急性精神病性表现的库欣综合征:一例病例报告（英文）

一位36岁的中国女性因出现狂躁、被害妄想和自杀意念3天被送至某综合医院急诊。六个月来患者易醒、过度警觉并出现躯体症状。入心身病房后,体检发现该患者满月脸、突眼,且双腿有紫纹,因此考虑急性精神症状继发于库欣综合征。血浆皮质醇、促肾上腺皮质激素(adrenocorticotropic hormone ACTH)水平升高,腹部计算机断层扫描(computed tomography,CT)发现左肾上腺肿块,证实了该诊断。使用小剂量喹硫平(75-125 mg/d)和阿普唑仑(0.4 mg/qn)来控制精神病性症状并改善其睡眠。将一个良性的非ACTH依赖性肾上腺肿瘤手术切除后,患者的皮质醇和ACTH水平恢复正常,其精神症状也在一个月内逐渐减少,此时该患者出院。患者出院后一直门诊随诊,维持喹硫平治疗(因为担心停药对睡眠和情绪稳定的影响),总时间持续1年左右,剂量从50mg渐减至25mg至减停。这时她的精神症状已经完全消失。该病例中,病人具有库欣综合征的特殊症状,因此相对容易诊断;但在库欣综合征中急性精神病性症状可能会危及生命,也可能不出现库欣综合征的典型躯体症状(如果皮质醇增多症不严重),所以临床精神科医师在鉴别难以解释的急性精神病时,应该始终考虑将库欣综合征纳入可能的鉴别诊断。     

垂体ACTH腺瘤经蝶术后复发的诊断与治疗

目的讨论复发性垂体促肾上腺皮质激素(ACTH)腺瘤的诊断和治疗.方法男性6例,女性12例.年龄8～43岁,平均25.7岁.平均病程29.5个月.均表现典型库欣综合征,诊断为垂体ACTH腺瘤行经蝶手术,术后病理为垂体腺瘤.术后皮质醇曾降至正常半年以上,再次出现库欣综合征,血和尿皮质醇增高,CT或MRI显示9例垂体腺瘤复发.12例采用再次经蝶手术,术中9例发现肿瘤,3例未发现肿瘤.6例未再行手术,其中4例行垂体放疗和肾上腺切除术,2例行肾上腺切除术.结果随诊1～12年,再次经蝶手术的治愈缓解率为58%(7/12).共有7例行垂体放疗加肾上腺切除术,4例行肾上腺切除术,术后皮质醇下降,有5例需用激素替代治疗.结论对于复发性垂体ACTH腺瘤首先应进行再次经蝶手术,如果术后皮质醇仍高,可行垂体放疗和/或肾上腺切除术.     

喹硫平联合血塞通治疗血管性痴呆精神症状的疗效分析

目的探讨喹硫平联合血塞通治疗血管性痴呆(VD)精神症状的疗效。方法将64例VD患者随机分为联合组(32例)及喹硫平组(32例),均给予喹硫平50~400 mg/d,联合组加用血塞通600 mg/d,治疗15 d,总疗程为4周。于治疗前、治疗第1、2、3、4周末采用神经精神问卷(NPI)评价精神症状,治疗结束后采用治疗中症状量表(TESS)评价不良反应。结果与喹硫平组比较,联合组治疗前NPI评分显著增高,治疗后各时间点NPI评分均显著降低(均P0.001)。联合组11例(34.3%)患者出现不良反应,喹硫平组22例(68.8%)患者出现不良反应;两组间不良反应出现率差异有统计学意义(P0.01)。患者予对症处理后不良反应均消失。联合组TESS量表各项评分均显著低于喹硫平组(P0.05~0.01)。结论喹硫平联合血塞通治疗VD精神行为障碍优于喹硫平单药治疗,起效快,不良反应少,安全性高。     

