{"id":387,"date":"2011-12-17T00:15:49","date_gmt":"2011-12-17T00:15:49","guid":{"rendered":"http:\/\/harpa.blogg.is\/2011-12-17\/thunglyndissjuklingur-i-salfraedibatteriinu-ham\/"},"modified":"2013-11-21T09:31:28","modified_gmt":"2013-11-21T09:31:28","slug":"thunglyndissjuklingur-i-salfraedibatteriinu-ham","status":"publish","type":"post","link":"https:\/\/harpahreins.com\/blogg\/2011\/12\/17\/thunglyndissjuklingur-i-salfraedibatteriinu-ham\/","title":{"rendered":"\u00deunglyndissj\u00faklingur \u00ed s\u00e1lfr\u00e6\u00f0ibatter\u00edinu – HAM"},"content":{"rendered":"

\u00cd fyrstu f\u00e6rslunni um hva\u00f0a kostir bj\u00f3\u00f0ast \u00feunglyndissj\u00faklingi<\/a> \u00e1 bor\u00f0 vi\u00f0 mig reyndi \u00e9g a\u00f0 teikna skemat\u00edska mynd yfir kostina. N\u00fa hef \u00e9g gert nokkra grein fyrir greiningu \u00feunglyndis og lyfjame\u00f0fer\u00f0 vi\u00f0 \u00fev\u00ed og n\u00e6st er a\u00f0 n\u00faa s\u00e9r a\u00f0 s\u00e1lfr\u00e6\u00f0ime\u00f0fer\u00f0um. S\u00e1 b\u00f6ggull fylgir skammrifi a\u00f0 \u00e9g hef \u00e1kaflega litla reynslu af \u00feess h\u00e1ttar me\u00f0fer\u00f0. \u00c9g man ekki til \u00feess a\u00f0 m\u00e9r hafi nokkurn t\u00edma bo\u00f0ist a\u00f0 tala vi\u00f0 s\u00e1lfr\u00e6\u00f0ing \u00feegar \u00e9g hef legi\u00f0 inn \u00e1 ge\u00f0deild, man \u00fe\u00f3 eftir a\u00f0 hafa leyft einhverjum s\u00e1lfr\u00e6\u00f0inema a\u00f0 taka vi\u00f0tal og krossa vi\u00f0 einhverjar spurningar \u00ed ge\u00f0deildardv\u00f6ld fyrir \u00e1ri s\u00ed\u00f0an en \u00fea\u00f0 er allt og sumt. (\u00c1 hinn b\u00f3ginn er valt a\u00f0 treysta \u00e1 minni\u00f0, heilu \u00e1rin eru meira og minna \u00ed blakk\u00e1ti vegna sj\u00fakd\u00f3msins og rafl\u00e6kninga). Aftur \u00e1 m\u00f3ti hef \u00e9g \u00e1tt regluleg samt\u00f6l vi\u00f0 ge\u00f0l\u00e6kninn minn \u00e1rum saman. \u00c9g hef a\u00f0eins or\u00f0i\u00f0 v\u00f6r vi\u00f0 \u00feann misskilning a\u00f0 samtalsme\u00f0fer\u00f0 s\u00e9 einungis \u00e1 hendi s\u00e1lfr\u00e6\u00f0inga. \u00dea\u00f0 er alrangt. Ge\u00f0l\u00e6knar sinna einnig samtalsme\u00f0fer\u00f0<\/b>. En \u00fea\u00f0 getur svo sem vel veri\u00f0 a\u00f0 a\u00f0fer\u00f0irnar sem \u00feessar tv\u00e6r st\u00e9ttir beita \u00ed samt\u00f6lum vi\u00f0 sj\u00fakling s\u00e9u \u00f3l\u00edkar, um \u00fea\u00f0 veit \u00e9g ekki.<\/p>\n

Pl\u00e1ssins vegna ver\u00f0ur \u00ed \u00feessari f\u00e6rslu einungis ger\u00f0 grein fyrir HAM, hugr\u00e6nni atferlisme\u00f0fer\u00f0, anna\u00f0 b\u00ed\u00f0ur. S\u00f6mulei\u00f0is b\u00ed\u00f0ur n\u00e6stu f\u00e6rslu a\u00f0 bera saman Kl\u00edn\u00edskar lei\u00f0beiningar um \u00feunglyndi og kv\u00ed\u00f0a<\/a><\/i> \u00e1 vef Landsp\u00edtala vi\u00f0 sl\u00edkar lei\u00f0beiningar \u00ed Noregi og Sv\u00ed\u00fej\u00f3\u00f0, grunnvinnu vi\u00f0 svolei\u00f0is sem er hafin \u00ed Danm\u00f6rku o.fl. S\u00e1 samanbur\u00f0ur er a\u00f0 nokkru leyti athyglisver\u00f0ur, einkum fr\u00e1 sj\u00f3narh\u00f3li sj\u00faklings.<\/font><\/p>\n

Og enn og aftur tek \u00e9g fram a\u00f0 \u00e9g skrifa \u00feessar f\u00e6rslur sem \u00feunglyndissj\u00faklingur, er hvorki menntu\u00f0 \u00ed s\u00e1lfr\u00e6\u00f0i n\u00e9 l\u00e6knisfr\u00e6\u00f0i og \u00fev\u00ed ber a\u00f0 taka umfj\u00f6llun me\u00f0 \u00feessum fyrirvara a\u00f0 \u00e9g er ekki s\u00e9rfr\u00e6\u00f0ingur \u00ed efninu (nema sem sj\u00faklingur au\u00f0vita\u00f0). Og \u00feessum f\u00e6rslum er alls ekki \u00e6tla\u00f0 a\u00f0 vera lei\u00f0beiningar fyrir a\u00f0ra sj\u00faklinga.<\/font><\/b> En vonandi eru \u00fe\u00e6r uppl\u00fdsandi fyrir einhverja.<\/font>
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HAM <\/b>er skammst\u00f6fun fyrir \u201ehugr\u00e6na atferlisme\u00f0fer\u00f0\u201c. S\u00fa heitir CBT \u00e1 ensku, sem er skammst\u00f6fun fyrir Cognitive Behavioral Treatment og n\u00faor\u00f0i\u00f0 vir\u00f0ist ekki miki\u00f0 greint milli hennar og CT, Cognitive Treatment, hugr\u00e6nnar me\u00f0fer\u00f0ar. HAM<\/b> er mj\u00f6g hampa\u00f0 \u00ed Kl\u00edn\u00edskum lei\u00f0beiningum um \u00feunglyndi og kv\u00ed\u00f0a<\/i>. \u00dear kann a\u00f0 valda einhverju a\u00f0 vinnuh\u00f3purinn sem \u00fe\u00fdddi, stytti og a\u00f0laga\u00f0i \u00feessar lei\u00f0beiningar (\u00far kl\u00edn\u00edskum lei\u00f0beiningum fyrir England og Wales) samanst\u00f3\u00f0 af t\u00edu s\u00e1lfr\u00e6\u00f0ingum, einum yfirl\u00e6kni og einum ge\u00f0l\u00e6kni. Umsagnara\u00f0ilar voru af fj\u00f6lbreyttari toga.<\/font><\/p>\n

\u00cd n\u00e6stn\u00fdjasta L\u00e6knabla\u00f0inu<\/i>, 11. tbl. 97. \u00e1rgangi 2011, birtist\u00a0 greinin \u201eGagnsemi hugr\u00e6nnar atferlisme\u00f0fer\u00f0ar vi\u00f0 lyndis- og kv\u00ed\u00f0ar\u00f6skunum hj\u00e1 fullor\u00f0num<\/a>\u201c eftir Magn\u00fas Bl\u00f6ndahl Sighvatsson, Hafr\u00fanu Kristj\u00e1nsd\u00f3ttur, Engilbert Sigur\u00f0sson og J\u00f3n Fri\u00f0rik Sigur\u00f0sson. Vill svo skemmtilega til a\u00f0 af fj\u00f3rum h\u00f6fundum greinarinnar eru \u00fer\u00edr s\u00e1lfr\u00e6\u00f0ingar (en einn h\u00f6funda er ge\u00f0l\u00e6knir); af s\u00e1lfr\u00e6\u00f0ingunum \u00feremur voru tveir \u00ed vinnuh\u00f3pnum sem s\u00f6mdu kl\u00edn\u00edsku lei\u00f0beiningarnar. Heimurinn er l\u00edtill og h\u00f3pur a\u00f0als\u00e1lfr\u00e6\u00f0inga \u00e1 \u00cdslandi greinilega p\u00ednul\u00edtill.<\/font><\/p>\n

