V minulosti sa predpokladalo, že hormonálne zmeny po pôrode spojené s dojčením sú rizikovým faktorom pre psychické zdravie žien a že dojčenie zhoršuje, či je priamo príčinou popôrodnej depresie či popôrodnej psychózy (dôkazom je napríklad zastaraný pojem "laktačná psychóza"). V súčasnosti však existuje veľa poznatkov v oblasti neuroendokrinológie, psychiatrie a psychológie, ktoré tento predpoklad nepodporujú, či dokonca priamo vyvracajú. Cieľom nášho článku bolo priniesť prehľad súčasných poznatkov k popôrodnej depresii a dojčeniu a porovnať odporúčania k liečbe dojčiacich žien na Slovensku a v zahraničí. Náš článok obsahuje súhrn aktuálnych výskumov v oblasti popôrodnej depresie a dojčenia v súvislosti so spánkom a s fungovaním hormonálneho systému a osi HPA žien po pôrode. Autori výskumov uvádzajú, že hormóny, ktoré sú po pôrode vylučované vďaka dojčeniu, majú stabilizačný účinok na psychiku žien a os HPA, čo naznačuje, že dojčenie môže mať ochranný účinok pred rozvojom popôrodnej depresie, či ju zmierňovať, ak sa napriek dojčeniu rozvinie. Nedojčenie je podľa našich zistení aj rizikovým faktorom pre kvalitu spánku žien po pôrode, čo môže ovplyvňovať ich psychické zdravie, a teda zvyšovať riziko, že sa popôrodná depresia rozvinie, či zhoršovať jej symptómy. V záverečnej kapitole článku sme zhrnuli slovenské a české odporúčania pri liečbe popôrodnej depresie a porovnali ich so zahraničnými, konkrétne v Spojených štátoch amerických. Zistili sme, že kým v zahraničí sa neodporúča ukončenie dojčenia a zastavenie tvorby mlieka v prípade diagnózy popôrodnej depresie, na Slovensku je to stále bežnou, odporúčanou praxou, ktorá v článkoch nebola podporená žiadnymi relevantnými výskumami či argumentmi.
In the past, postpartum hormonal changes associated with breastfeeding were thought to be a risk factor for women ́s mental health. It was assumed that breastfeeding either worsened or was the direct cause for postpartum depression or postpartum psychosis (as evidenced, for example, by the outdated term "lactation psychosis"). However, there is currently much knowledge in the field of neuroendocrinology, psychiatry and psychology that does not support or even refutes this assumption. The aim of this article is to provide an overview of current knowledge on postpartum depression and breastfeeding and to compare recommendations for the treatment of breastfeeding women in Slovakia and abroad. Our article contains a summary of current research in the field of postpartum depression and breastfeeding in connection with sleep and the functioning of the hormonal system and the HPA axis of women after childbirth. Researchers report that hormones secreted due to breastfeeding have a stabilizing effect on women ́s mental health and HPA axis, suggesting that breastfeeding may have a protective effect against the development of postpartum depression or alleviate it if it develops despite breastfeeding. According to our findings, bottle feeding is also a risk factor for the quality of women ́s sleep after childbirth, which can affect their mental health and thus increase the risk that postpartum depression will develop or worsen its symptoms afterwards. In the final chapter of the article, we summarize the Slovak and Czech recommendations for the treatment of postpartum depression and compare them with those from abroad, specifically from the United States. We found that while breastfeeding cessation and lactation suppression in the case of a diagnosis of postpartum depression is not recommended abroad, it is still a common, recommended practice in Slovakia. Though recommended, this practice isn ́t supported in Slovak articles by any relevant research or arguments.
Práce se zabývá nejnovějšími pohledy na diagnostiku a léčbu neuroleptického maligního syndromu (NMS). NMS je vzácný antipsychotiky navozený, život ohrožující stav, charakterizovaný hyperpyrexií, svalovou rigiditou, kvalitativní změnou vědomí a deregulací autonomního nervového systému. Prevalence a mortalita se v průběhu posledních 30 let snížila, hlavně zřejmě díky časné diagnostice a vhodné intervenci. Recentní data uvádějí prevalenci 0,02-0,03 % a mortalitu 5,6 %. Léčba zahrnuje vysazení syndrom vyvolávajícího dopaminového antagonisty a podpůrnou léčbu, může dále zahrnovat specifickou farmakoterapii (benzodiazepiny, bromokriptin, amantadin, dantrolen) a elektrokonvulzivní léčbu. Nicméně klinici, a zvláště lékaři v primární péči, kteří často užívají antipsychotika jako přídatnou léčbu, by měli být s tímto syndromem obeznámeni.