住院未成年精神疾病患者抗精神病药物使用情况调查

目的调查2018年广州医科大学附属脑科医院住院未成年精神疾病患者抗精神病药物使用情况。方法通过电子住院信息系统收集2018年广州医科大学附属脑科医院所有住院年龄≤18岁且确诊为精神疾病的患者的临床、人口学和出院当日使用抗精神病药物情况,进行统计和分析。结果共入组626例未成年精神疾病患者,出院时93例(14.9%)患者未使用抗精神病药物,92例(14.7%)患者接受两种抗精神病药物联合治疗,441例(70.4%)患者使用一种抗精神病药物治疗;双相障碍(233例)、抑郁症(124例)、精神分裂症(108例)是诊断频率最高的三种精神疾病,其抗精神病药物使用率为别为94.0%、74.2%和99.1%。使用频率最高五种抗精神病药物依次为喹硫平、奥氮平、阿立哌唑、利培酮和帕利哌酮;双相障碍和抑郁症使用频率最高的抗精神病药物为喹硫平,精神分裂症最常使用奥氮平;儿童组患者最常使用阿立哌唑,青少年组患者最常使用喹硫平;男性患者最常使用奥氮平,女性患者最常使用喹硫平。儿童组患者阿立哌唑、利培酮和喹硫平剂量显著低于青少年组,男女两组间抗精神病药物剂量无显著差异。结论大部分住院未成年精神疾病患者在出院时接受单种抗精神病药物治疗,不同诊断抗精神病药物使用种类不同,不同年龄组抗精神病药物使用种类、剂量不同。     

喹硫平治疗精神分裂症急性发作

本文叙述作者对精神分裂症急性发作时采用喹硫平治疗的临床经验和观点。急性精神分裂症可能需注射镇静药物,但作者相信单独服用抗精神病药或与其他药物合用都具有药物干预的关键作用。喹硫平所具有这种优点并成功治疗精神分裂症急性式恶化时所表现的攻击性、焦虑和敌对症状。基于对公开发表的研究论文、最近的国际性精神病学会议资料和作者临床试验的回顾,作者提出一种比现行喹硫平处方资料更为快速的药物启动和增加剂量方案,并认为对急性精神分裂症住院患者是安全、有效的,具体方法为第2天加至400mg,第3天加至600mg,第4天加至800mg,对各别严重病例,第1天即为300mg.第2天加至600mg,第3天加至900mg。(必需注意,对首发精神分裂症患者剂量应适当减低)。而目前的处方建议通常为剂量最高至750mg/d(美国和加拿大为800 mg/d),越来越多的证据提示,喹硫平加至1 600mg/d时.一些患者仍能很好地耐受。通常认为.新型抗精神病药在耐受性方面优于常规抗精神病药,然而在新一代抗精神病药之间还是存在耐受性方面的明显差异。喹硫平在耐受性方面具有突出的优势而为患者良好地接受,而且这种良好的接受能促进患者的服药依从性和生活质量的改善。正因如此,作者认为喹硫平可成为精神分裂症急性发作或恶化的一线选择药物。     

临床如何选择非经典药物——喹硫平治疗精神分裂症急性发作

本文叙述作者对精神分裂症急性发作时采用喹硫平治疗的临床经验和观点。急性精神分裂症可能需注射镇静药物，但作者相信单独服用抗精神病药或与其他药物合用都具有药物干预的关键作用。喹硫平所具有这种优点并成功治疗精神分裂症急性式恶化时所表现的攻击性、焦虑和敌对症状。基于对公开发表的研究论文、最近的国际性精神病学会议资料和作者临床试验的回顾，作者提出一种比现行喹硫平处方资料更为快速的药物启动和增加剂量方案，并认为对急性精神分裂症住院患者是安全、有效的，具体方法为第2天加至400mg，第3天加至600mg，第4天加至800mg，对各别严重病例，第1天即为300mg，第2天加至600mg，第3天加至900mg。(必需注意，对首发精神分裂症患者剂量应适当减低)。而目前的处方建议通常为剂量最高至750mg／d(美国和加拿大为800mg／d)，越来越多的证据提示．喹硫平加至1600mg／d时．一些患者仍能很好地耐受。通常认为，新型抗精神病药在耐受性方面优于常规抗精神病药．然而在新一代抗精神病药之间还是存在耐受性方面的明显差异。喹硫平在耐受性方面具有突出的优势而为患者良好地接受．而且这种良好的接受能促进患者的服药依从性和生活质量的改善。正因如此．作者认为喹硫平可成为精神分裂症急性发作或恶化的一线选择药物。     