\u00c9g m\u00e6li eindregi\u00f0 me\u00f0 \u00feessari grein fyrir \u00fe\u00e1 sem vilja kynna s\u00e9r a\u00f0fer\u00f0ina, \u00fattekt \u00e1 ranns\u00f3knum, \u00e1rangur og anna\u00f0 sem snertir HAM. Greinin er \u00e1 g\u00f3\u00f0u m\u00e1li og vel skiljanleg \u00fe\u00f3tt lesandinn hafi litla \u00feekkingu \u00e1 s\u00e1lfr\u00e6\u00f0ihugt\u00f6kum. Einnig m\u00e1 benda \u00e1hugas\u00f6mum \u00e1 a\u00f0 HAM handb\u00f3k og verkefnahefti<\/a>, unni\u00f0 af ge\u00f0teymi Reykjalundar, liggur n\u00fa frammi \u00ed opnum a\u00f0gangi \u00e1 vefsetri Reykjalundar.<\/font><\/p>\n

\u00cd greininni \u00ed L\u00e6knabla\u00f0inu<\/i> sem fyrr var \u00e1 minnst kemur fram a\u00f0 HAM s\u00e9 \u201e[…] gjarna kennd vi\u00f0 bandar\u00edska ge\u00f0l\u00e6kninn Aaron T. Beck sem var mennta\u00f0ur \u00ed s\u00e1lgreiningu […][en] komst […] a\u00f0 \u00fev\u00ed a\u00f0 a\u00f0fer\u00f0ir s\u00e1lgreiningar gengju ekki upp vi\u00f0 me\u00f0fer\u00f0 \u00feunglyndis.\u201c (s. 613.) \u00deetta er einmitt s\u00e1 sami Beck og samdi \u00feunglyndispr\u00f3fi\u00f0 sem m\u00e9r gengur alltaf jafn dj\u00f6full illa a\u00f0 taka og \u00e9g minntist \u00e1 \u00ed s\u00ed\u00f0ustu f\u00e6rslu. Beck komst a\u00f0 \u00feeirri ni\u00f0urst\u00f6\u00f0u a\u00f0 \u201e\u00fea\u00f0 hvernig vi\u00f0 hugsum, t\u00falkum atbur\u00f0i og h\u00f6gum daglegu l\u00edfi r\u00e1\u00f0i miklu um l\u00ed\u00f0an okkar.\u201c (s. 613.)\u00a0\u00deetta eru n\u00fa t\u00e6past nein kjarnorkuv\u00edsindi, t.d. haf\u00f0i h\u00f6fundur H\u00e1vam\u00e1la kveikt \u00e1 \u00feessu sama t\u00e6pum 1000 \u00e1rum fyrr – en Beck \u00fatf\u00e6r\u00f0i s\u00edna uppg\u00f6tvun \u00feannig:<\/font><\/p>\n

\u00a0[…] \u00feeir sem klj\u00e1st vi\u00f0 ge\u00f0raskanir [\u00fer\u00f3a] oft me\u00f0 s\u00e9r bjaga\u00f0 mat \u00e1 umhverfi og innri \u00e1reitum, svo sem l\u00edkamlegum einkennum. Me\u00f0 \u00fev\u00ed a\u00f0 kortleggja hugsun og heg\u00f0un \u00feeirra sem finna fyrir vanl\u00ed\u00f0an megi sk\u00fdra hvers vegna \u00feeir gl\u00edma vi\u00f0 ge\u00f0r\u00f6skun og me\u00f0 \u00fev\u00ed a\u00f0 breyta hugsun og heg\u00f0un s\u00e9 h\u00e6gt a\u00f0 breyta l\u00ed\u00f0an til hins betra.<\/b> (Feitletrun m\u00edn, s. 613.)<\/font><\/p><\/blockquote>\n

Taki\u00a0 ma\u00f0ur \u00feessa kenningu Beck tr\u00faanlega ver\u00f0ur \u00ed lei\u00f0inni a\u00f0 sam\u00feykkja a\u00f0 \u00feunglyndi stafi af einhvers konar bjaga\u00f0ri hugsun, s\u00e9 \u201es\u00e1lfr\u00e6\u00f0ilegur\u201c e\u00f0a \u201eandlegur\u201c sj\u00fakd\u00f3mur<\/b>. \u00dev\u00ed er \u00e9g algerlega \u00f3samm\u00e1la<\/b> og au\u00f0vita\u00f0 litar s\u00fa sko\u00f0un m\u00edn \u00feessa umfj\u00f6llun um HAM. \u00c1 hinn b\u00f3ginn er \u00e9g til \u00ed a\u00f0 sam\u00feykkja a\u00f0 margt sem hj\u00e1lpar manni a\u00f0 l\u00edta l\u00edfi\u00f0 j\u00e1kv\u00e6\u00f0ari (e\u00f0a bara minna neikv\u00e6\u00f0um) augum geti veri\u00f0 hj\u00e1lplegt \u00ed hvers lags veikindum. \u00dea\u00f0 geta veri\u00f0 einhver konar tr\u00faarbr\u00f6g\u00f0 e\u00f0a f\u00edl\u00f3s\u00f3f\u00eda, 12 spora kerfi …\u00a0 e\u00f0a \u00feess vegna HAM.<\/font><\/p>\n

H\u00f6fundar greinarinnar \u201eGagnsemi hugr\u00e6nnar atferlisme\u00f0fer\u00f0ar vi\u00f0 lyndis- og kv\u00ed\u00f0ar\u00f6skunum hj\u00e1 fullor\u00f0num\u201c<\/a> \u00fatsk\u00fdra svo HAM, sem \u00ed stuttu m\u00e1li felst \u00ed a\u00f0 bera kennsl \u00e1 \u00f3sj\u00e1lfr\u00e1\u00f0ar hugsanir sem ekki eru til b\u00f3ta, sj\u00e1 a\u00f0ra m\u00f6guleika \u00e1 \u00feankagangi og breyta heg\u00f0un einnig, til a\u00f0 b\u00e6ta s\u00edna l\u00ed\u00f0an.<\/b> Svo taka \u00feeir d\u00e6mi af hvernig HAM virki \u00ed tilviki \u00feunglynds sj\u00faklings:<\/font><\/p>\n

\u00a0Hugsun \u00feess \u00feunglynda einkennist i\u00f0ulega af ofmati \u00e1 mist\u00f6kum \u00ed fort\u00ed\u00f0 og vanmati \u00e1 eigin getu til a\u00f0 r\u00e1\u00f0a vi\u00f0 daglegt l\u00edf. \u00deess vegna eru \u00feunglyndir oft ekki n\u00e6gilega virkir, eiga erfitt me\u00f0 a\u00f0 framkv\u00e6ma einf\u00f6ldustu hluti og draga sig \u00ed hl\u00e9. \u00cd HAM l\u00e6rir skj\u00f3lst\u00e6\u00f0ingurinn \u00fev\u00ed a\u00f0 kortleggja og endurmeta \u00f3hj\u00e1lplegt mat sitt \u00e1 fyrri mist\u00f6kum, eigin getu og st\u00f6\u00f0u. Skj\u00f3lst\u00e6\u00f0ingi er einnig kennt a\u00f0 auka daglega virkni s\u00edna til a\u00f0 sporna vi\u00f0 framtaksleysi. \u00deetta er gert \u00e1 skipulegan h\u00e1tt \u00fear sem hinn \u00feunglyndi eykur virkni s\u00edna stig af stigi. Me\u00f0 \u00f6\u00f0rum or\u00f0um tileinkar hinn \u00feunglyndi s\u00e9r n\u00fdjar a\u00f0fer\u00f0ir til a\u00f0 gl\u00edma vi\u00f0 vanl\u00ed\u00f0an; l\u00e6rir a\u00f0 greina og endurmeta \u00f3sj\u00e1lfr\u00e1\u00f0ar ni\u00f0urrifshugsanir; l\u00e6rir a\u00f0 takast \u00e1 vi\u00f0 m\u00f3tl\u00e6ti og daglegt l\u00edf \u00e1 annan h\u00e1tt en \u00e1\u00f0ur og kannar hvort \u00fea\u00f0 lei\u00f0i ekki til breytinga \u00e1 l\u00ed\u00f0an. \u00deennan l\u00e6rd\u00f3m tekur einstaklingurinn me\u00f0 s\u00e9r inn \u00ed framt\u00ed\u00f0ina. \u00dev\u00ed heldur \u00e1rangur HAM gjarna \u00e1fram a\u00f0 skila s\u00e9r eftir a\u00f0 me\u00f0fer\u00f0 l\u00fdkur svo fremi sem skj\u00f3lst\u00e6\u00f0ingurinn beiti \u00e1fram \u00feeim a\u00f0fer\u00f0um sem hann hefur l\u00e6rt \u00ed HAM. (s. 613-14.)<\/font><\/p><\/blockquote>\n