The paper deals with recent aspects of diagnosis and treatment of neuroleptic malignant syndrome (NMS). NMS is an antipsychotic-induced, life-threatening condition, characterized by hyperpyrexia, muscle rigidity, qualitative alteration of consciousness and autonomic nervous system dys-regulation. NMS prevalence and mortality rates have declined over the past 30 years, most likely due to early recognition of the syndrome and appropriate intervention. Recent reports suggest a prevalence of 0.02-0.03%, and 5.6% mortality. Treatment includes withdrawal of the offending dopamine antagonist, supportive care and may include the use of specific pharmacotherapies (benzodiazepines, bromocriptine, amentadine, dantrolene) and electroconvulsive therapy. Nonetheless, clinicians, especially primary care clinicians who are using antipsychotics more often for adjunctive treatments, must be cognizant of this syndrome.
- MeSH
- Amantadine therapeutic use MeSH
- Antipsychotic Agents adverse effects therapeutic use MeSH
- Benzodiazepines therapeutic use MeSH
- Bromocriptine therapeutic use MeSH
- Dantrolene therapeutic use MeSH
- Diagnosis, Differential MeSH
- Pharmacovigilance MeSH
- Incidence MeSH
- Humans MeSH
- Neuroleptic Malignant Syndrome * diagnosis drug therapy MeSH
- Practice Guidelines as Topic * MeSH
- Check Tag
- Humans MeSH
- MeSH
- Dopamine Agonists therapeutic use MeSH
- Bariatric Surgery MeSH
- Bromocriptine therapeutic use MeSH
- Phentermine administration & dosage adverse effects therapeutic use MeSH
- Prenatal Nutritional Physiological Phenomena MeSH
- Sodium-Glucose Transporter 2 Inhibitors MeSH
- Glucagon-Like Peptide 1 analogs & derivatives therapeutic use MeSH
- Pregnancy Complications * MeSH
- Lactones administration & dosage pharmacology therapeutic use MeSH
- Anti-Obesity Agents * pharmacology therapeutic use MeSH
- Humans MeSH
- Obesity * complications physiopathology therapy MeSH
- Orlistat MeSH
- Diet, Reducing MeSH
- Pregnancy MeSH
- Sodium-Glucose Transport Proteins therapeutic use MeSH
- Infertility, Female etiology MeSH
- Check Tag
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Review MeSH
- MeSH
- Dopamine Agonists administration & dosage adverse effects therapeutic use MeSH
- Bromocriptine administration & dosage adverse effects therapeutic use MeSH
- Hyperprolactinemia * diagnosis etiology therapy MeSH
- Cabergoline administration & dosage adverse effects therapeutic use MeSH
- Humans MeSH
- Pituitary Neoplasms diagnosis etiology therapy MeSH
- Prolactinoma * surgery diagnosis drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Neuroleptický maligní syndrom (NMS) je antipsychotiky navozený, život ohrožující stav, charakterizovaný hypertermií, svalovou rigiditou, kvalitativními změnami vědomí a deregulací autonomního nervového systému. Byl popsán záhy po uvedení antipsychotik do klinické praxe. Dle recentních údajů se incidence pohybuje od 0,02 % do 0,03 %, s mortalitou 5,6 %. Relativně častěji bývá popisován na antipsychotikách druhé generace atypický obraz, který je charakterizován nižším výskytem a nižší intenzitou základních příznaků. Léčba spočívá v podpůrných opatřeních a specifické farmakoterapii. Kazuistiky upozorňují na rizikové faktory pro rozvoj NMS.
Neuroleptic malignant syndrome (NMS) is an antipsychotic-induced, life-threatening condition, characterized by hyper-pyrexia, muscle rigidity, qualitative alteration of consciousness and autonomie nervous system dysregulation. Neuroleptic malignant syndrome was described early after introduction of antipsychotics into clinical practice. According the recent review the reported incidence of NMS was 0.02% to 0.03%, with a mortality rate of 5.6%. With the second-generation antipsychotics more frequently an atypical clinical picture, characterized by lower frequency and lower intensity of basal symptoms is found. The treatment includes supportive treatment and specific drug therapy. Case reports bring attention to risk factor for development of NMS.
- MeSH
- Antipsychotic Agents adverse effects therapeutic use MeSH
- Bromocriptine administration & dosage pharmacology adverse effects MeSH
- Dantrolene administration & dosage pharmacology MeSH
- Diagnosis, Differential MeSH
- Mental Disorders drug therapy MeSH
- Humans MeSH
- Neuroleptic Malignant Syndrome * diagnosis epidemiology etiology therapy MeSH
- Risk Factors MeSH
- Check Tag
- Humans MeSH
- Publication type
- Case Reports MeSH
- Review MeSH
Nežádoucí vliv účinku dopaminových agonistů na srdeční chlopně vzbudil ve své době nebývalý ohlas. Postupně s přibývajícími daty došlo k racionalizaci přístupu a indikaci dalších vyšetření jen v jednoznačně opodstatněných případech. Článek shrnuje současné znalosti o léčbě hyperprolaktinemie dopaminovými agonisty a riziku vzniku vady srdeční chlopně.
Adverse effect of dopamine agonists on the heart valves aroused much attention some time ago. Gradually, as data accumulated, the approach to the problem was rationalised and further examinations were only recommended in indicated cases. The paper reviews the current knowledge about the treatment of hyperprolactinemia with dopamine agonists and the risk of valvular disease.