喹硫平合并碳酸锂治疗伴精神病性症状抑郁症临床对照研究

目的比较喹硫平合并碳酸锂与喹硫平合并帕罗西汀对有精神病性症状的抑郁症的疗效和安全性。方法选取2010年-2011年广西脑科医院住院患者120例,均符合《国际疾病分类(第10版)》(ICD-10)中伴精神病性症状抑郁症的诊断标准,按入组先后顺序随机分为研究组(喹硫平合并碳酸锂组)和对照组(喹硫平合并帕罗西汀组)各60例,疗程8周,使用汉密尔顿抑郁量表(HAMD)、阳性与阴性症状量表(PANSS)分别于治疗前和治疗第1、2、4、8周评定疗效,以副反应量表(TESS)评定不良反应。结果治疗8周两组HAMD、PANSS评分差异无统计学意义(P0.05),研究组显效率为71.7%,对照组显效率为78.3%。TESS评分差异无统计学意义(P均0.05)。结论喹硫平合并碳酸锂治疗伴精神病性症状的抑郁症的效果与喹硫平合并帕罗西汀治疗效果相当,安全性相似。     

慢性精神分裂症患者应用氯氮平和喹硫平的疗效及认知功能变化

目的 观察氯氮平和喹硫平对慢性精神分裂症的治疗效果及治疗后患者认知功能的变化。方法 选取2010-02—2012-11在我院就诊的90例慢性精神分裂症患者,将经典抗精神病药物随机分配替换为氯氮平和喹硫平,分别对入组时和8个月末的精神症状及认知功能进行评估,用不良反应症状量表评定治疗16周后的不良反应。结果 88例临床稳定型慢性精神分裂症患者在经氯氮平或喹硫平治疗8个月后精神症状均明显好转,8个月后的认知功能也有显著改善,差异有统计学意义(P<0.05)。换药16周后喹硫平组患者出现活动减少、嗜睡、便秘、流涎、头晕及体质量增加等不良反应的发生率明显少于氯氮平组,差异有统计学意义(P<0.05)。结论 氯氮平和喹硫平对慢性精神分裂症均有显著治疗作用,且二者在认知功能的改善及疗效方面无显著差异,但与氯氮平相比,喹硫平的不良反应较少,是一种相对安全有效的抗精神病药物。     

新冠肺炎疫情期间急性短暂性精神病性障碍伴自杀1例

本文目的是为急性短暂性精神病性障碍的诊治提供参考。在新冠肺炎爆发期间,患者有疫区旅游史,并出现发热、咳嗽症状,属于新冠肺炎疑似病例,由此而导致患者急起出现幻觉、妄想等精神症状,并伴有自杀行为。经过1周喹硫平联合心理治疗后,患者症状改善,社会功能逐渐恢复。     

喹硫平治疗神经内科门诊阿尔茨海默病患者精神行为症状的效果分析

目的分析神经内科门诊阿尔茨海默病患者精神行为症状治疗效果。方法选取在我院门诊就诊的伴精神行为症状的阿尔茨海默病患者80例,随机分为喹硫平组和利培酮组各40人,喹硫平组服用喹硫平;利培酮组服用利培酮观察所有患者治疗前后BEHAVE-AD、治疗效果、不良反应出现情况进行记录和分析。结果两组治疗前、治疗后2周BEHAVE-AD与疗效分级差异无统计学意义,P=0.8829,但是治疗后4周,喹硫平组BEHAVE-AD(10.5±5.6)小于利培酮组(12.8±4.3),差异有统计学意义,P=0.0427;喹硫平组出现锥体外系反应比率(5.00%)小于利培酮组(25.00%),差异有统计学意义,P=0.0123。结论喹硫平对于控制阿尔茨海默病患者精神行为症状的短期疗效优于利培酮,安全性也更优,值得推广。     

What psychiatrists should know about sporadic Creutzfeldt-Jakob disease

OBJECTIVE: To provide psychiatrists with relevant, up to date information about sporadic Creutzfeldt-Jakob disease. CONCLUSIONS: A 59-year-old bookkeeper presented with psychiatric symptoms in the context of stressors and past history of depression, for which her GP prescribed sertraline and olanzapine. Following a further deterioration in her mental state she was referred to acute psychiatric services, and there found to have dementia and myoclonus, and investigations supported a diagnosis of probable Creutzfeldt-Jakob disease, sporadic type (sCJD). This paper serves to outline the emerging literature challenging the notion that suggests psychiatric symptoms are uncommon in the presentation of sCJD.     