\u00cd kaflanum um \u00feunglyndi \u00ed \u00feessari grein kemur fram a\u00f0 \u00ed ranns\u00f3knum sem hafa bori\u00f0 saman \u00e1rangur HAM og \u00feunglyndislyfjame\u00f0fer\u00f0ar beri ni\u00f0urst\u00f6\u00f0ur flestar a\u00f0 sama brunni: \u201e[…] a\u00f0 \u00fea\u00f0 s\u00e9 ekki munur \u00e1 \u00e1rangri \u00feessara me\u00f0fer\u00f0a vi\u00f0 \u00feunglyndi, \u00f3h\u00e1\u00f0 alvarleika \u00feess, vi\u00f0 me\u00f0fer\u00f0arlok.\u201c (s. 614.) Jafnframt er bent \u00e1 a\u00f0 fremur f\u00e1ar ranns\u00f3knir hafa beinst a\u00f0 mj\u00f6g veikum sj\u00faklingum, sem s\u00e9u oftast me\u00f0h\u00f6ndla\u00f0ir me\u00f0 lyfjum e\u00f0a rafl\u00e6kningum: \u201e\u00dev\u00ed er ekki h\u00e6gt a\u00f0 \u00fatiloka a\u00f0 lyfjame\u00f0fer\u00f0 skili meiri \u00e1rangri en HAM vi\u00f0 me\u00f0fer\u00f0 allra veikustu sj\u00faklinganna \u00e1 legudeildum.\u201c (s. 614). \u00dev\u00ed mi\u00f0ur skilgreina h\u00f6fundar hvorki hva\u00f0 \u00feeir eiga vi\u00f0 me\u00f0 \u201elegudeildum\u201c (falla t.d. svokalla\u00f0ar m\u00f3tt\u00f6kuge\u00f0deildir ge\u00f0svi\u00f0s Lsp. undir legudeildir, \u00fe.e. 32 A, 32 C, 32 BP og 33 C?) n\u00e9 hverjir falla undir a\u00f0 vera \u201eallra veikustu \u00feunglyndissj\u00faklingarnir\u201c \u00e1 \u00feessum legudeildum.<\/font><\/p>\n

H\u00f6fundar greinarinnar sta\u00f0h\u00e6fa samt a\u00f0: \u201e[…] \u00feegar \u00feunglyndi er alvarlegt reynist best a\u00f0 b\u00e6ta \u00feessum tveimum me\u00f0fer\u00f0um (HAM og nefaz\u00f3d\u00f3n) samt\u00edmis.\u201c (s. 614) \u00deess ber a\u00f0 geta a\u00f0 lyfi\u00f0 nefaz\u00f3d\u00f3n var teki\u00f0 af marka\u00f0i \u00e1ri\u00f0 2004 \u00ed Bandar\u00edkjunum, Kanada og v\u00ed\u00f0ar vegna sjaldg\u00e6frar aukarverkunar, sem var h\u00e6tta \u00e1 alvarlegum lifrarskemmdum. \u00c9g gat ekki s\u00e9\u00f0 \u00ed lyfjaskr\u00e1 a\u00f0 lyfi\u00f0 s\u00e9 leyft h\u00e9r \u00e1 landi en h\u00f6fundarnir v\u00edsa \u00ed tv\u00e6r greinar um s\u00f6mu ranns\u00f3knina, sem var\u00a0ger\u00f0 \u00e1ri\u00f0 2000.<\/font><\/p>\n

\u00cd greininni er \u00fev\u00ed l\u00edka haldi\u00f0 fram a\u00f0 HAM s\u00e9 gagnlegt jafnvel eftir a\u00f0 me\u00f0fer\u00f0 l\u00fdkur. \u00deetta er ni\u00f0ursta\u00f0an af efnisgrein \u00fear sem HAM er hampa\u00f0 heilmiki\u00f0 og dregnar fram fr\u00e1b\u00e6rar ni\u00f0urst\u00f6\u00f0ur \u00far ranns\u00f3knum sem vitna\u00f0 er \u00ed, t.d. a\u00f0 ein yfirlitsranns\u00f3kn s\u00fdndi a\u00f0 hlutfall hr\u00f6sunar (\u00e1tt er vi\u00f0 bakslag, \u00fe.e. a\u00f0 sj\u00faklingi versni aftur) hafi m\u00e6lst 60% hj\u00e1 h\u00f3pnum sem f\u00e9kk lyfjame\u00f0fer\u00f0 vi\u00f0 s\u00ednu \u00feunglyndi en 29% hj\u00e1 \u00feeim sem fengu HAM. \u00c9g fletti upp nokkrum ranns\u00f3knum sem\u00a0h\u00f6fundar vitna \u00ed og kom margt fr\u00f3\u00f0legt \u00e1 daginn. Til a\u00f0 einfalda lestur \u00feessarar f\u00e6rslu er umfj\u00f6llun um tilvitnu\u00f0u ranns\u00f3knirnar og fleiri ranns\u00f3knir haf\u00f0ar ne\u00f0anm\u00e1ls \u00ed f\u00e6rslunni, \u00fe\u00f3 me\u00f0 venjulegri leturst\u00e6r\u00f0. Sj\u00e1 ne\u00f0anm\u00e1lsgrein.<\/b><\/font>
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Hvernig kemst \u00feunglyndissj\u00faklingur \u00ed HAM me\u00f0fer\u00f0 h\u00e9r \u00e1 \u00cdslandi?<\/font><\/b>
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\"GosiBo\u00f0i\u00f0 er upp \u00e1 HAM-me\u00f0fer\u00f0 \u00e1 ge\u00f0svi\u00f0i Landsp\u00edtala, b\u00e6\u00f0i vi\u00f0 kv\u00ed\u00f0a og \u00feunglyndi eftir sem \u00e9g best veit. Uppl\u00fdsingar um \u00feetta er ekki a\u00f0 finna \u00e1 s\u00ed\u00f0um Landsp\u00edtalans en \u00e9g hef margoft gengi\u00f0 fram hj\u00e1 augl\u00fdsingaspj\u00f6ldum sem augl\u00fdsa \u00feessa me\u00f0fer\u00f0, fyrir utan bi\u00f0stofu g\u00f6ngudeildar\/br\u00e1\u00f0am\u00f3tt\u00f6ku ge\u00f0svi\u00f0s. \u00dea\u00f0 sem h\u00e9r fer \u00e1 eftir er einkum byggt \u00e1 uppl\u00fdsingum sem fengust \u00ed s\u00edmt\u00f6lum vi\u00f0 fulltr\u00faa \u00e1 g\u00f6ngudeild og fj\u00e1rm\u00e1lasvi\u00f0i ge\u00f0deildar Landsp\u00edtala. Af \u00fev\u00ed engar uppl\u00fdsingar er a\u00f0 hafa um HAM-me\u00f0fer\u00f0ir \u00e1 vegum ge\u00f0svi\u00f0s \u00e1 opinberum vefs\u00ed\u00f0um veit \u00e9g ekki hvort me\u00f0fer\u00f0in er einstaklingsme\u00f0fer\u00f0 e\u00f0a h\u00f3pme\u00f0fer\u00f0 en giska \u00e1 hi\u00f0 s\u00ed\u00f0ara (byggt \u00e1 stopulu minni um hva\u00f0 stendur \u00e1 \u00feessum augl\u00fdsingaspj\u00f6ldum).<\/font><\/p>\n

