{"id":427,"date":"2012-05-30T21:34:29","date_gmt":"2012-05-30T21:34:29","guid":{"rendered":"http:\/\/harpa.blogg.is\/2012-05-30\/svidsrannsokn-i-thunglyndisfraedum\/"},"modified":"2013-11-21T09:18:49","modified_gmt":"2013-11-21T09:18:49","slug":"svidsrannsokn-i-thunglyndisfraedum","status":"publish","type":"post","link":"https:\/\/harpahreins.com\/blogg\/2012\/05\/30\/svidsrannsokn-i-thunglyndisfraedum\/","title":{"rendered":"Svi\u00f0sranns\u00f3kn \u00ed \u00feunglyndisfr\u00e6\u00f0um"},"content":{"rendered":"<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" hspace=\"10\" vspace=\"10\" border=\"1\" src=\"https:\/\/i0.wp.com\/this.is\/harpa\/blogg_nytt\/pillumull.jpg?resize=109%2C138\" alt=\"M\u00fdldur me\u00f0 pillu\" align=\"left\" height=\"138\" width=\"109\" \/>Eitt af \u00fev\u00ed sem borgar sig a\u00f0 sko\u00f0a \u00ed vangaveltum um \u00feunglyndi, \u00feunglyndislyf og annars konar \u00feunglyndisme\u00f0fer\u00f0 er hvar f\u00f3kus ge\u00f0l\u00e6kninga er: <strong>\u00c1 hva\u00f0 bl\u00edna fr\u00e6\u00f0imenn \u00ed ge\u00f0l\u00e6kningum?<\/strong> Fyrir sk\u00f6mmu rakst \u00e9g \u00e1 svi\u00f0sranns\u00f3kn (scope review) \u00e1 umfj\u00f6llun um me\u00f0fer\u00f0ar\u00feoli\u00f0 \u00feunglyndi (Treatment resistant depression). \u00c9g minnist \u00feess ekki a\u00f0 hafa s\u00e9\u00f0 akk\u00farat \u00feessa a\u00f0fer\u00f0 nota\u00f0a \u00e1\u00f0ur en s\u00e9 \u00ed hendi m\u00e9r hversu miklar v\u00edsbendingar a\u00f0fer\u00f0in getur gefi\u00f0. \u00cd svi\u00f0sranns\u00f3kn felst a\u00f0 l\u00edta yfir svi\u00f0i\u00f0 og athuga umfj\u00f6llunarefni fr\u00e6\u00f0ilegra greina (\u00f3l\u00edkt &#8220;review&#8221;ranns\u00f3knum \u00fear sem fari\u00f0 er \u00ed saumana \u00e1 m\u00f6rgum ranns\u00f3knum \u00e1 einhverju afm\u00f6rku\u00f0u efni).<\/p>\n<p>\u00cd \u00feessari svi\u00f0sranns\u00f3kn var leita\u00f0 \u00ed sex gagnab\u00f6nkum (t.d. Medline, PsycArticles og PsychInfo) a\u00f0 fr\u00e6\u00f0igreinum sem snertu me\u00f0fer\u00f0ar\u00feoli\u00f0 \u00feunglyndi. Svi\u00f0i\u00f0 var afmarka\u00f0 vi\u00f0 einp\u00f3la \u00feunglyndi, greinar me\u00f0 enskum\u00a0\u00fatdr\u00e1ttum, sj\u00faklinga \u00e1 aldrinum 18-65 \u00e1ra og \u00fatg\u00e1fut\u00edma \u00e1 \u00e1runum 2005-2010. Sj\u00e1 Emily Jenkins\u00a0og Elliot M. Goldner. <a href=\"http:\/\/www.hindawi.com\/journals\/drt\/2012\/469680\/\" title=\"Svi\u00f0sranns\u00f3kn \u00e1 fr\u00e6\u00f0igreinum um me\u00f0fer\u00f0ar\u00feoli\u00f0 \u00feunglyndi\">Approaches to Understanding and Addressing Treatment-Resistant Depression: A Scoping Review<\/a>. <em>Depression Research and Treatment<\/em> 2012.