Benh Than Kinh
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Transcript of Benh Than Kinh
5/5/12
BNH THN KINHClick to edit Master subtitle style Nguyn Th Nhung GV: Email: [email protected]
5/5/12
1. PAKINSON
5/5/12
BNH PARKINSON
L bnh thoi ha TK tin trin chm thng cht en gy thiu ht dopamine n ri lon vn ng gy tn ph khi pht 60, 5-10% khi pht < 40
Tn
a Tui
5/5/12
Sinh l bnh (pathophysiology) Mt
80-90% t bo sn xut dopamine trong vng th en (substantia nigra) thuc trung no t bo cht ca t bo thn kinh c hin din -synuclein gi l th Lewy cn bng lng acetylcholine (tc dng kch thch) v dopamine (tc dng c ch)
Trong Mt
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DOPAMINE
Trong cc catecholamine th dopamine c vai tr h TK TW cn epinephrine v norepinephrine c vai tr ngoi bin
5
C 5/5/12 3 ng dopaminergic
Th vn en: kim sot vn ng vin gia v v no gia: cm xc v h thng thng tuyn yn (t h i TY) iu ho nhiu hormone tuyn yn6
Th
Li
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DopaminergicReceptor
D1: iu ha trng lc c lon trng lc c khi dng lu di trng lc c D2: kim sot t th v cc c ng khng t bnh Parkinson D2 vng h i khi kch thch lm gim tit Prolactine7
Receptor
R
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NGUYN NHN CA HC PARKINSONHC Parkinson nguyn pht Bnh Parkinson Parkinson ngi tr HC Parkinson th pht Nhim trng : vim no, virus chm
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Thuc: thuc hng TK, reserpine, tetrabenazine, -methydopa, lithium, flunarizine Mch mu : Nhi mu nhiu c t: MPTP, CO, Mn, Hg, cyanide Chn thng Nguyn nhn khc: Suy gip, thoi ho gan u
5/5/12
Biu hin ca bnh PakinsonT R A P
remor ( chn tay run) igidity ( cng c) kinesian and bradykinesia
ostural instability (mt kh nng iu chnh t th, thng bng)
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Pathogenesis-
t bin gen (Genetic predisposition)t bin gene tng hp protein -synuclein NST s 4
-
H hng proteasome Ri lon chc nng ti th Stress oxy ha (Oxidative damage ) Cht gy hi t mi trng (Environmental toxins)
MPTP-Methyl-phenyl tetrahydropyridine
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S tng hp dopamine
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Tyrosine hydroxylase (TH), levodopa (L-DOPA), dopa decarboxylase (DDC) ,monoamine oxidase A (MAOA), bloodbrain barrier (BBB), catechol-O-methyltransferase (COMT); D1, D2, dopamine receptors.
5/5/12
-synuclein Tng Tng
tc vi cc protein khc nh tubulincan thip vo s hnh thnh ti tit tc vi mng phospholipid ca cc ti tit, vn chuyn lipid n v tr cn thit cho qu trnh hnh thnh ti tit ti synapse ch enzyme tyrosine hydroxylase (enzyme tham gia tng hp dopamine) kim sot s tng hp dopamin
c
Chc nng ca -synuclein trong qu trnh trao i dopamin
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-synuclein
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trng thi t nhin, -synuclein tn ti dng cu trc bc 1 t bin hnh thnh oligomer vi cc phin protofibril fibril trong th Lewy
Dng
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Stress oxy ha Cc
t bo sn xut dopamin ti vng cht en thng xuyn chu tc ng ca stress oxy ha do s chuyn ha dopamin thnh cc cht trung gian c t ni sinh enzyme catalase v glutathione peroxidase ng vai tr phn hy cc gc oxy ha gim trong cc vng cht en bnh nhn Pakinson
Nng
Cac kiu gc t do (Free radicals)Superoxid e: Hydrox yl: Hydroperox yl: Hydrogen peroxide: Lipid peroxide: Kiu phn ng nitrogen (RNS): Thiyl radical (oxy ha GSH): O 2 H O H O H
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2
2O 2
L H 2 O NO GS
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Gc oxy ha gy c cho t bo?