Til a\u00f0 komast \u00ed HAM-me\u00f0fer\u00f0 \u00e1 vegum ge\u00f0svi\u00f0s \u00fearf tilv\u00edsun fr\u00e1 heimilisl\u00e6kni, ge\u00f0l\u00e6kni e\u00f0a br\u00e1\u00f0am\u00f3tt\u00f6ku ge\u00f0deildar. Sex vikna me\u00f0fer\u00f0, \u00fear sem m\u00e6tt er einu sinni \u00ed viku \u00ed tv\u00e6r klukkustundir, kostar 6.600 kr. og auk \u00feess eiga me\u00f0fer\u00f0ar\u00feegar a\u00f0 kaupa b\u00f3k sem kostar 1000 kr. Einnig er bo\u00f0i\u00f0 upp \u00e1 \u00e1tta vikna me\u00f0fer\u00f0 sem kostar 8.800 kr. + b\u00f3kin. Vi\u00f0tal vi\u00f0 s\u00e1lfr\u00e6\u00f0ing \u00e1 g\u00f6ngudeild ge\u00f0deildar kostar 2.600 kr. og er klukkustundar langt. (Sj\u00e1 Gjaldskr\u00e1 g\u00f6ngudeilda ge\u00f0svi\u00f0s<\/a>, li\u00f0urinn \u201eKomur og endurkomur \u00e1 g\u00f6ngudeildir vegna annarra en l\u00e6kna\u201c \u00e1 vi\u00f0 \u00feetta. Svo l\u00e6kkar l\u00edklega ver\u00f0i\u00f0 me\u00f0 afsl\u00e1ttarkorti S\u00cd og \u00f6rorkusk\u00edrteini.)<\/font><\/p>\n

\u00deessi HAM-me\u00f0fer\u00f0 er hr\u00e6\u00f3d\u00fdr mi\u00f0a\u00f0 vi\u00f0 \u00fea\u00f0 sem b\u00fd\u00f0st \u00e1 almennum marka\u00f0i. \u00c9g nefni sem d\u00e6mi eitt augl\u00fdst n\u00e1mskei\u00f0 Kv\u00ed\u00f0ame\u00f0fer\u00f0armi\u00f0st\u00f6\u00f0varinnar (KMS), \u201eN\u00e1mskei\u00f0 vi\u00f0 ofsakv\u00ed\u00f0a<\/a>\u201c, sem fer fram \u00ed alls sex skipti, auk greiningarvi\u00f0tals \u00ed upphafi. \u201eGreiningarvi\u00f0tal fyrir \u00feetta n\u00e1mskei\u00f0 kostar 9000 kr\u00f3nur en ver\u00f0i\u00f0 \u00e1 n\u00e1mskei\u00f0inu er 39.000 kr\u00f3nur. N\u00e1mskei\u00f0sgjald grei\u00f0ist \u00ed upphafi fyrsta t\u00edma.\u201c \u00c9g hef teki\u00f0 svipa\u00f0 n\u00e1mskei\u00f0 hj\u00e1 \u00feessum a\u00f0ilum, \u00fear sem nota\u00f0ar voru HAM-a\u00f0fer\u00f0ir vi\u00f0 kv\u00ed\u00f0a, og \u00fea\u00f0 gagna\u00f0ist pr\u00fd\u00f0ilega. \u00de\u00e1 var \u00e9g enn \u00e1 vinnumarka\u00f0i (raunar \u00ed veikindaleyfi samt) og f\u00e9kk kostna\u00f0inn endurgreiddan \u00far sj\u00fakrasj\u00f3\u00f0i st\u00e9ttarf\u00e9lagsins m\u00edns en \u00feurfti svo vel a\u00f0 merkja a\u00f0 grei\u00f0a skatt af endurgrei\u00f0slunni \u00feannig a\u00f0 segja m\u00e1 a\u00f0 \u00e9g hafi fengi\u00f0 h\u00e1lfa upph\u00e6\u00f0ina endurgreidda.\u00a0 KMS b\u00fd\u00f0ur l\u00edka n\u00e1mskei\u00f0i\u00f0 \u201eVell\u00ed\u00f0an \u00e1n lyfja<\/a>\u201c sem vir\u00f0ist eiga a\u00f0 henta jafnt \u00feunglyndum, streittum, kv\u00ed\u00f0num og fleirum. Skv. \u00feeirra eigin ranns\u00f3kn er g\u00f3\u00f0ur \u00e1rangur af \u00feessu n\u00e1mskei\u00f0i<\/a> en \u00e9g hj\u00f3 eftir a\u00f0 hinir \u00feunglyndu m\u00e6ldust einungis me\u00f0 v\u00e6gt \u00feunglyndi, \u00ed h\u00e6sta lagi \u00e1 m\u00f6rkum \u00feess a\u00f0 n\u00e1\u00a0ni\u00f0ur \u00ed me\u00f0aldj\u00fapt \u00feunglyndi. Ekki kemur fram hva\u00f0 n\u00e1mskei\u00f0i\u00f0 kostar.<\/font><\/p>\n

Eftir \u00fev\u00ed sem \u00e9g best veit kosta vi\u00f0t\u00f6l hj\u00e1 s\u00e1lfr\u00e6\u00f0ingum yfirleitt um 10.000 kr. skipti\u00f0. \u00c9g held a\u00f0 meirihluti st\u00e9ttarf\u00e9laga endurgrei\u00f0i \u00fatlag\u00f0an kostna\u00f0 s\u00edns f\u00f3lks a\u00f0 hluta e\u00f0a \u00f6llu leyti (\u00fe\u00e1 mi\u00f0a\u00f0 vi\u00f0 einhvern takmarka\u00f0an fj\u00f6lda t\u00edma). En \u00e9g veit ekki til \u00feess a\u00f0 Sj\u00fakratryggingar \u00cdslands (Tryggingastofnun er framkv\u00e6mdara\u00f0ili \u00feeirra) endurgrei\u00f0i neitt \u00ed s\u00e1lfr\u00e6\u00f0ikostna\u00f0i, fyrir utan s\u00e1lfr\u00e6\u00f0i\u00fej\u00f3nustu \u00e1 ge\u00f0svi\u00f0i Landsp\u00edtalans. M\u00f6gulega endurgrei\u00f0ir f\u00e9lags\u00fej\u00f3nusta sveitarf\u00e9laga s\u00e1lfr\u00e6\u00f0ikostna\u00f0, s\u00e9 f\u00f3lk ekki \u00e1 vinnumarka\u00f0i og geti \u00fev\u00ed ekki treyst \u00e1 st\u00e9ttarf\u00e9lagsa\u00f0ild.\u00a0<\/font>
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\u00c1 heimas\u00ed\u00f0u S\u00e1lfr\u00e6\u00f0ingaf\u00e9lags \u00cdslands<\/i> er listi yfir f\u00e9lagsmenn, hva\u00f0a vi\u00f0urkenningu \u00feeir hafa og hvar \u00feeir starfa<\/a>. \u00dea\u00f0 er eflaust \u00e1g\u00e6tt a\u00f0 k\u00edkja \u00e1 \u00feennan lista ef menn hafa hug \u00e1 a\u00f0 komast til s\u00e1lfr\u00e6\u00f0ings. Einnig er til s\u00e9rstakt F\u00e9lag um hugr\u00e6na atferlisme\u00f0fer\u00f0<\/i>, Ham.is<\/i>, \u00fear sem er listi, Me\u00f0fer\u00f0ara\u00f0ilar \u00ed hugr\u00e6nni atferlisme\u00f0fer\u00f0 \u00e1 vegum FHAM<\/a>, \u00feeirra sem hafa loki\u00f0 s\u00e9rn\u00e1mi \u00ed hugr\u00e6nni atferlisme\u00f0fer\u00f0 \u00e1 vegum f\u00e9lagsins. Eflaust er gott a\u00f0 sty\u00f0jast vi\u00f0 \u00feann lista s\u00e9u menn s\u00e9rstaklega a\u00f0 leita a\u00f0 s\u00e1lfr\u00e6\u00f0ingi sem veitir HAM-me\u00f0fer\u00f0.<\/font>
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M\u00edn sko\u00f0un<\/font><\/b><\/p>\n

