ϴ ΰ ౹ [3] ˸ ִ
ü ð 鿪, Ű, ٰݰ Ͼ, óϱ , ü ȸ, ߴ, ġ , , , 鿪, ִ. ݴ Ҹ() ð , Ƿ, ߷ , ɷ , ְ , Ҿ , Ŀ ȭ , 鿪ý ϵ ʷǰ ȯ, 索 ȯ , Ҿ ȯ ͰDZ Ѵ. 24ð ڿ 0.1% ¿͵ ٰ Ѵ.
Ҹ (Ӽ) Ǵ ο з ִµ, Ը , , ϰ ְ, 1 Ҹ 2 Ҹ ִ. ο з , Ҹ ϼ ܱҸ(Ͽ / Ǵ Ʈ ) Ҹ(ֿ ̻ / ܱҸ Ҹ鿡 Ʈ ȭǴ Ǵ ȯ )ε з ִ. ̷ Ҹ() зϴ , ¿ ġ DZ ̴. , Ʈܿ Ư ߿ 1 Ҹ鿡 ⼺ 鹫ȣ, Ҿı, ֱ⼺ , ֱ⼺ , Ҿֵ ȯ, (1.5), ȭ, ߵ , , ̻, õĵ ȯ Ǿ ϴ 2 Ҹ Ҹ üӸ ƴ϶ ߿ ذᵵ ÿ ̷ Ѵ.
ֱ DSM-5(Diagnostic and Statistical Manual Disorders) 1, 2 з ϰ Ҹ (insomnia disorders) ƴ. ұϰ, κм ߿伺 . , Ҹ() ȣϴ ȯڰ з м ع ã ߿ϴ. ߰ Ҹ ϴ ȯ õ Ҵ. Ҹ ȣϴ ȯڰ Ȥó ش ȯ ִ, ش Ǵ õ Ȯ ʿ䰡 ִ.
(Ӽ) з ϰ ٸ, ȯ ° ľ Ǹ, ش ε ȯڸ ϱ ٶ.
, ü ȭ Ǹ鼭 ڿ Ҹ ٴ ϰ ̸ Ѵ. ̷ ̵鿡 ð ħ ڰ ʿ ŭ Ͽ ˷־ Ƚɽų ʿ䰡 ִ. Ҹ鿡 ȭǴ . ȯ ߾ ϹǷ, ̵鿡 ָ ް ִ. ̷ ġǿ Ǵ ġ ִ.
Ҹ ġῡ ġ(pharmacological treatment) ġ(non-pharmacological treatment) ִ. AASM(American association of sleep medicine) ϸ ġᰡ first line treatment Ǿ Ѵٰ ϰ , ȿ ʴٸ ġḦ ϰ ȴ. õ ġ 캸, 1 Ÿ(diphenhydramine, doxylamine, dimetindene , dimenhydrinate), (Melatonin,ī), (sedating antidepressants), ̾ ü ȿ(benzodiazepine receptor agonist), ü ȿ(melatonin receptor agonist -Ramelteon, ̱, Ϻ, ƽþƿ / 2008EMA ź / ȿɿ ٰ / ۿ 5%̻ , Ƿ, , ) , ̾ ü ȿ ٽ benzodiazepine(flurazepam, estrazolam, quazepam, temazepam, triazolam) benzodiazepine receptor agonist( Z-drug̶ Ҹ, zolpidem, zaleplon, eszopiclone) зȴ.
1 Ÿ ˷ ֵ ݸۿ뿡 ۿ Ǹ, Ҹ ġῡ ȿ ٰϴ ڷᰡ · Ǵ Ҹ ʴ´. Ư (diphenhydramine) ϱ Ǹ Ÿμ ְ ϰų, ߷ ϴ ϴ 쿡 ɰ ʷ ִ. ݸ ۿ , ΰ 鿡 ̳ 财ָ ְ Ѵ. ȿ ĥ ӵ , Ư ε ɷ ջ ۿ Ƿ ʿ䰡 ִ.
Ǵ ü 鿡 ʿϱ , ν Ҹ ġѴٴ δ δ. õ ϰ ִ. ڵ ȿ Ͽ ڴ ѿ پ ӻ ܱ(4) , (primary sleep disorders) ġϴµ ȿ ٰŰ . Ͽ ƴϴ. ٸ ܱ ϴ ü ذ δ. Ͽ. 17 Ÿм ɸ ð Ű ð Ų. ߴ. ũ ִ Ҹȯڵ(delayed sleep phase insomnia) ̴.