\u00a0\u00a0Hvorugur h\u00f6funda st\u00e1tar af gr\u00e1\u00f0ufj\u00f6ld og l\u00edklega er \u00feetta vefrit, sem byggir \u00e1 Creative Commons dreifileyfi, ekki vir\u00f0ulegt ritr\u00fdnt rit en \u00e9g tel fullv\u00edst a\u00f0 h\u00f6fundarnir kunni a\u00f0 vel a\u00f0 telja og s\u00e9u l\u00e6sir\u00a0og treysti \u00fev\u00ed ni\u00f0urst\u00f6\u00f0um \u00feeirra. Alls fundu \u00feau 345 greinar sem uppfylltu fyrrnefnd skilyr\u00f0i. S\u00ed\u00f0an sko\u00f0u\u00f0u Jenkins og Goldner\u00a0um hva\u00f0 greinarnar fj\u00f6llu\u00f0u.<\/p>\n<p>\u00cd lj\u00f3s kom a\u00f0 st\u00e6rstur hluti greinanna e\u00f0a 80% \u00feeirra fjalla\u00f0i um einhvers konar r\u00e1\u00f0 e\u00f0a me\u00f0fer\u00f0 vi\u00f0 sj\u00fakd\u00f3mnum en \u00ed einungis 10%\u00a0greinanna var reynt a\u00f0 greina \u00e1st\u00e6\u00f0ur e\u00f0a hvata \u00feessa v\u00e1gests, t.d. af hverju gengur svo illa a\u00f0 r\u00e1\u00f0a b\u00f3t \u00e1 me\u00f0fer\u00f0ar\u00feolnu \u00feunglyndi. Annar t\u00edundipartur sn\u00e9rist um greiningarvi\u00f0mi\u00f0 og skilgreiningar, helstu stefnur og strauma \u00ed me\u00f0fer\u00f0, vangaveltur um hvers lags ranns\u00f3knir vanta\u00f0i o.fl..<\/p>\n<p>\u00deegar sko\u00f0a\u00f0 var hva\u00f0a vi\u00f0mi\u00f0 l\u00e1gu a\u00f0 baki greinunum e\u00f0a hvers lags ranns\u00f3knarrammi\u00a0\u00feeim var marka\u00f0ur\u00a0reyndust yfir 80% greinanna \u00ed \u00feessum gagnab\u00f6nkum bygg\u00f0ar \u00e1 l\u00edffr\u00e6\u00f0ilegum forsendum, alls 281 grein. H\u00e6gt var a\u00f0 skipa l\u00edffr\u00e6\u00f0ilegu vi\u00f0mi\u00f0unum og me\u00f0fer\u00f0 bygg\u00f0ri \u00e1 \u00feeim n\u00e1nar ni\u00f0ur:\u00a0<\/p>\n<ul>\n<li>Lyfjame\u00f0fer\u00f0 (145 greinar);<\/li>\n<li>Taugaskur\u00f0l\u00e6kninga e\u00f0a taugafr\u00e6\u00f0ileg me\u00f0fer\u00f0 (104 greinar,\u00a0um rafl\u00e6kningar, segul\u00f3munar\u00f6rvun, skreyjutaugar\u00f6rvun o.fl.);\u00a0<\/li>\n<li>Greinar sem fj\u00f6llu\u00f0u um m\u00f6gulegar l\u00edffr\u00e6\u00f0ilegar orsakir me\u00f0fer\u00f0ar\u00feolins \u00feunglyndis (30 greinar sem fj\u00f6llu\u00f0u m.a. um heilamyndat\u00f6ku og l\u00edkamleg m\u00e6lanleg einkenni sem m\u00f6gulega tengjast sl\u00edku \u00feunglyndi)\u00a0<\/li>\n<li>Greinar sem ekki f\u00e9llu undir \u00e1\u00f0urnefnt (2 talsins).