Eins og kemur v\u00e6ntanlega betur fram \u00ed lok yfirfer\u00f0ar um helstu s\u00e1lfr\u00e6\u00f0ime\u00f0fer\u00f0ir sem bj\u00f3\u00f0ast f\u00f3lki me\u00f0 sl\u00e6mt \u00feunglyndi tel \u00e9g a\u00f0 HAM geti l\u00edklega gagnast einhverjum vel<\/b> en finnst \u00f3l\u00edklegt a\u00f0 hi\u00f0 mikla lofsor\u00f0 sem loki\u00f0 er \u00e1 HAM\u00a0 \u00ed n\u00fdju \u00edslensku greininni \u00ed L\u00e6knabla\u00f0inu<\/i> standist<\/b>. A\u00f0allega byggi \u00e9g \u00feessa sko\u00f0un \u00e1 \u00fev\u00ed a\u00f0 hvers kyns lofor\u00f0 um g\u00edfurlega virkni vi\u00f0 b\u00f3kstaflega \u00f6llu \u00feunglyndi hafa ekki sta\u00f0ist, hvort sem \u00feau voru gefin um SSRI-lyf, K\u00edna-l\u00edfselex\u00edr, steinol\u00edu, bl\u00f3\u00f0t\u00f6ku\u00a0 e\u00f0a anna\u00f0. Hin fr\u00e1b\u00e6ra lausn er ekki til. Og hin eina r\u00e9tta lausn er heldur ekki til<\/b>.<\/font>
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\"hugr\u00e6nTilraunir sem v\u00edsa\u00f0 er \u00ed, t.d. \u00ed yfirlitsranns\u00f3knum (sem er svo aftur v\u00edsa\u00f0 \u00ed, t.d. \u00ed \u00edslensku greininni) fara fram vi\u00f0 gervi-kringumst\u00e6\u00f0ur en m\u00e6la f\u00e6star hvernig a\u00f0fer\u00f0in n\u00fdtist til langframa \u00feegar \u00fat \u00ed l\u00edfi\u00f0 er komi\u00f0 og sj\u00faklingurinn er h\u00e6ttur a\u00f0 hitta sinn l\u00e6kni e\u00f0a s\u00e1lfr\u00e6\u00f0ing reglulega. \u00c9g held a\u00f0 bara s\u00e1 \u00fe\u00e1ttur a\u00f0 tala vi\u00f0 einhvern sem hlustar, a\u00f0 geta tj\u00e1\u00f0 l\u00ed\u00f0an s\u00edna, g\u00e6ti\u00a0einn og s\u00e9r vegi\u00f0 \u00feungt (sem hefur\u00a0lengi veri\u00f0 vita\u00f0). \u00c1hrif \u00feess eru illm\u00e6lanleg \u00ed svona tilraunum – \u00fe\u00e6r g\u00e6tu v\u00e6ntanlega ekki fari\u00f0 fram \u00e1n or\u00f0a e\u00f0a samskipta vi\u00f0 anna\u00f0 hvort ge\u00f0l\u00e6kni e\u00f0a HAM-s\u00e1lfr\u00e6\u00f0ing – svo ekki s\u00e9 tala\u00f0 um m\u00f6guleg j\u00e1kv\u00e6\u00f0 \u00e1hrif \u00feess a\u00f0 tilheyra h\u00f3pi, \u00ed \u00feessum tilvikum ranns\u00f3knarh\u00f3pi.<\/font><\/p>\n

Satt best a\u00f0 segja kem \u00e9g ekki auga \u00e1 yfirbur\u00f0i HAM fram yfir t.d. t\u00f3lf spora vinnu (sem margir hafa reynslu af), s\u00e6milega skynsamlega l\u00edfsafst\u00f6\u00f0u sem menn geta \u00f6\u00f0last af lestri gamalla l\u00edfsst\u00edlsrita og samr\u00e6\u00f0um vi\u00f0 trausta vini e\u00f0a \u00fe\u00e1 fr\u00f3 sem reglusamt l\u00edf gefur (\u00fe.e. a\u00f0 hafa reglu \u00e1 l\u00edfi s\u00ednu). Allt skilar \u00feetta manni \u00e1lei\u00f0is a\u00f0 meiri \u00feroska og aukinn \u00feroski gerir mann h\u00e6fari til a\u00f0 f\u00e1st vi\u00f0 erfi\u00f0leika. S\u00fa litla reynsla sem \u00e9g hef sj\u00e1lf af HAM, vi\u00f0 kv\u00ed\u00f0a, hefur gefi\u00f0 g\u00f3\u00f0a raun, \u00fe.e.a.s. \u00e9g eigna\u00f0ist d\u00e1gott verkf\u00e6rasafn sem n\u00fdtist talsvert vi\u00f0 a\u00f0 f\u00e1st vi\u00f0 kv\u00ed\u00f0a og draga \u00far ofsakv\u00ed\u00f0ak\u00f6stum. En samfara br\u00faka \u00e9g kv\u00ed\u00f0astillandi lyf sem eru einnig gott verkf\u00e6ri vi\u00f0 \u00fev\u00ed sama. \u00c9g hef pr\u00f3fa\u00f0 a\u00f0 sleppa \u00feessu lyfi, \u00e1\u00f0ur fyrr gat \u00e9g stundum veri\u00f0 \u00e1n \u00feess um \u00fe\u00f3 nokkurn t\u00edma en veikindi m\u00edn versna me\u00f0 hverju \u00e1rinu og undanfari\u00f0 \u00e1r er \u00fatiloka\u00f0 a\u00f0 reyna bara a\u00f0 br\u00faka HAM \u00e1 kv\u00ed\u00f0ann, \u00fea\u00f0 dugar of skammt.<\/font><\/p>\n

\u00c9g \u00e1 mj\u00f6g erfitt me\u00f0 a\u00f0 sj\u00e1 fyrir m\u00e9r hvernig HAM g\u00e6ti gert alvarlegt \u00feunglyndi mitt b\u00e6rilegra<\/b>. Fyrir svo utan \u00fea\u00f0 a\u00f0 \u00e9g er hreinlega of veik til a\u00f0 \u00fev\u00e6last til Reykjav\u00edkur einu sinni \u00ed viku og \u00e1rangurinn af hugsanlegri HAM me\u00f0fer\u00f0 \u00e1 \u00feessu \u00e1ri hef\u00f0i eflaust a\u00f0allega or\u00f0i\u00f0 s\u00e1 a\u00f0 \u00e9g hef\u00f0i \u00feurft a\u00f0 leggjast inn \u00e1 ge\u00f0deild. Svo \u00e9g er ekki einu sinni \u00ed standi til a\u00f0 ganga \u00far skugga um hvort a\u00f0fer\u00f0in virki eitthva\u00f0 \u00e1 dj\u00fapa vi\u00f0varandi ge\u00f0l\u00e6g\u00f0 \ud83d\ude09<\/font>
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\u00a0 \u00a0<\/font><\/b>Um HAM-ranns\u00f3knir, tilv\u00edsanir til \u00feeirra og tilv\u00edsanir \u00ed yfirlitsranns\u00f3knir\/\u00fattektir \u00e1 ranns\u00f3knum \u00ed \u00edslensku greininni<\/font><\/b>\u00cd rauninni vir\u00f0ist um fj\u00f6lda ranns\u00f3kna og yfirlitsranns\u00f3kna a\u00f0 r\u00e6\u00f0a en svo er ekki endilega. \u00cd stikkprufu \u00ed ranns\u00f3knir \u00fear sem borinn er saman \u00e1rangur HAM og \u00feunglyndislyfjame\u00f0fer\u00f0ar kom \u00ed lj\u00f3s a\u00f0 margir h\u00f6fundar voru a\u00f0 endursegja ni\u00f0urst\u00f6\u00f0ur tilt\u00f6lulega f\u00e1rra og jafnvel f\u00e1mennra ranns\u00f3kna, \u00ed m\u00f6rgum greinum sem v\u00edsa fram og aftur \u00ed hi\u00f0 sama og hver \u00ed a\u00f0ra. \u00deetta er nokkurs konar \u201eEinbj\u00f6rn \u00ed Tv\u00edbj\u00f6rn, Tv\u00edbj\u00f6rn \u00ed \u00der\u00edbj\u00f6rn\u201c o.s.fr. saga.<\/font>Fyrsta ranns\u00f3knin er yfirlitsanns\u00f3kn Gloaguen o.fl., sem ger\u00f0 var 1998, \u201eA meta-analysis of the effects of cognitive therapy in depressed patients<\/a>\u201c, \u00fear sem\u00a0 sko\u00f0a\u00f0ar voru \u00e1tta f\u00e1mennar ranns\u00f3knir \u00e1 langt\u00edmavirkni HAM versus langt\u00edmavirkni lyfja, \u00e1 t\u00edmabilinu 1981-1992. \u00cd fimm af \u00feessum \u00e1tta ranns\u00f3knum virtist minna um hr\u00f6sun (bakslag, \u00fe.e. a\u00f0 sj\u00faklingnunum versna\u00f0i aftur) hef\u00f0i HAM me\u00f0fer\u00f0 veri\u00f0 beitt heldur en \u00ed h\u00f3pi \u00feeirra sem fengu \u00feunglyndislyf. Alls voru sj\u00faklingar \u00ed \u00feessum fimm ranns\u00f3knum 144 og \u00feunglyndi \u00feeirra mismunandi v\u00e6gt\/alvarlegt. Gloaguen og f\u00e9lagar reiknu\u00f0u svo eintaldlega \u00fat pr\u00f3sentut\u00f6lur bygg\u00f0ar \u00e1 \u00feessum 144 \u00f3l\u00edku sj\u00faklingum, \u00ed \u00f3l\u00edkum ranns\u00f3knum, \u00fdmist fylgt eftir \u00ed eitt \u00e1r, eitt og h\u00e1lft \u00e1r e\u00f0a tvo \u00e1r, og fengu \u00far a\u00f0 a\u00f0 me\u00f0altali m\u00e6ldist hr\u00f6sun 29,5% hef\u00f0u sj\u00faklingarnir fengi\u00f0 HAM me\u00f0fer\u00f0 en 60% hef\u00f0u \u00feeir veri\u00f0 me\u00f0h\u00f6ndla\u00f0ir me\u00f0 lyfjum. \u00deessar ranns\u00f3knir voru ger\u00f0ar fyrir daga SSRI-lyfjanna.<\/font>
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\u00dev\u00ed leitu\u00f0u h\u00f6fundar \u00edslensku greinarinnar einnig a\u00f0 samb\u00e6rilegum ranns\u00f3knum \u00fear sem SSRI-lyf\u00a0 (Seroxat) var til samanbur\u00f0ar og v\u00edsa \u00ed \u00ferj\u00e1 greinar um \u00fea\u00f0. S\u00fa fyrsta er \u00fattekt Butler o.fl. \u00e1 \u00f6\u00f0rum ranns\u00f3knum, \u201eThe empirical status of cognitive-behavioral therapy: A review of meta-analyse<\/a>\u201c (2006). \u00dear er\u00a0 au\u00f0vita\u00f0 v\u00edsa\u00f0 \u00ed Gloaguen ranns\u00f3knina og bent \u00e1 a\u00f0 e.t.v. s\u00fdni h\u00fan of sterka st\u00f6\u00f0u HAM \u00fev\u00ed Gloaguen hafi tali\u00f0 me\u00f0 ranns\u00f3knir \u00fear sem a\u00f0fer\u00f0afr\u00e6\u00f0ilegir \u00fe\u00e6ttir hef\u00f0u veri\u00f0 HAM \u00ed hag. Butler vitnar svo m.a. \u00ed DeRubies og\u00a0 Crits-Christoph (1998) sem hafi fengi\u00f0 \u00fat svipa\u00f0ar t\u00f6lur um \u00e1rangur, mi\u00f0a\u00f0 vi\u00f0 eftirfylgni \u00ed eitt \u00e1r, \u00fe.e. 26% hr\u00f6sunarhlutfall me\u00f0al \u00feeirra sem notu\u00f0 HAM og 64% hr\u00f6sunarhlutfall\u00a0me\u00f0al \u00feeirra sem notu\u00f0u ge\u00f0lyf. Butler vitnar einnig \u00ed yfirlitsranns\u00f3kn De Rubeis og Crits-Cristoph (2005) \u00fear sem hafi komi\u00f0 \u00ed lj\u00f3s a\u00f0 HAM v\u00e6ri jafn \u00e1rangursr\u00edkt paroxetine (Seroxat) \u00ed fyrstu me\u00f0fer\u00f0 vi\u00f0 me\u00f0al\u00feungu e\u00f0a alvarlegu \u00feunglyndi. Loks vitnar hann \u00ed Hollon o.fl. (2005) \u00fear sem komi\u00f0 hafi \u00ed lj\u00f3s a\u00f0 HAM styrkti sj\u00faklinga me\u00f0 me\u00f0al\u00feungt e\u00f0a alvarlegt \u00feunglyndi og haf\u00f0i jafn \u00f6flug (forvarnar)\u00e1hrif eftir a\u00f0 me\u00f0fer\u00f0 lauk og a\u00f0 vera \u00e1fram \u00e1 lyfjum.<\/font><\/p>\n

