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Dopaminowa patogeneza majaczenia – przegląd dopaminergicznych metod terapeutycznych w leczeniu i prewencji delirium
 
Więcej
Ukryj
1
Students’ Scientific Club, Department of Pharmacology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
 
2
Department of Pharmacology, Faculty of Medical Sciences in Katowice, Medical University of Silesia
 
 
Autor do korespondencji
Nikodem Świderski   

Studenckie Koło Naukowe, Zakład Farmakologii, ul. Medyków 18, 40-752 Katowice, tel. +48 32 208 85 10
 
 
Ann. Acad. Med. Siles. 2026;80:113-123
 
SŁOWA KLUCZOWE
DZIEDZINY
STRESZCZENIE
Delirium (majaczenie) jest zaburzeniem neuropsychiatrycznym, którego wielowektorowa patogeneza nie jest jeszcze w pełni wyjaśniona. Obecny stan wiedzy przemawia za hipotezą nieprawidłowego funkcjonowania integracji układów (system integration failure hypothesis – SIFH), w której kluczową rolę odgrywają struktury ośrodkowego układu nerwowego zaangażowane w przekaźnictwo dopaminergiczne. Celem przeglądu jest analiza działania oraz skuteczności metod terapeutycznych ukierunkowanych na modulacje transmisji dopaminergicznej. Wykazano, że metylofenidat poprawia funkcje poznawcze u pacjentów z zaawansowanym nowotworem i majaczeniem hipoaktywnym, o czym świadczy wzrost średnich wyników w skali Mini-Mental State Examination (MMSE) z 20,9 do 27,8. Yokukansan nie wpłynął znacząco na ogólne ryzyko wystąpienia majaczenia pooperacyjnego po operacjach onkologicznych, jednak u pacjentów w wieku 75 lat i starszych zmniejszył częstość występowania majaczenia z pobudzeniem (21,4% vs. 71%). Arypiprazol nie wykazał różnic w porównaniu z innymi lekami przeciwpsychotycznymi pod względem skuteczności w łagodzeniu objawów majaczenia, bez rozróżnienia na podtypy, ale jego stosowanie wiązało się z mniejszą liczbą działań niepożądanych. W przypadku majaczenia hipoaktywnego lek ten wykazał zarówno wyższy wskaźnik remisji, jak i poprawę wyniku w skali Memorial Delirium Assessment Scale (MDAS) w porównaniu z haloperydolem. Interwencja z zastosowaniem leków dopaminergicznych wykazała lepszą skuteczność w leczeniu podtypu hipoaktywnego ze współistniejącym nowotworem w stadium terminalnym, podczas gdy wszystkie metody terapeutyczne wykazały podobną skuteczność w porównaniu z placebo w leczeniu i zapobieganiu epizodom majaczenia.
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