A case of marital discord and secondary depression with attempted suicide resulting from REM sleep behavior disorder in a 35-year-old woman

A 35-year-old woman with childhood-onset parasomnia, marked by arm waving with talking and shouting, developed marital discord solely because her parasomnia disrupted her husband's sleep. She became progressively depressed after her husband began to sleep in a separate bedroom, eventually becoming acutely suicidal. There had been no psychiatric history prior to her marriage. An evaluation with a sleep specialist-neurologist and polysomnographic monitoring confirmed the diagnosis of idiopathic REM sleep behavior disorder (RBD). Treatment with clonazepam, 1.0-1.5 mg at bedtime controlled her RBD and she again slept with her husband, which fully resolved their marital discord and her secondary depression.     

血锂浓度正常时锂盐中毒的病例报告(英文)

患者是一名18岁的女性,因首次躁狂发作而入院。给予常规剂量的碳酸锂治疗,两周后她的症状缓解;随即出院,在家服药剂量为250 mg,每天两次。出院五天后,她由于食欲差和意识模糊被送入一家综合医院急诊室。由于综合医院医师无法诊断该问题,患者被转诊送入我院。虽然入院时血锂浓度为0.57 mmol/L(即,治疗量的下限),但是她已经表现出锂盐中毒的症状,包括无尿,四肢震颤、吐词不清、肌张力升高、和腱反射亢进。给予甘露醇静滴,她的急性症状很快得到缓解。此病例说明,无论血锂浓度的高低,对使用锂盐的患者必须监测锂盐中毒的临床症状;同时必须告知患者、家属、和普通医师锂盐中毒的症状和处理。     

Psychiatric Symptoms in Temporal Lobe Epilepsy with Left Mesial Hippocampal Sclerosis

A 16-year-old woman was referred to us for depression and persistent suicidal and homicidal ideation. From 2010, the patient visited a neurologist due to recurrent grand mal epilepsy, auditory and visual hallucinations, episodic memory loss, and persistent depression. Upon admission, it was revealed through clinical history taking that she had suffered from chronic bullying from same-sex peers and sexual abuse, twice, from an adult male in the neighborhood when she was 10 years old. A brain magnetic resonance imaging study showed left mesial hippocampal sclerosis. The patient exhibited improvement of her psychiatric symptoms after treatment with a combination of fluoxetine (30 mg) and aripiprazole (10 mg). Children and adolescents with epilepsy experience conflicts in the family, challenges at school, stigma, and psychosocial limitations or deprivations due to their comorbid psychiatric symptoms and hence, psychiatric evaluation and early intervention is important when treating these patients.     

A 'psychogenic psychosis' turns out to be a subarachnoid haemorrhage. A case study

A 50-year-old woman is admitted to the emergency ward by reason of her psychotic state. Because she has a history of psychiatric problems and has been previously diagnosed as having borderline personality disorder it is assumed that she has had a brief psychogenic psychosis. When the psychosis recurs and the symptoms increase in intensity the patient is given a computerized tomography brain scan. The scan reveals a subarachnoid haemorrhage. In discussing this case history we try to interpret the symptoms of this neurological disorder against the background of the premorbid psychiatric diagnosis. We supplement our interpretation with data from case histories reported in the literature.     

Adrenal Cushing's syndrome may resemble eating disorders

We encountered a patient who presented extreme weight loss and received an eating disorder diagnosis that was later identified as adrenal Cushing's syndrome. A 32-year-old woman with a 2-year history of an eating disorder was admitted to our psychiatric ward due to dehydration, malnutrition and low weight. Her height and body weight were 152.1 cm and 29.8 kg, respectively (body mass index: 12.8). Her other symptoms included a depressed mood, decreased interest, retardation and suicidal ideation. Standard medical cares were prescribed to treat the depressive symptoms and eating disorder, but the depressive episode and low body weight of the patient persisted. Computed tomography of the abdomen revealed an unexpected left adrenal gland tumor. Cushing's syndrome was diagnosed based on several endocrinological examinations. After an enucleation of the left adrenal gland tumor, the patient began eating, and her body weight increased gradually. Her body weight increased to 42.0–47.0 kg (body mass index: 18.2–20.3). Her mental and physical conditions had stabilized. This case suggests that adrenal Cushing's syndrome may resemble eating disorders.     