N\u00e6sta ranns\u00f3kn sem h\u00f6fundar \u00edslensku greinarinnar vitna \u00ed er einmitt ranns\u00f3kn Hollon, DeRubeis o.fl. fr\u00e1 2005, \u201ePrevention of Relapse Following Cognitive Therapy<\/a><\/font>
\nvs Medications in Moderate to Severe Depression<\/a>.\u201c Seinni greinin eftir Hollon o.fl. fr\u00e1 2006, \u201eEnduring effects for cognitive behavior therapy in the treatment of depression and anxiety\u201c, sem h\u00f6fundar \u00edslensku greinarinnar vitna \u00ed \u00feri\u00f0ja lagi \u00ed, um samanbur\u00f0 SSRI-lyfs og HAM, segir a\u00f0allega fr\u00e1 \u00feessari s\u00f6mu ranns\u00f3kn hans og vangaveltum \u00fat fr\u00e1 henni.<\/font>
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Kannski finnst einhverjum fr\u00f3\u00f0legt a\u00f0 vita hvernig svona ranns\u00f3kn er ger\u00f0<\/b>. H\u00e9r er stutt endurs\u00f6gn bygg\u00f0 \u00e1\u00a0 \u201ePrevention of Relapse Following Cognitive Therapy vs Medications in Moderate to Severe Depression<\/a>.\u201c<\/font><\/p>\n

Markmi\u00f0 rannsakenda var a\u00f0 sko\u00f0a hvort hugr\u00e6n me\u00f0fer\u00f0 (CT – n\u00e1skyld CBT svo k\u00f6llum \u00feetta bara HAM) hef\u00f0i varanlegri \u00e1hrif, \u00fe.e. k\u00e6mi fremur \u00ed veg fyrir bakslag, en lyfjame\u00f0fer\u00f0, \u00ed me\u00f0h\u00f6ndlun sj\u00faklinga me\u00f0 alvarlegt \u00feunglyndi. Vi\u00f0fangi\u00f0 var 240<\/b> manna h\u00f3pur g\u00f6ngudeildarsj\u00faklinga \u00e1 aldrinum 18-70 \u00e1ra, sem greindir voru upphaflega me\u00f0 me\u00f0al\u00feungt e\u00f0a alvarlegt einp\u00f3la \u00feunglyndi og ekki gl\u00edmdu vi\u00f0 a\u00f0rar ge\u00f0raskanir einnig. Sj\u00faklingarnir g\u00e1fu uppl\u00fdst skriflegt sam\u00feykki sitt fyrir a\u00f0 taka \u00fe\u00e1tt \u00ed tilrauninni. \u00dea\u00f0 kemur ekki fram hvort \u00feeir t\u00f3ku \u00fe\u00e1tt af hugsj\u00f3ninni einni saman e\u00f0a fengu greitt fyrir \u00fe\u00e1tt\u00f6ku e\u00f0a gr\u00e6ddu \u00e1 henni \u00e1 einhvern annan h\u00e1tt, t.d. me\u00f0 grei\u00f0ari a\u00f0gengi a\u00f0 l\u00e6knis- e\u00f0a s\u00e1lfr\u00e6\u00f0i\u00fej\u00f3nustu en \u00feeir hef\u00f0u ella haft. M\u00e9r finnst \u00feetta skipta m\u00e1li.<\/b><\/font><\/p>\n

Fyrst var \u00feeim skipt \u00ed 3 h\u00f3pa; 60 manns voru sett \u00ed \u00f6fluga HAM-me\u00f0fer\u00f0<\/b>, 120 manns \u00ed lyfjame\u00f0fer\u00f0<\/b> (fengu a\u00f0allega Seroxat en sto\u00f0lyf ef Seroxati\u00f0 dug\u00f0i ekki eitt s\u00e9r: Litium e\u00f0a Desipramine\/ Norpramine, \u00fer\u00edhringlaga lyf sem vir\u00f0ist ekki \u00e1 marka\u00f0i h\u00e9rlendis) og 60 manns l\u00e1tnir eta lyfleysupillur \u00ed tvo m\u00e1nu\u00f0i – au\u00f0vita\u00f0 \u00e1n \u00feess a\u00f0 vita hvort um lyfleysu e\u00f0a lyf var a\u00f0 r\u00e6\u00f0a. (S\u00ed\u00f0astnefndi h\u00f3purinn kemur \u00ed raun ekki meira vi\u00f0 s\u00f6gu \u00ed \u00feessari ranns\u00f3kn.)<\/font><\/p>\n

