019\\\/11\\\/20\\\/tardive-dyskinesia-more-than-a-side-effect\\\/\"},\"wordCount\":559,\"publisher\":{\"@id\":\"https:\\\/\\\/curesz.org\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/curesz.org\\\/2019\\\/11\\\/20\\\/tardive-dyskinesia-more-than-a-side-effect\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/curesz.org\\\/wp-content\\\/uploads\\\/2019\\\/09\\\/Dr-Chepke-225x300.jpg\",\"articleSection\":[\"Uncategorized\"],\"inLanguage\":\"pt-PT\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/curesz.org\\\/2019\\\/11\\\/20\\\/tardive-dyskinesia-more-than-a-side-effect\\\/\",\"url\":\"https:\\\/\\\/curesz.org\\\/2019\\\/11\\\/20\\\/tardive-dyskinesia-more-than-a-side-effect\\\/\",\"name\":\"Tardive Dyskinesia: More than a Side Effect - 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