ÖZEL GRUPLARDA ALKOL VE MADDE KULLANIM BOZUKLUKLARI VE TEDAVİSİ

Ozel_Gruplarda_Alkol_ve_Madde_Kullanimi_Bozukluklari_ve_Tedavisi_kapak

ALKOL VE MADDE KULLANIM BOZUKLUKLARINDA GELECEK PERSPEKTİFLERİ VE YENİ TEDAVİ YAKLAŞIMLARI

Serdar Bulut

Ankara Bilkent Şehir Hastanesi, Psikiyatri Kliniği, Ankara, Türkiye

Bulut S. Alkol ve Madde Kullanım Bozukluklarında Gelecek Perspektifleri ve Yeni Tedavi Yaklaşımları. Doğan Bulut S, editör. Özel Gruplarda Alkol ve Madde Kullanım Bozuklukları ve Tedavisi. 1. Baskı. Ankara: Türkiye Klinikleri; 2025. p.221-233.

ÖZET

Alkol ve madde kullanım bozuklukları (AMKB) sosyal, toplumsal ve ekonomik zorluklara yol açan küresel bir sağlık sorunudur. Dünya genelinde alkol ve madde isteğine yönelik yeni tedavi yöntemleri araştırılmaktadır. Umut vaat eden araştırmalar arasında Glukagon benzeri peptid 1 (GLP-1) reseptör agonistleri, Oksitosin ve Oksitosin Reseptör Agonistleri, Oreksin (hipokretin) reseptör antagonistleri, mGLU5 antagonistleri, Transkraniyal Doğru Akım Stimülasyonu (tDCS), Trans Magnetik Stimülasyon (TMS), Nörogeri bildirim, Derin beyin stimülasyonu (DBS), Psikedelik Destekli Psikoterapiler ve aşı çalışmaları yer almaktadır. GLP-1RA’ların alkol, kokain, nikotin ve opioidlerin alımını azalttığı tutarlı bir şekilde gösterilmiştir. Semaglutid diğer GLP-1RA’lara göre daha uzun etkili, daha iyi tolere edilen ve en az yan etkilere sahip GLP-1 agonistidir. Oksitosin (OKST) AMKB gelişiminde yer alan nörodevrelerle önemli ölçüde ilişkili olan bir nöropeptittir. İnsanlarda ve hayvanlarda bağımlılık yapan maddelere kronik maruziyet OKST nöronlarının sayısında azalmaya ve oksitosin reseptör (OKSTR) üretiminde değişikliklere yol açmaktadır. OKSTR agonizması yoluyla OKST’nin bağımlılıkla ilgili sinir yolaklarındaki sinyalleri düzenleyebileceğine dair kanıtlar bulunmaktadır. Pek çok preklinik çalışmada ödül motivasyonu, istek, stres ve uyarılma/uyanıklık dahil bağımlılıkla ilgili birçok fizyolojik süreçte oreksinlerin rol aldığı gösterilmiştir. Oreksin A ve B peptitleri etkilerini oreksin 1 (OR1R) ve oreksin 2 (OR2R) reseptörü aracılığıyla göstermektedir. Oreksin sinyallemesini azaltma stratejileri (oreksin reseptör antagonizması) tüm madde sınıflarına karşı arayışı ve özlemine karşı koruyucu olabileceği düşünülmektedir. Nöromodülasyon teknikleriyle belirli prefrontal alanları hedeflemenin istek, tüketim ve bilişsel işlevi artırmada etkili olduğu gösterilmiştir. Nöromodülasyon çalışmalarının bazı sonuçları umut verici görünmektedir. Derin beyin stimülasyonunun bağımlılık-ödül yolunda faydalı bir azalma sağlayabileceği, dirençli hastalarda kullanılabilecek bir tedavi yöntemi olduğu düşünülmektedir. Çalışmalar tedaviye dirençli hastaların isteklerinin azaldığını ve uzun vadeli remisyona ulaşabildiklerini göstermektedir. Psikedelik maddeler arasında ketamin, liserjik asit dietilamid (LSD), meskalin, 5-metoksi-N,N-dimetiltriptamin (5-MeO-DMT), dimetiltriptamin (DMT), psilosibin gibi “klasik psikedelikler” bulunur. Psikedeliklerin terapötik kullanımına ilişkin araştırmalar son 20 yılda Psikedelik Destekli Psikoterapiler bağlamında yeniden başlatılmıştır. Psikedelik Destekli Psikoterapiler psikoterapi ve yeni farmakolojik tedavi yaklaşımlarını birleştirir ve giderek ilgi görmeye başlamıştır. Çalışmalarda psikedelik maddelerin psikoterapötik müdahaleleri kolaylaştırdıkları, bilişsel esneklikte kalıcı iyileşmelere yol açabildikleri, ödülle ilgili karar alma ve yoksunluğu teşvik eden ve nüksetmeyi azaltan yeni davranış kalıpları oluşturmasını sağlayabilecekleri bildirilmiştir. Günümüzde aşı geliştirme çalışmaları opioid, kokain, metamfetamin ve nikotin bağımlılığı üzerine yapılmaktadır. Mevcut aşı geliştirme çalışmalarının sonuçları, geleceğe umutla bakmamızı engellememelidir.

Anahtar Kelimeler: Ketamin; Oksitosin; Oreksin; Nöromodülasyon; Psikedelik; Derin beyin stimülasyonu; Transmagnetik stimülasyon; Aşı

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