Eftir 4 m\u00e1nu\u00f0i kom \u00ed lj\u00f3s a\u00f0 einungis 104 sj\u00faklingum af \u00feeim 180 sem hlutu raunverulega me\u00f0fer\u00f0, e\u00f0a 57.8%, haf\u00f0i\u00a0 batna\u00f0 a\u00f0 r\u00e1\u00f0i<\/font><\/b>. Mi\u00f0a\u00f0 var vi\u00f0 a\u00f0 sj\u00fakd\u00f3mseinkenni hef\u00f0u minnka\u00f0 um a.m.k. 40% (m\u00e6lt me\u00f0 skori \u00e1 Hamilton Depression Rating Scale<\/a>, HDRS, sem \u00e9g veit ekki til a\u00f0 hafi veri\u00f0 \u00fe\u00fdddur \u00e1 \u00edslensku en kr\u00e6kt er \u00ed gagnvirka vefs\u00ed\u00f0u me\u00f0 kvar\u00f0anum \u00e1 ensku). \u00cd lyfjat\u00f6kuh\u00f3pnum h\u00f6f\u00f0u 69 af 120 (57,5%) n\u00e1\u00f0 \u00feessum \u00e1rangri og \u00ed HAM h\u00f3pnum 35 af 60 sj\u00faklingum (58,3%). \u00deessir 104 sj\u00faklingar h\u00e9ldu \u00e1fram \u00ed 12 m\u00e1na\u00f0a tilraun<\/b> en hinum var hent \u00far ranns\u00f3kninni.<\/font><\/p>\n

\u00cd greininni \u00fear sem h\u00f6fundar segja fr\u00e1 \u00feessari ranns\u00f3kn er \u00feess hvergi geti\u00f0 \u00ed hverju hugr\u00e6na me\u00f0fer\u00f0in (CT) f\u00f3lst n\u00e9 hversu oft sj\u00faklingar s\u00f3ttu svolei\u00f0is me\u00f0fer\u00f0. \u00dea\u00f0 finnst m\u00e9r alvarlegur galli! <\/b>M\u00e1 \u00fe\u00f3 af samhenginu skilja a\u00f0 h\u00fan hafi l\u00edklega veri\u00f0 st\u00edf.<\/font><\/p>\n

\u00c1 n\u00e6sta stigi, sem skyldi vara \u00ed \u00e1r<\/b>, var lyfjat\u00f6kuh\u00f3pnum skipt \u00feannig a\u00f0 34 sj\u00faklingar fengu \u00e1fram s\u00f6mu lyf en fari\u00f0 var a\u00f0 gefa 35 sj\u00faklingum lyfleysu. \u00deeir h\u00e9ldu \u00e1fram a\u00f0 hitta sinn sama l\u00e6kni reglulega, tvisvar fyrsta m\u00e1nu\u00f0inn og svo einu sinni \u00ed m\u00e1nu\u00f0i. Sj\u00faklingarnir sem lentu \u00ed lyfleysu-h\u00f3pnum voru trappa\u00f0ir ni\u00f0ur af Seroxati \u00e1 4-6 vikum. Hvorki sj\u00faklingarnir, ge\u00f0l\u00e6knarnir n\u00e9 \u00feeir sem m\u00e1tu \u00e1rangurinn vissu hva\u00f0a sj\u00faklingar fengju raunveruleg lyf og hva\u00f0a sj\u00faklingar fengju alveg eins \u00fatl\u00edtandi lyfleysu. L\u00e6knar sj\u00faklinganna sem h\u00e9ldu sig taka Litium en \u00e1tu lyfleysu fengu uppdikta\u00f0ar bl\u00f3\u00f0ranns\u00f3knarni\u00f0urst\u00f6\u00f0ur \u00feeirra sj\u00faklinga.<\/font><\/p>\n

Sj\u00faklingarnar sem h\u00f6f\u00f0u veri\u00f0 \u00ed HAM-me\u00f0fer\u00f0 h\u00e6ttu \u00ed henni a\u00f0 mestu nema \u00feeir fengu \u00ferj\u00e1r \u201estyrktar-HAM-lotur\u201c (Booster sessions) \u00e1 \u00feessu t\u00f3lf m\u00e1na\u00f0a t\u00edmabili og m\u00e1ttu s\u00e1lfr\u00e6\u00f0ingur og sj\u00faklingur velja hven\u00e6r \u00feessar lotur voru teknar \u00fat.<\/font><\/p>\n

Fylgst var reglulega me\u00f0 sj\u00faklingunum \u00e1 \u00feessu 12 m\u00e1na\u00f0a t\u00edmabili og \u00e1stand \u00feeirra meti\u00f0, me\u00f0 skori \u00e1 HDRS-kvar\u00f0anum og fleiri m\u00e6likv\u00f6r\u00f0um \u00e1 l\u00ed\u00f0an. Versna\u00f0i sj\u00faklingi a\u00f0 r\u00e1\u00f0i taldist hann brottfallinn \u00far ranns\u00f3kninni, s\u00f6mulei\u00f0is ef hann h\u00e6tti a\u00f0 m\u00e6ta \u00ed matsvi\u00f0tal e\u00f0a l\u00e6knisheims\u00f3kn. Sext\u00e1n sj\u00faklinganna f\u00e9llu brott<\/b>: \u00c1tta \u00far lyfleysuh\u00f3pnum, fimm \u00far ge\u00f0lyfjah\u00f3pnum og \u00fer\u00edr \u00far \u201etakmarka\u00f0 styrkta HAM-lotu\u201c h\u00f3pnum.<\/font><\/p>\n

Eftir voru \u00fe\u00e1 alls 88 sj\u00faklingar af \u00feeim 104 sem t\u00f3ku \u00fe\u00e1tt \u00ed framhaldsranns\u00f3kninni e\u00f0a 84,5%. Tveir sj\u00faklingar a\u00f0 auki voru voru \u00fatiloka\u00f0ir af rannsakendum<\/b>, annar var \u00far lyfjat\u00f6kuh\u00f3pnum en kraf\u00f0ist \u00feess a\u00f0 f\u00e1 s\u00e1lfr\u00e6\u00f0ime\u00f0fer\u00f0 a\u00f0 auki og einn HAM-sj\u00faklinganna h\u00f3f a\u00f0 taka ge\u00f0lyf \u00ed 10. m\u00e1nu\u00f0i ranns\u00f3knarinnar.<\/font><\/p>\n

\u00c1 \u00feessu 12 m\u00e1na\u00f0a t\u00edmabili veiktust margir sj\u00faklingar eitthva\u00f0 \u00ed framhaldsranns\u00f3kninni. \u00deeir sem h\u00e9ldust fr\u00edskir allan t\u00edmann voru 40 sj\u00faklingar sem skiptust \u00feannig: 6 sj\u00faklingar sem t\u00f3ku (\u00f3afvitandi) lyfleysu (e\u00f0a 16,4% af \u00feeim h\u00f3pi), 14 sj\u00faklingar sem t\u00f3ku ge\u00f0lyf (e\u00f0a 26,9% af \u00feeim h\u00f3pi) og 20 sj\u00faklingar sem h\u00f3fu st\u00edfa HAM-me\u00f0fer\u00f0 \u00ed upphafi og fengu 3 Ham-styrktarlotur \u00e1 \u00feessu 12 m\u00e1na\u00f0a t\u00edmabili (e\u00f0a 37,3% af \u00feeim h\u00f3pi). Af \u00fev\u00ed \u00feessir 40 fengu ekki nein \u00feunglyndiseinkenni \u00e1 \u00feessu t\u00f3lf m\u00e1na\u00f0a t\u00edmabili var \u00fea\u00f0 t\u00falka\u00f0 sem svo a\u00f0 \u00feeir hef\u00f0u l\u00e6knast af sinni upphaflegu dj\u00fapu ge\u00f0l\u00e6g\u00f0 (\u00feunglyndiskasti). Veiktust \u00feeir a\u00f0 loknu pr\u00f3funart\u00edmabilinu taldist \u00fea\u00f0 sem n\u00fd veikindi, \u00fe.e. n\u00fd ge\u00f0l\u00e6g\u00f0 e\u00f0a \u00feunglyndiskast.<\/font><\/b><\/p>\n