ȯڵ ħð(3 Ǵ4) ð ( 10 30) ſ ʴ. ð ̷ ħ α ¿ . Ҹ ȯڴ ħ3-4ð 5mg ϸ ð ȭ ִ. ۰ ſ ȿ ִ. ħ ϰų ġ Ҹ ȯڰ ȿ Ÿ ʴ´. ħ к ̴. ݸ, ġ ε Ҹ ġÿ ȿ̴ 差 ۿ ʾ, ȯ ִ. , 4 1 8mg뷮(뷮) ȣ к ȭ Ͼٰ Ǿ.
ϰ Ҹġῡ off-label Ǵ ̴. ǥδ trazodone, amitriptylline, mirtazapine , ġ 뷮ٴ 뷮 Ҹ ġῡ ȴ. 뷮̶ ۿ ̸, ȿɿ ӻ Ͱ ̴. Ϲ 뷮 ݸ ȿ , 财, ȯ, ⸳ , ߱, ɺƹ ֱ, ̵ο ̵ Ҹ ġ ġ ϰ ִ.
̾ ü ȿ(benzodiazepine receptor agonist), benzodiazepine(flurazepam, estrazolam, quazepam, temazepam, triazolam) GABAAüǥ-subunit Ư ϱ , Ҿ, װ ۿ ִ. , , ߷ , , ħ ȿ , ټ Ѵ. Ư ü ɷ ̿ ſ ũ. sleep architecture deep sleep ҽŰ light sleep ϸ ʷϱ ̸, ᱹ ȸҰ ¿ ̸ ִ. ߿ ̵ (tolerance) (dependency) ϴ ū ̴. κ benzodiazepine 2-4̳ ϰ , δ Ҹ ۿ . ̷ ൿп پϰ ȴ. (triazolam: short acting ݰ 1.5-5.5ð/ flurazepam: long acting ݰ 47-100ð) , ̸ ̿ؼ ̾ (BDZ Tapering off) ϱ Ѵ. ̿ ڿ ٽ Ѵ.
ϳ ̾ ü ȿμ benzodiazepine receptor agonist(Z-drug/ zolpidem, zaleplon, eszopiclone) Ư GABAAü subunit ϹǷ ۿ ϸ zaleplon, zolpidem, eszopiclone ǥ̳ zolpidem Ͽ Դ. Ambien(zolpidem) Ư Ҹϱ , ȸ ۿð Ambien CR ̴ Ǿ ִ. ù° ż صǾ ȯڸ ϰ, صǾ ð ֹǷ ӻ迡 Ambien CR ð 10 Ű鼭 ߿ Ƚ ٿִ ȮεǾ. Ambien ħ ʾҴ Ambien CR ۿ ħ ϸ鼭, ְ ɷ¿ ĥ ִ. ȸ ̽ȭ DZ Ͽ. Դٰ Ambien CR ڱ ߴܽ ݵ Ҹ ʷ ִٴ ̴. ۿδ , , Ƿ, , Ǹ, , ָ ų , ڱ ߴϸ Ϸ糪 Ʋ Ҹ ȭ ִ. (ݵ Ҹ), ٸ ݴδ Ҿ, ִ. ȣۿ SSRI ؼ ȵȴ.
ݱ 캻 ó, Ҹ ġ Ȱ ־ ̵ Ƚϰ . , Ҹ ȯڰ ̿ Ȥ ſ ƴ. Benzodiazepine ϴٰ ڱ ߴϸ ĥ Ҹ Ѵ. ᱹ ĥȸ ٽ ϸ ѵ ̷ ߴܽ ݵ Ҹ(rebound insomnia) ް ǰ, ̴ ٽ ã ϴ ʷμ ü İ Ǽȯ Ͱȴ.
ذ ִ Ϻ ü ڿ . ذϷ ǻ Ͽ Ⱓ ģ ݴ(Withdrawal strategy) (Tapeing off)ȹ õؾ Ѵ. ̷ ݴ ̵ ħ ֿ ǰ ְ ̽鵵 ̿ ϰ Ѵ.