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Ri lon chc nng ti th MPTP (methylphenyl tetrahydropyridine)
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5/5/12
RI LON CHC NNG TY TH
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apopto sis
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Ma ty tng hp (amphetamin) c nhn din (qua DAT) v a vo vng tng hp dopamin lm c ch tng hp knh proton cn cho s hp thu dopamin vo ti tit dopamin tch t trong t bo
iu tr thiu ht dopamine
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Tyrosine hydroxylase (TH), levodopa (L-DOPA), dopa decarboxylase (DDC) ,monoamine oxidase A (MAOA), bloodbrain barrier (BBB), catechol-O-methyltransferase (COMT); D1, D2, dopamine receptors.
5/5/12
2. Alhzeimers disease
5/5/12
LCH S
1907, Alzheimer m t bn n 51 tui b suy gim nhn thc, o gic, hoang tng, cc triu chng thn kinh cc b. T thit cho thy cc mng (plaque), cc bi (tangle) v nhng thay i x cng mch mu
5/5/12
LM SNGCc triu chng thng gp: Mt Kh
tr nh. giao tip. th hc hay nh thng tin mi. lp k hoch v t chc.
Khng Kh
Chc
nng vn ng v phi hp b nh hng.
5/5/12
LM SNG Nhng Khng Hnh
thay i v nhn cch. c kh nng l lun. tng.
vi khng ph hp.
Hoang Kch o m Ri
ng.
gic. nh lon hnh vi
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BNH HCC 4 c im quan trng: Mt Teo
cc neuron (c bit l cc neuron cholinergic). v no. hin cc bi si thn kinh. t cc mng vim thn kinh.
Xut Tch
.
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BNH HC
Cc mng beta-amyloid Cc bi protein tau bt thng, Lm gin on chc nng bnh thng ca t bo, t gy ra cht t bo.
.
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LM SNGCc triu chng thng gp: Mt Kh
tr nh. giao tip. th hc hay nh thng tin mi. lp k hoch v t chc.
Khng Kh
Chc
nng vn ng v phi hp b nh hng.
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LM SNG Nhng Khng Hnh
thay i v nhn cch. c kh nng l lun. tng.
vi khng ph hp.
Hoang Kch o m Ri
ng.
gic. nh lon hnh vi
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Nguyn nhnC TH HI PHC
Nhim trng v cc RL min dch. RL chuyn ha v ni tit. Suy dinh dng. T mu di mng cng. Ng c. U no. Thiu oxy no. Cc vn tim, phi.
5/5/12
SINH L BNHNeuron lin quan tr nh v nhn thc l neuron cholinergic, s dng acetylcholine (ACh). Bnh Alzheimer gim khong 90% Ach.
t bin gene Presinilin-1 v -2 (PS1 v PS2) chim a s cc trng hp bnh Alzheimer loi di truyn khi pht sm (50-60 tui). Khim khuyt gene ny lm gia tng to cc mng protein betaamyloid. Mt s bt thng NST khc c th d b bnh Alzheimer nh hi chng Down (3 NST 21) b AD tui 50.
5/5/12
3. TM THN PHN LIT Schizophrenia
Thnh cng l mt trng thi tinh thn. Nu bn mun thnh cng, hy bt u suy ngh nh mnh l mt ngi thnh cng -
5/5/12
I CNGL mt bnh lon thn nng, hay gp Chim khong 1% dn s Thng bt u t 15-45 tui, him gp trc 10 tui v sau 50 tui Thng xut hin sm phi nam so vi n Bnh thng xut hin ngi tr tui nn nh hng n hc tp, cng vic ca BN Bnh c khuynh hng tin trin mn tnh Bnh thng c RL hnh vi => nh hng trt t, an ton XH
5/5/12
Bleuler a ra 4 triu chng c bnca TTPLq
Ri lon lin tng (Association disturbances) Ri lon cm xc (Affective disturbances) T k (Autism) Hai chiu (Ambivalence)
q q q
Lm sngq
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c im chung: Cac ri loan v t duy va tri giac Ngi bnh cho rng cac nghi cam xuc va hanh vi su kin nht cua ho bi ngi khac bit hoc chia s va co nhng sc manh siu nhin hoc t nhin chi phi cac y nghi va hanh vi cua ho theo nhng phng thc ki quai
q
5/5/12
Ngi bnh cam thy minh la trung tm cua tt moi vic ang xay ra ao giac c bit la ao thanh rt thng gp
Cac
Khi
bnh co th cp tinh vi ri loan nng n v hanh vi hoc m i vi s phat trin t t cac y nghi va hanh vi ki di
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Mt s biu hin thng gp1. 2. 3. 4. 5. 6.