Eftirfylgni me\u00f0 h\u00f3punum st\u00f3\u00f0 \u00ed eitt \u00e1r \u00ed vi\u00f0b\u00f3t<\/b>. Raunar f\u00f3r \u00fea\u00f0 svo a\u00f0 7 af hinum 20 \u201el\u00e6knu\u00f0u\u201c HAM-me\u00f0fer\u00f0arsj\u00faklingum veiktust aftur, 7 af \u00feeim 13 sem voru \u00ed lyfjame\u00f0fer\u00f0 og 2 af \u00feeim 6 sem eftir voru \u00ed lyfleysut\u00f6kuh\u00f3pnum.<\/font>
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Ni\u00f0urst\u00f6\u00f0urnar gefa til kynna a\u00f0 HAM (CT) hafi varanleg \u00e1hrif sem dragi \u00far h\u00e6ttunni a\u00f0 veikjast aftur eftir me\u00f0fer\u00f0ina. \u00c1hrif HAM eru a.m.k. jafng\u00f3\u00f0 og \u00e1hrif langvarandi lyfjaneyslu. Af \u00feessu m\u00e1 draga \u00fe\u00e1 \u00e1lyktun a\u00f0 h\u00e6gt s\u00e9 a\u00f0 fyrirbyggja bakslag hj\u00e1 sj\u00faklingi sem hefur n\u00e1\u00f0 bata anna\u00f0 hvort me\u00f0 \u00e1framhaldandi lyfjanotkun e\u00f0a \u00f6flugri HAM me\u00f0fer\u00f0 um lei\u00f0 og bata ver\u00f0ur vart.<\/font>
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Athugasemd m\u00edn: M\u00e9r finnst \u00feessi me\u00f0fer\u00f0 \u00e1 veiku f\u00f3lki hreinasti hryllingur, jafnvel \u00fe\u00f3tt tilgangurinn hafi eflaust veri\u00f0 g\u00f3\u00f0ur. Og m\u00e9r finnst si\u00f0laust a\u00f0 falsa ni\u00f0urst\u00f6\u00f0ur bl\u00f3\u00f0prufa sj\u00faklinga handa l\u00e6knum \u00fe\u00f3tt tilgangurinn s\u00e9 a\u00f0 enginn k\u00e6mist a\u00f0 \u00fev\u00ed hva\u00f0a sj\u00faklingar fengju lyfleysu og hverjir raunverulegt Litium. Eiginlega finnst m\u00e9r merkilegust ni\u00f0ursta\u00f0na \u00feessara ranns\u00f3knar a\u00f0 86 manns skuli hafa tolla\u00f0 \u00ed henni \u00ed 16 m\u00e1nu\u00f0i (af \u00feeim 240 sem \u00ed upphafi voru valdir og g\u00e1fu skriflegt sam\u00feykki sitt fyrir \u00fe\u00e1ttt\u00f6ku). M\u00e9r er lj\u00f3st a\u00f0 s\u00e1lfr\u00e6\u00f0ingum \u00feykir miki\u00f0 til svona ranns\u00f3kna koma en sem sj\u00faklingur mundi \u00e9g aldrei lj\u00e1 m\u00e1ls \u00e1 a\u00f0 taka \u00fe\u00e1tt \u00ed svonal\u00f6gu\u00f0u – nema m\u00e9r v\u00e6ri sl\u00e9tt sama hvort \u00e9g lif\u00f0i \u00fea\u00f0 af e\u00f0a dr\u00e6pist.<\/font><\/b>
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\u00c9g rek ekki a\u00f0rar ranns\u00f3knir sem \u00edslensku h\u00f6fundarnir greinarinnar \u201eGagnsemi hugr\u00e6nnar atferlisme\u00f0fer\u00f0ar vi\u00f0 lyndis- og kv\u00ed\u00f0ar\u00f6skunum hj\u00e1 fullor\u00f0num<\/a>\u201c vitna \u00ed, m\u00e1li s\u00ednu til stu\u00f0nings, \u00fe\u00e6r eru v\u00e6ntanlega jafn a\u00f0fer\u00f0afr\u00e6\u00f0ilega vel unnar og \u00feessi sem \u00e9g var a\u00f0 endursegja. \u00de\u00f3 ber kannski a\u00f0 nefna a\u00f0 \u00ed n\u00e6stu efnisgrein eftir \u00feessari um HAM samanbori\u00f0 vi\u00f0 \u00feunglyndislyf er sta\u00f0h\u00e6ft: \u201eRanns\u00f3knir hafa einnig s\u00fdnt a\u00f0 sam\u00fe\u00e6tt me\u00f0fer\u00f0 \u00fear sem HAM er beitt eftir a\u00f0 lyfjame\u00f0fer\u00f0 l\u00fdkur er \u00e1rangursr\u00edk, m.a. me\u00f0 tilliti til bakslags\u201c og vitna\u00f0 \u00ed Eugene S. Paykel. \u201eCognitive therapy in relapse prevention in depression<\/a>.” (2007) Paykel fjallar au\u00f0vita\u00f0 um fyrri ranns\u00f3knir og telur ranns\u00f3kn Hollon, sem \u00e9g var a\u00f0 endursegja, gefa ansi takmarka\u00f0ar uppl\u00fdsingar. (s. 132 \u00ed skjalinu sem kr\u00e6kt er \u00ed).<\/font>
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\u00deannig a\u00f0 um lei\u00f0 og \u00f3mennta\u00f0ur (\u00ed s\u00e1lfr\u00e6\u00f0i) sj\u00faklingur eins og \u00e9g fer a\u00f0 sko\u00f0a s\u00fdnishorn af \u00feeim ranns\u00f3knum og yfirlitum sem vitna\u00f0 er \u00ed blasir vi\u00f0 tvennt: Menn vitna fram og aftur hver \u00ed annan \u00ed kross og a\u00f0 menn reyna a\u00f0 gera fyrri ranns\u00f3knir heldur \u00f3merkilegar og s\u00ednar eigin n\u00fdrri ranns\u00f3knir miklu merkilegri. \u00deessar stikkprufur eru ekki til \u00feess fallnar a\u00f0 auka tr\u00fa \u00f3mennta\u00f0s (\u00ed s\u00e1lfr\u00e6\u00f0i) sj\u00faklings \u00e1 \u00feann v\u00edsindalegan grunn sem HAM-fr\u00e6\u00f0in ku reist \u00e1, skv. \u00edslensku greininni.<\/font>
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Loks nefni \u00e9g a\u00f0 \u00ed tveimur n\u00fdlegum ranns\u00f3knum \u00fear sem sj\u00faklingarnir vissu sj\u00e1lfir hva\u00f0 er \u00ed gangi og v\u00f6ldu sj\u00e1lfir me\u00f0fer\u00f0arform, \u00fe.e. STAR*D ranns\u00f3kninni (\u00fear sem sj\u00faklingar voru haldnir mismunandi v\u00e6gu\/alvarlegu \u00feunglyndi) og REVAMP (\u00fear sem sj\u00faklingarnir voru varanalega (kr\u00f3n\u00edskt) \u00feunglyndir) m\u00e6ldist l\u00edtill e\u00f0a enginn merkjanlegur munur milli HAM sem sto\u00f0ar vi\u00f0 lyfjame\u00f0fer\u00f0 og \u00feegar \u00f6nnur lyf voru sto\u00f0 vi\u00f0 lyfjame\u00f0fer\u00f0.\u00a0<\/font><\/p>\n

Um STAR*D: Michael E. Thase o.fl.\u201eCognitive Therapy Versus Medication in Augmentation and Switch Strategies as Second-Step Treatments: A STAR*D Report<\/a>“. American Journal of Psychiatry<\/i> 164:739-752, ma\u00ed 2007. American Psychiatric Association.<\/font>
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Um REVAMP: James H. Kocsis o.fl. \u201eCognitive Behavioral Analysis System of Psychotherapy and Brief Supportive Psychotherapy for Augmentation of Antidepressant Nonresponse in Chronic Depression The REVAMP Trial<\/a>“. Archives of General Psychiatry<\/i>, 66. \u00e1rg., 11. tbl. 2009, s. 1178-1188.<\/font>
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\u00cd fyrstu f\u00e6rslunni um hva\u00f0a kostir bj\u00f3\u00f0ast \u00feunglyndissj\u00faklingi \u00e1 bor\u00f0 vi\u00f0 mig reyndi \u00e9g a\u00f0 teikna skemat\u00edska mynd yfir kostina. N\u00fa hef \u00e9g gert nokkra grein fyrir greiningu \u00feunglyndis og lyfjame\u00f0fer\u00f0 vi\u00f0 \u00fev\u00ed og n\u00e6st …<\/span> Read More …<\/span><\/a><\/span><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[9],"tags":[],"class_list":["post-387","post","type-post","status-publish","format-standard","hentry","category-gedheilsa"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts\/387","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/comments?post=387"}],"version-history":[{"count":1,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts\/387\/revisions"}],"predecessor-version":[{"id":706,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts\/387\/revisions\/706"}],"wp:attachment":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/media?parent=387"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/categories?post=387"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/tags?post=387"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}