- MeSH
- Dopamine Antagonists adverse effects therapeutic use MeSH
- Bromocriptine therapeutic use MeSH
- Ergolines adverse effects therapeutic use MeSH
- Hyperprolactinemia * drug therapy MeSH
- Cabergoline MeSH
- Clinical Trials as Topic MeSH
- Humans MeSH
- Pituitary Neoplasms MeSH
- Heart Valve Diseases * etiology MeSH
- Parkinson Disease drug therapy MeSH
- Prolactinoma drug therapy MeSH
- Practice Guidelines as Topic MeSH
- Heart diagnostic imaging MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Dopamine Agonists therapeutic use MeSH
- Bariatric Surgery MeSH
- Bromocriptine therapeutic use MeSH
- Phentermine administration & dosage adverse effects therapeutic use MeSH
- Prenatal Nutritional Physiological Phenomena MeSH
- Sodium-Glucose Transporter 2 Inhibitors MeSH
- Glucagon-Like Peptide 1 analogs & derivatives therapeutic use MeSH
- Pregnancy Complications * MeSH
- Lactones administration & dosage pharmacology therapeutic use MeSH
- Anti-Obesity Agents * pharmacology therapeutic use MeSH
- Humans MeSH
- Obesity * complications physiopathology therapy MeSH
- Orlistat MeSH
- Diet, Reducing MeSH
- Pregnancy MeSH
- Sodium-Glucose Transport Proteins therapeutic use MeSH
- Infertility, Female etiology MeSH
- Check Tag
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
Hyperprolaktinemie je častým laboratorním nálezem a vyskytuje se za fyziologických stavů, u endokrinologických a neendokrinologických onemocnění. Nejčastější příčinou patologické hyperprolaktinemie jsou prolaktinomy, které jsou i nejčastějšími hypofyzárními adenomy. Hyperprolaktinemie se u žen manifestuje infertilitou, poruchami menstruačního cyklu s hypoestrinismem a galaktoreou, u mužů ztrátou libida a potence. Klinicky manifestní hyperprolaktinemii je nutné léčit s ohledem na příčinu hyperprolaktinemie. U prolaktinomů je léčbou volby medikamentózní léčba dopaminergními agonisty. Chirurgická a radiační léčba se uplatňují u rezistentních prolaktinomů, při intoleranci dopaminergních agonistů nebo při komplikacích. V graviditě se u žen s mikroprolaktinomy léčba dopaminergními agonisty přerušuje, u žen s makroprolaktinomy je nutné postupovat individuálně.
Hyperprolactinemia is a common laboratory finding. It is found in some physiological states and in endocrinological and nonendocrinologcal diseases. Prolactinomas are the most common cause of pathologic hyperprolactinemia and the most frequent type of pituitary adenoma. Hyperprolactinemia causes infertility, disturbance of the menstrual cycle due to hypoestrogenism and galactorrhea in women, and decreased libido and impotency in men. In cases of the clinical manifestation of hyperprolactinemia, it is necessary to treat its cause. The primary therapy for prolactinomas is pharmacological treatment with dopamine agonists. Surgical and radiation treatments are used for prolactinoma patients who are resistant or intolerant to dopamine agonists or in the case of complications. During pregnancy of women with microprolactinoma, the pharmacological treatment with dopamine agonists is withdrawn, with pregnant women with macroprolactinoma, it is necessary to assess every single case individually.
- Keywords
- quinagolid,
- MeSH
- Dopamine Agonists * administration & dosage adverse effects therapeutic use MeSH
- Aminoquinolines administration & dosage adverse effects therapeutic use MeSH
- Bromocriptine administration & dosage adverse effects therapeutic use MeSH
- Ergolines administration & dosage adverse effects therapeutic use MeSH
- Hyperprolactinemia * diagnosis etiology physiopathology MeSH
- Remission Induction MeSH
- Cabergoline MeSH
- Drug Resistance MeSH
- Humans MeSH
- Pituitary Neoplasms diagnosis drug therapy pathology MeSH
- Prolactin blood MeSH
- Prolactinoma * diagnosis drug therapy physiopathology MeSH
- Pregnancy MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Pregnancy MeSH
- Female MeSH
[Hyperprolactinaemia in men with sexual dysfunction]
- MeSH
- Dopamine Agonists MeSH
- Antidepressive Agents, Second-Generation MeSH
- Bromocriptine administration & dosage therapeutic use MeSH
- Citalopram administration & dosage therapeutic use MeSH
- Adult MeSH
- Erectile Dysfunction drug therapy MeSH
- Hyperprolactinemia * diagnosis drug therapy pathology MeSH
- Humans MeSH
- Prolactin physiology MeSH
- Receptors, Dopamine D2 agonists therapeutic use MeSH
- Sexual Dysfunction, Physiological * drug therapy pathology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- Overall MeSH