Tnh thiu ha hp v t k Gim st th nng tm thn Cc ri lon t duy Cc ri lon tri gic Cc ri lon cm xc Cc ri lon hnh vi
5/5/121.
Thiu hoa hp va t ki
Thiu hoa hp: Thiu hoa hp gia cac hoat ng tm thn cua ngi bnh va gia ngi bnh vi mi trng xung quanh T ki: Ngi bnh ngay cang tch minh ra khoi thc tai, thu minh vao th gii ni tm
5/5/122.
Giam sut th nng tm thn
Ngi bnh khng co cac ri loan nng v tri nh, tri nng, ma chu yu la s giam sut hoat ng trong cac linh vc nh trong hoc tp va cng tac, trong quan h xa hi va chm soc cho ban thn
5/5/12 3.
Cac ri loan t duyRi loan hinh thc t duy: T duy ngheo nan, ngt quang, khng lin quan, tra li bn canh, sang tao ngn ng, noi h ln, noi mt minh hoc khng noi Ri loan ni dung t duy: Cac hoang tng, hay gp la hoang tng bi hai, bi theo doi, t cao, phat minhCo th co t duy vang thanh ting, t duy phat thanh, t duy bi anh cp hay cac hoang tng vi ni dung ki quai
5/5/124.
Cac ri loan tri giacCo th gp moi loai ao giac hay gp nht la ao thanh Ni dung: chi bi, e da, ra lnh, bn tn v BN, ph bnh hnh vi v ngh ca h o thanh mnh lnh n th gy nguy him cho bn thn BN hay nhng ngi chung quanh
5/5/125.
Cac ri loan cam xucCam xuc cun mon, bang quan, v cam Cm xc tri ngc, cm xc hai chiu hay cm xc thiu ha hp cng hay gp
5/5/126.
Cac ri loan hanh viTri tr, chm chap, th vi moi vic, n mc li thi, hnh vi k d, cng trng lc, p ph, tn cng ngi xung quanh, t gy thng tch cho bn thn hay t st
5/5/12
q
Hin nay cac triu chng cua bnh TTPL c chia thanh hai nhom triu chng Triu chng dng tinh Triu chng m tinh
5/5/12
Triu chng dng tinh: Hoang tng, ao giac, kich ng, cng trng lc, t duy khng lin quan,... Triu chng m tinh: Cam xuc cun mon, th , v cam, mt ch, t duy ngho nn,
5/5/12
Chn ona. T duy vang thnh ting, b p t, b nh cp, b pht thanh b. Hoang tng b kim sot, chi phi hay b ng c. o thanh li ni lin tc: bnh phm, bn tn v BN hay o thanh li ni xut pht t 1 phn no ca c th d. Cc loi hoang tng dai dng khc khng ph hp vi vn ha v hon ton khng th c
5/5/12
Chn on xc nhe)
f)
Cc o gic dai dng bt k loi no km cc hoang tng thong qua hay mi hnh thnh, khng c ni dung cm xc r rt hay km cc nh kin dai dng hoc cc o gic xut hin hng ngy trong nhiu tun, nhiu thng lin tip T duy b ngt qung hay xn ln => ngn ng khng lin quan hoc khng ph hp hoc sng to ngn ng
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Chn on xc nhg) h)
Hnh vi cng trng lc V cm r rt, ngn ng ngho nn, s cn mn hay khng ph hp ca cc phn ng cm xc => tch ri XH, gim st thnh tch XH Hnh vi khng mc ch, khng hot ng, t thu rt v c lp XH
i)
5/5/12
Chn on TTPL cn:
t nht 1 triu chng r rt thuc bt k 1 nhm trong cc nhm t (a) n (d) hay nht 2 trong cc nhm t (e) n (h) 1 thng hay lu hn
t
Trong Nu