<\/li>\n<\/ul>\n<p>S\u00e1 hluti greinanna sem ekki fjalla\u00f0i um l\u00edffr\u00e6\u00f0ilegt efni r\u00e9\u00f0ist af eftirt\u00f6ldu:\u00a0<\/p>\n<p>S\u00e1lfr\u00e6\u00f0ilegum vi\u00f0mi\u00f0um, \u00feetta voru\u00a03% greinanna (11 talsins);<br \/>\nF\u00e9lagsfr\u00e6\u00f0ileg vi\u00f0mi\u00f0 l\u00e1gu a\u00f0 baki 1% greinanna (2 greinum alls);<br \/>\n\u00c1 sam\u00fe\u00e6ttum vi\u00f0mi\u00f0um bygg\u00f0ust 2% greina \u00ed gagnab\u00f6nkunum (6 greinar), \u00fe.e. um s\u00e1lfr\u00e6\u00f0ilega og l\u00edffr\u00e6\u00f0ilega me\u00f0fer\u00f0 nota\u00f0a samt\u00edmis.<br \/>\nA\u00f0rar greinar voru 13% greinafj\u00f6ldans (45 talsins), t.d. greinar um skilgreiningu me\u00f0fer\u00f0ar\u00feolins \u00feunglyndis, greinar um stefnur og strauma \u00ed me\u00f0h\u00f6ndlun \u00feess o.fl.<\/p>\n<p>H\u00f6fundarnir fjalla s\u00ed\u00f0an stuttlega um helstu efnis\u00fe\u00e6tti \u00ed flokkunum. \u00cd st\u00f3ra lyfjame\u00f0fer\u00f0arflokknum eru mest \u00e1berandi greinar um \u00fdmiss konar sto\u00f0lyfjagj\u00f6f (augmentation), \u00fe.e.a.s. lyf af \u00fdmsum toga sem g\u00e6tu m\u00f6gulega n\u00fdst \u00feeim sem ekki n\u00e1 bata af \u00feunglyndislyfjum eing\u00f6ngu. \u00dear er aragr\u00fai greina um f\u00e1mennar litlar ranns\u00f3knir sem menn telja a\u00f0 gefi v\u00edsbendingar um gagnsemi einhvers tiltekins lyfs \u00ed sto\u00f0lyfjagj\u00f6f en vantar tilfinnanlega st\u00f3rar almennilega ger\u00f0ar ranns\u00f3knir, a\u00f0 s\u00f6gn Jenkins og Goldner. Sem d\u00e6mi um sto\u00f0lyfjaumfj\u00f6llun eru nefndar greinar um gagnsemi Seroquels, lit\u00edum, MAO hemla, \u00fer\u00edhringlaga ge\u00f0lyfja, skjaldkirtilsvakahorm\u00f3na, sv\u00e6fingarlyfs, s\u00fdklalyfs o.fl. Satt best a\u00f0 segja kanna\u00f0ist \u00e9g vi\u00f0 margt \u00far sto\u00f0lyfjafl\u00f3runni af eigin raun.<\/p>\n<p>N\u00e6stvins\u00e6lasta \u00feema\u00f0, \u00fe.e. greinar sem tengdust taugaskur\u00f0l\u00e6knisfr\u00e6\u00f0i e\u00f0a taugafr\u00e6\u00f0ilegri \u00f6rvun, einkennist af umfj\u00f6llun um gagnsemi einstakra a\u00f0fer\u00f0a og mati \u00e1 \u00e1h\u00e6ttu\u00fe\u00e1ttum. A\u00f0 s\u00f6gn h\u00f6funda eru margar ranns\u00f3knir sem greint er fr\u00e1 f\u00e1mennar, athugun \u00e1 hvernig \u00fe\u00e1tttakendum hefur reitt af stendur of\u00a0stutt og ni\u00f0urst\u00f6\u00f0um sumra ranns\u00f3kna ber ekki saman.<\/p>\n<p>Meirihluti \u00feeirra ellefu greina sem bygg\u00f0u \u00e1 s\u00e1lfr\u00e6\u00f0ilegum vi\u00f0mi\u00f0um sn\u00e9rust um gagnsemi hugr\u00e6nnar atferlisme\u00f0fer\u00f0ar vi\u00f0 me\u00f0fer\u00f0ar\u00feolnu \u00feunglyndi. Ni\u00f0urst\u00f6\u00f0um \u00far \u00feeim tveimur sem flokka\u00f0ar voru sem f\u00e9lagsfr\u00e6\u00f0ilegar bar ekki saman (\u00ed annarri var \u00fatkoman s\u00fa a\u00f0 \u00e1f\u00f6ll \u00e1 l\u00edfslei\u00f0inni tengdust me\u00f0fer\u00f0ar\u00feolnu \u00feunglyndi, \u00ed hinni kom \u00fat a\u00f0 engin tengsl v\u00e6ru milli \u00e1falla og me\u00f0fer\u00f0ar\u00feolins \u00feunglyndis). \u00c9g hir\u00f0i ekki um a\u00f0 rekja a\u00f0ra umfj\u00f6llun en m\u00e6li me\u00f0 grein Jenkins og Goldner hafi menn \u00e1huga \u00e1 \u00feessu ranns\u00f3knarefni.