[Ϲ ]
Ϲ ϳ ȯڿ 1ϸ ˾ 뷮1/4 ߶鼭 뷮 ٿ ̴. ȯڰ 4ָ ߴ ְ ӻǵ ñⰡ ʹ ٰ ִ. ڵ GABA ü ϸ ϰ ִ. ̵ 4ֶ ð ü ȸDZ ϴٰ Ǵϱ ̴. Ⱓ BDZ 32-42% ȿ ʾҴٴ ־, ӻ ʹ ӵ , ݴ (seizure disorder) ʵ . ܰ ݴ ݷ 18-24 Ÿ ִ. BDZ ִ 뷮 ȭ ſ ΰϰ Ͽ ɰ 1/4п ū ִ.
ٸ Ϲ μ, 1ϵ 1 1˾ ٿ ִ. . ߳ ް ȭ ɰ ´.
[The Ashton protocol]
̷ Ͽ The Ashton protocol̴. ̴ ŷ ־ θ ̻ ǰ ִ ħ̴. ̴ ٸ newer, shorter acting benzodiazepines 뷮 ۰, ݰⰡ diazepam(valium) ̿ؼ ϴ Ѵ. clonazepam ߰ ݰ⸦ , 뷮 0.5mg̴. Clonazepam 0.5mg 뷮̶ , ̴ diazepam(valium) 10mg شȴ. ̴ 뷮 clonazepam diazepam 20̻ ϴٴ ̴. ᱹ diazepam ȯϿ , ð ̷ ְ ȴ. ̿ ٽô Table.1 ̸ Ͽ ȹ ȴ. ( ó: ttp://www.benzo.org.uk )
Chrystal Heather Ashton DM, FRCP the University of Newcastle upon Tyne Clinical Psycho-pharmacology μ ̸, 12Ⱓ BDZ ݴ Ͽ ִ ȸ ִ the North East Council for Addictions (NECA) ҼӵǾ BDZ ٷ ôü ϵ ϰ ִ о ְ ˷ ִ. Ashton 20071 ߿ ̴.
IMPORTANT MESSAGE FROM PROFESSOR ASHTON, JANUARY 2007
(1)It is worth pointing out to your prescriber that the withdrawal schedules provided in the manual are only intended as general guides. The rate of tapering should never be rigid but should be flexible and controlled by the patient, not the doctor, according to the patient's individual needs which are different in every case. The decision to withdraw is also the patient's decision and should not be forced by the doctor. ( ƴ κ Ȳ ̾ Ѵ, ǻ簡 ƴ ȯ 켱Ѵ.
(2)Note that alcohol acts like benzodiazepines and should be used, if at all, in strict moderation as advised in this manual. (ڿ BDZ ϰ )
(3)Antibiotics for some reason, sometimes seem to aggravate withdrawal symptoms. However, one class of antibiotics, the quinolones, actually displace benzodiazepines from their binding sites on GABA-receptors. These can precipitate acute withdrawal in people taking or tapering from benzodiazepines. It may be necessary to take antibiotics during benzodiazepine withdrawal but if possible the quinolones should be avoided. (There are at least six different quinolones - ask your doctor if in doubt).( δ ݴ ݷϰ ų ִ , quinolones GABAü պ BDZ ϰ ̰ 鿡 ݴ ˹߽ų ִ. Ⱓ ϰ , , quinolones ݵ ؾ Ѵ.)
Ashton 2-4ְ5-10%̻ Ѵ. ̴ ٲ㸻ϸ ȯ ʱ뷮 κ 10̻ ɸٴ ̴. ߿ ΰϰ , ְ ȹ Ȧϵ ϰ ִ. ̵ ʱ ȹ Ⱓ ʰϴ ſ 幰, ʰǴ Ⱓ BDZ ־ ߿ ʴٰ Ѵ.
Schedule 1alprazolam(Xanax)diazepam(Valium)the Ashton protocol ÷ ̴. (ó: http://www.benzo.org.uk )
ܿ Ashton protocol ȯ ϴ ״ ϴ ̵ε ְ , Ÿ, װ غϱ ϴ ̵ε鵵 ִ.
̺
̷ κ ̻ ð ҿ ִ. , õ ̿ 곪 ǰɽǰ ݷ ݴ Ǽȯ, ݵ Ҹ ʷ ʰ ϰ Ҹ ġϴ ϴ. , ǻ Ͽ ̿ ݴ ΰ õ ȯ δ 氨 ִ. ϴ ǻ ӻ ȯڿ Բ ռ Ashton protocol ħ鿡 Z-drug BDZ ǽϰ ִٰ Ѵ.