PDF(Pubmed)
Abstract：
Suicide is the most common cause of death in male resident physicians and the second most common cause of death in resident physicians overall. Physicians also experience high rates of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and burnout. These conditions frequently develop during medical school, and threaten not only physicians but the patients they care for. A 30-year-old medical student presented to our clinic with a history of treatment-resistant depression (TRD), generalized anxiety disorder (GAD), PTSD, and 5 years of daily suicidal ideation. Previous treatments included therapy, lifestyle modifications, and various combinations of six antidepressants. These interventions had little effect on the patient\'s mental health. The patient was treated at our clinic with an 8-month regimen of IV ketamine infusions and ketamine-assisted psychotherapy (KAP). The patient achieved remission from suicidality and PTSD within 1 month; and TRD and GAD within 7 months. The patient\'s Patient Health Questionnaire (PHQ-9) score decreased from 25 (severe depression) to 1 (not depressed). These findings suggest that ketamine and KAP may represent effective interventions for mental health applications in healthcare professionals. The patient made the unique decision to attempt to type narrative journals during four of his ketamine infusions (doses ranged from 1.8 to 2.1 mg/kg/h IV). The patient successfully typed detailed journals throughout each 1-h ketamine infusion. To our knowledge, these journals represent the first independently typed, first-person, real-time narratives of ketamine-induced non ordinary states of consciousness. The transcripts of these journals may provide useful insights for clinicians, particularly in the context of KAP.
摘要：
自杀是男性住院医师中最常见的死亡原因，也是住院医师中第二常见的死亡原因。医生也经历了严重抑郁症（MDD）的高发病率，创伤后应激障碍（PTSD），和倦怠。这些情况经常在医学院期间发展，不仅威胁医生，也威胁他们关心的病人。一位30岁的医学生到我们的诊所就诊，有难治性抑郁症（TRD）的病史，广泛性焦虑症（GAD），创伤后应激障碍,每天有5年的自杀意念.以前的治疗包括治疗，改变生活方式,和六种抗抑郁药的各种组合。这些干预措施对患者的心理健康影响不大。该患者在我们的诊所接受了8个月的静脉氯胺酮输注和氯胺酮辅助心理治疗（KAP）方案。患者在1个月内实现自杀和PTSD的缓解；在7个月内实现TRD和GAD。患者的患者健康问卷（PHQ-9）评分从25（重度抑郁症）降至1（非抑郁症）。这些发现表明，氯胺酮和KAP可能代表医疗保健专业人员心理健康应用的有效干预措施。患者做出了独特的决定，在他的四次氯胺酮输注（剂量范围为1.8至2.1mg/kg/hIV）期间尝试键入叙述日记。患者在每次1小时氯胺酮输注中成功键入详细的日志。据我们所知,这些期刊代表了第一个独立类型的期刊，第一人称,氯胺酮诱导的非普通意识状态的实时叙述。这些期刊的转录本可能为临床医生提供有用的见解，特别是在KAP的背景下。
