抗精神病药物是治疗精神分裂症和其他精神病的主要药物;然而,这些药物与广泛的副作用有关,这可能使治疗结果复杂化.我们介绍了一名35岁的女性,该女性有分裂情感障碍病史,并且有五次精神病住院。病人首先出现在医院,表现出杂乱无章的行为,除了睡眠不好,幻听,以及在药物不依从性的背景下竞相思考。她接受了两种负荷剂量的肌肉内帕潘立酮,症状有所改善。放电后,她计划每月服用一次帕潘立酮,她错过了,导致代偿失调,重新出现精神病,两个月后又住院了.她被给予错过的剂量,没有改善和进行性恶化,尝试了替代药物。她接受了奥氮平,并在喹硫平和氟哌啶醇上进行了短暂的尝试,没有任何好处,她还出现了异常的口周运动。她用了帕潘立酮,她的精神病症状有所改善,尽管她出现了静坐不能和高催乳素血症。病人出院两天后返回医院,由于混乱的行为和多重妄想。开始服用氯氮平,并滴定至100mgqam和200mgqhs。在服用氯氮平的时候,她出现了大量流涕,用舌下阿托品滴剂治疗,到出院时,精神病症状已经明显改善,口周运动减少,催乳素水平呈下降趋势.患者在最后一次入院后维持稳定超过一年。确定抗精神病药物以成功治疗难治性精神病并控制其多种潜在副作用具有挑战性,但可以为患者带来更好的生活质量以及改善的治疗依从性。这个病例报告在说明这一点的方式上是独一无二的,同时讨论管理可能同时发生的多种副作用的不同方法。
Antipsychotics are the mainstay for the treatment of schizophrenia and other psychotic disorders; however, these agents are associated with an extensive side effect profile that may complicate treatment outcomes. We present the
case of a 35-year-old woman with a history of schizoaffective disorder and five prior psychiatric hospitalizations. The patient first presented to the hospital for disorganized behavior, in addition to poor sleep, auditory hallucinations, and racing thoughts in the context of medication nonadherence. She received two loading doses of intra-muscular paliperidone with fair symptomatic improvement. After discharge, she was scheduled to receive a monthly dose of paliperidone, which she missed, resulting in decompensation, re-emergence of psychosis, and another hospitalization two months later. She was given the missed dose with no improvement and progressive deterioration, for which alternative agents were tried. She received olanzapine and was tried briefly on quetiapine and haloperidol as well, with no benefit, and she also developed abnormal perioral movements. She was reloaded with paliperidone, and her psychotic symptoms improved, although she developed akathisia and hyperprolactinemia. The patient returned to the hospital two days later after being discharged, due to disorganized behavior and multiple delusions. Clozapine was started and titrated to 100 mg qam and 200 mg qhs. While on clozapine, she developed profuse sialorrhea that was treated with sublingual atropine drops, and by the time of discharge psychotic symptoms had markedly improved, perioral movements diminished, and prolactin level trended down. The patient maintained stability for over a year after the last admission. Identifying antipsychotics to successfully treat refractory psychosis and managing their multiple potential side effects is challenging but can result in better quality of life for patients as well as improved treatment adherence. This
case report is unique in the way it illustrates this point, while discussing different approaches to managing multiple side effects that can happen simultaneously.