妊娠期患者的精神药物使用问题

概述:妊娠对于重性精神疾病患者来说至少面临两方面挑战:即精神疾病的遗传风险以及精神药物的可能致畸风险.本文复习了相关文献及研究证据,包括抗精神病药物、抗抑郁药物及心境稳定剂等在妊娠期患者的使用问题,最后介绍了最新治疗指南及FDA建议.     

The therapeutic transnosological use of psychotropic drugs

The current clinical use of psychotropic drugs is transnosologically oriented. This is facilitated by the current classification of mental disorders (International Classification of Diseases, 10th Revision [ICD-10]) and is perhaps justified if depression and psychosis (taken here as examples) are considered as being complex syndromes with heterogeneous etiologies, but common pathogenesis, more than specific entities. However, this approach does not identify possible differences between specific psychiatric entities, which could in turn mask differences in therapeutic responses and, therefore, therapeutic outcome. This is compounded by the current disharmony between the nosological classification of diseases, drug development, clinical research, and therapeutic uses of psychotropic drugs. Functional pharmacology targeting abnormal behavioral traits could represent an avenue for future research and treatment.     

Combined use of ECT with duloxetine and olanzapine: a case report

ABSTRACT: A 38-year-old woman with medication-resistant major depression and posttraumatic stress disorder was treated with electroconvulsive therapy (ECT) concurrent with a duloxetine-olanzapine combination. The treatment resulted in complete resolution of major depression without any complications. This case report suggests that treatment with the combination of duloxetine and olanzapine concurrently with ECT was found safe and uncomplicated. The literature on the combined use of antidepressants and ECT is briefly reviewed.     

The rational use of psychotropic drugs in pregnancy and postpartum

When a pregnant woman or nursing mother requires psychotropic medication, one must consider the effect of such medications on the fetus or baby. The authors review the evidence for teratogenic effects of such drugs given during pregnancy, toxic or withdrawal effects in the newborn and dangers to the breast-fed baby. Suggestions are made for judicious use of psychotropic drugs in pregnant or nursing women.     

合用精神药物对无抽搐电休克治疗指标的影响

目的探讨合用精神药物对无抽搐电休克治疗指标的影响,为无抽搐电休克并药物治疗提供参考依据。方法收集无抽搐电休克治疗患者第一次电休克治疗发作的主要指标(抽搐时间,简称T;抽搐指数,简称SEI;抑制指数,简称PSI)和治疗前一天所用的主要精神药物种类及剂量;然后根据合用药物情况进行T、SEI、PSI值的比较,计算T、SEI、PSI值与药物剂量之间的相关系数。结果苯二氮卓艹类药物对T、SEI值有明显影响,且药物剂量与T、SEI值呈负性相关;锂盐对T、SEI值无明显影响;氯丙嗪组的T、SEI值明显大于氯氮平组;合用精神药物对提示本次治疗成败PSI值均无明显影响。结论在常规剂量条件下,各类精57神药物对无抽搐电休克发作效果无重大影响,治疗前可以不必考虑停药或减药;苯二氮卓艹类药物对治疗电量的控制有一定关系,对使用较大剂量苯二氮卓艹类药物的患者,可以考虑使用较大的电量。     

The use of psychotropic drugs in epilepsy: what every neurologist should know

Psychiatric disorders, such as mood, anxiety, attention deficit, and psychotic disorders, are among the most frequent comorbidities experienced by patients with epilepsy. While these psychiatric disorders have typically been considered as one of its complications, there is increasing evidence of a bidirectional relationship between the seizure disorder and mood and ADHD. Indeed, not only are patients with epilepsy at greater risk of developing these two disorders, but patients with mood and attention deficit disorders are at greater risk of developing epilepsy. Comorbid psychiatric disorders have a negative impact on the quality of life of patients with epilepsy. For patients with pharmacoresistant epilepsy, mood disorders are a stronger predictor of a worse perception of their quality of life than is their seizure frequency and severity. Thus, the use of psychotropic drugs is often necessary in patients with epilepsy, be they children or adults. Unfortunately, there are many misconceptions regarding the safety of psychotropic drugs, particularly of antidepressants and central nervous system stimulants, which are often erroneously thought of as being "proconvulsant." Such misconceptions have resulted in the undertreatment of psychiatric comorbidities in patients with epilepsy. This article provides a practical review of the use of antidepressants, central nervous system stimulants, and antipsychotic drugs in patients with epilepsy.     

Placebo use in clinical trials on psychotropic drugs in France

The use of placebos is often justified in therapeutic drug testing. They may be employed in order to compare their effects with those of a so-called active treatment, to compare two active medications, in double-blind comparisons of two drugs of different appearance (double-dummy technique) or to carry through initial washout periods. Although the scientific justification for this procedure is hardly contestable, the methodological difficulties and demands must be considered. The clinical use of placebo comparison poses a true ethical dilemma which increases with the effectiveness of psychotropic drugs. Placebos were used relatively rarely in France before 1978 as a general review of 120 controlled psychotropic drug trials published in French shows. Various precautions undertaken in drug testing designs respond, nevertheless, to both ethical and methodological demands in the majority of the cases. Examples are given regarding the testing of major or minor tranquilizers and antidepressive drugs.     

青岛市残疾精神分裂症患者精神药物使用调查研究

目的：了解青岛市残疾精神分裂症患者药物使用情况。方法：调查残疾精神分裂症患者及同期门诊患者各500例的精神药物使用情况。结果：残疾组合并使用抗精神病药、抗震颤麻痹药,苯二氮董类药和镇静安眠药较多。残疾组以典型抗精神病药为主,门诊组以非典型抗精神病药为主。结论：残疾精神分裂症患者的治疗有待改善。