<\/p>\n<p><strong>Meginni\u00f0ursta\u00f0a h\u00f6funda \u00feessarar svi\u00f0sranns\u00f3knar er au\u00f0vita\u00f0 s\u00fa a\u00f0<\/strong> <strong>\u00e1herslan \u00e1 lyfjame\u00f0fer\u00f0 vi\u00f0 me\u00f0fer\u00f0ar\u00feolnu \u00feunglyndi yfirskyggi svi\u00f0i\u00f0<\/strong>. Greiningin &#8220;me\u00f0fer\u00f0ar\u00feoli\u00f0 \u00feunglyndi&#8221; byggist einmitt \u00e1\u00a0a\u00f0\u00a0svolei\u00f0is \u00feunglyndi svarar ekki \u00feunglyndislyfjagj\u00f6f. Lyfja\u00e1herslan beri vott um l\u00edffr\u00e6\u00f0ilega sm\u00e6ttun &#8211; a\u00f0 sj\u00f3narhorn \u00ed ge\u00f0heilbrig\u00f0isfr\u00e6\u00f0um s\u00e9\u00a0bjaga\u00f0 og veiti ekki n\u00e6gilegt svigr\u00fam til a\u00f0 gefa f\u00e9lagslegum og s\u00e1lfr\u00e6\u00f0ilegum kveikjum sj\u00fakd\u00f3msins almennilegan gaum, segja Jenkins og Goldner<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Eitt af \u00fev\u00ed sem borgar sig a\u00f0 sko\u00f0a \u00ed vangaveltum um \u00feunglyndi, \u00feunglyndislyf og annars konar \u00feunglyndisme\u00f0fer\u00f0 er hvar f\u00f3kus ge\u00f0l\u00e6kninga er: \u00c1 hva\u00f0 bl\u00edna fr\u00e6\u00f0imenn \u00ed ge\u00f0l\u00e6kningum? Fyrir sk\u00f6mmu rakst \u00e9g \u00e1 svi\u00f0sranns\u00f3kn (scope <span class=\"ellipsis\">&hellip;<\/span> <span class=\"more-link-wrap\"><a href=\"https:\/\/harpahreins.com\/blogg\/2012\/05\/30\/svidsrannsokn-i-thunglyndisfraedum\/\" class=\"more-link\"><span>Read More &#8230;<\/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":[9,11],"tags":[],"class_list":["post-427","post","type-post","status-publish","format-standard","hentry","category-gedheilsa","category-gedlyf"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts\/427","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=427"}],"version-history":[{"count":1,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts\/427\/revisions"}],"predecessor-version":[{"id":658,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/posts\/427\/revisions\/658"}],"wp:attachment":[{"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/media?parent=427"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/categories?post=427"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/harpahreins.com\/blogg\/wp-json\/wp\/v2\/tags?post=427"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}