Ziprasidone in the treatment of delayed carbon monoxide encephalopathy

Delayed carbon monoxide (CO) encephalopathy is a serious complication of acute CO poisoning. We present a case of successful treatment of ziprasidone, a newer atypical antipsychotic, in delayed CO encephalopathy. A 52-year-old depressed woman suffered acute CO intoxication after an attempt of suicide by burning charcoal. She was initially treated with hyperbaric oxygen (HBO) therapy for the acute intoxication. One week later, the patient developed neuropsychiatric symptoms including parkinsonism, tardive dyskinesia (TD), cognitive deterioration, urinary incontinence, gait disturbance, mutism, disorientation to time, place and person, and disorganized as well as disturbing behavior. During her psychiatric hospitalization, the patient had been treated with daily HBO therapy, bromocriptine (2.5 mg/day), the conventional antipsychotic sulpiride (600 mg/day), and atypical antipsychotics such as risperidone (5 mg/day) and quetiapine (400 mg/day). However, her delayed neuropsychiatric sequelae of CO intoxication persisted despite of these treatments. It was until she had been treated with ziprasidone (80 mg/day) for 10 days that her mental condition was improved. With ziprasidone therapy, the patient obtained substantial improvement in her neuropsychiatric symptoms, cognitive function, and daily activities. Our case indicates that ziprasidone can be used effectively in the treatment of delayed CO encephalopathy.     

Hallucinations and comorbid renal tubular acidosis caused by topiramate in a patient with psychiatric history

Few studies have shown that topiramate may induce psychiatric symptoms and metabolic disorders, respectively. Here, we reported a 13-year-old female who presented with topiramate-induced hallucinations and comorbid renal tubular acidosis. She had a history of psychiatric illness and had been taking the medication for 3 months without prior side effects. After the discontinuation of topiramate, she was treated with supplementary potassium and sodium bicarbonate. Subsequently, her psychiatric symptoms and biochemical findings improved. Recognition of drug-induced psychotic symptoms and renal tubular acidosis is important during concomitant topiramate therapy in psychiatric clinic.     

Deep venous thrombosis of the leg due to psychiatric stupor

Abstract  We report the cases of two patients with psychiatric stupor who developed venous thrombosis. A 29-year-old schizophrenic woman had been hospitalized in psychiatric institutions three times because of stupor associated with auditory hallucinations and thought blocking. These symptoms recurred and she was admitted to our hospital with deep venous thrombosis of her left leg. The other patient was a 67-year-old woman with depression. She had also suffered from insomnia. Following admission to our hospital, she developed a depressive stupor complicated by deep venous thrombosis of her left leg. Both cases were treated with sodium heparin and urokinase, and completely resolved. It is well known that dehydration, infection and decubitus ulcers are important physical complications of psychiatric stupor, but there have been few reports of deep venous thrombosis as a physical complication of stupor.     

Multiple sclerosis and Capgras' syndrome

Psychotic disorders in patients with multiple sclerosis (MS), although reported in the literature, are quite rare. The maniac psychosis is increased in MS patients, especially after steroid use, but a pure paranoid (delusional) state is very uncommon. We report a case of a patient with MS complicated by Capgras' syndrome. This disorder, characterized by misidentification and also known as "illusion of double", was first described by the French psychiatrist Joseph Capgras in 1923. Our patient was a 36-year-old female, with a negative psychiatric history; the diagnosis of MS dated back to the age of 18. Subsequently, after a treatment with high dosage of steroids for optic neuritis, her psychiatric symptoms (delusion of references) began and she was then treated with clozapine. Thereafter she had repeated relapses. Immunomodulatory treatments with beta-interferon first and azathioprine then were stopped for intolerance. She came to our hospital for a new relapse with severe dynamic ataxia. After a treatment with corticosteroids the patient developed a paranoid disorder characterized by persecutory delusion (illusion of double) towards her husband. Treatment with glatiramer acetate and quetiapine improved her neuropsychiatric condition.