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The Role of Artificial Intelligence in Consultation-Liaison Psychiatry
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2025.01.007
Hochang B. Lee M.D., F.A.C.L.P.
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引用次数: 0
Metabolic and Endocrine Correlates of Subclinical Hypothyroidism in Young Adults With First-Episode and Drug-Naive Major Depressive Disorder 首次发病和无药可治的重度抑郁症青年患者亚临床甲状腺机能减退的代谢和内分泌相关性。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2024.10.003
ZhaoXuan Shang MSc , ChunQing Fang MSc , XiaoE. Lang MD, PhD , Xiangyang Zhang MD, PhD

Background

Major depressive disorder is often associated with subclinical hypothyroidism (SCH), but the clinical and biochemical characteristics in young, first-episode, drug-naive patients remain unclear. This study aims to examine the prevalence and clinical correlates of SCH in this population to enhance screening and management strategies.

Method

A cross-sectional study included 917 young Chinese patients (aged 18–35 years) diagnosed with first-episode, drug-naive Major depressive disorder. Comprehensive clinical assessments were conducted, involving demographic data, psychiatric evaluations using the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Positive and Negative Syndrome Scale, alongside biochemical measurements such as thyroid stimulating hormone, thyroid peroxidase antibodies, fasting blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure. Binary logistic regression identified clinical correlates of SCH.

Results

The prevalence of SCH among the study population was 58%. Logistic regression analysis identified significant predictors of SCH, including higher Hamilton Depression Rating Scale scores (odds ratio [OR] = 1.26), thyroid peroxidase antibodies (OR = 1.003), fasting blood glucose (OR = 2.28), total cholesterol (OR = 1.66), systolic blood pressure (OR = 1.11), and diastolic blood pressure (OR = 1.07). In contrast, lower high-density lipoprotein cholesterol levels (OR = 0.28) were inversely associated with SCH.

Conclusion

The high prevalence of SCH in young, first-episode, drug-naive Major depressive disorder patients emphasizes the need for comprehensive metabolic and endocrine evaluations. Regular monitoring of thyroid function, glucose levels, blood pressure, and lipid profiles is crucial for early detection and intervention, potentially improving clinical outcomes in this vulnerable group.
背景:重度抑郁障碍(MDD)通常与亚临床甲状腺功能减退症(SCH)有关,但首次发病、未服药的年轻患者的临床和生化特征仍不清楚。本研究旨在探讨SCH在这一人群中的患病率和临床相关性,以加强筛查和管理策略:一项横断面研究纳入了917名被诊断为首次发病、对药物无效的MDD中国年轻患者(18-35岁)。研究人员对这些患者进行了全面的临床评估,包括人口统计学数据、使用汉密尔顿抑郁评定量表(HAMD)、汉密尔顿焦虑评定量表(HAMA)和阳性与阴性综合征量表(PANSS)进行的精神评估,以及生化指标(如促甲状腺激素、甲状腺过氧化物酶抗体和甲状腺激素)、甲状腺过氧化物酶抗体 (TPOAb)、空腹血糖 (FBG)、总胆固醇 (TC)、高密度脂蛋白胆固醇 (HDLC)、低密度脂蛋白胆固醇 (LDLC)、收缩压 (SBP) 和舒张压 (DBP)。二元逻辑回归确定了 SCH 的临床相关因素:结果:研究人群中 SCH 的患病率为 58%。逻辑回归分析确定了SCH的重要预测因素,包括较高的HAMD评分(OR = 1.26)、TPOAb(OR = 1.003)、FBG(OR = 2.28)、TC(OR = 1.66)、SBP(OR = 1.11)和DBP(OR = 1.07)。相反,较低的 HDLC 水平(OR = 0.28)与 SCH 成反比:结论:SCH在年轻、首次发病、对药物无效的MDD患者中的高发病率强调了对代谢和内分泌进行全面评估的必要性。定期监测甲状腺功能、血糖水平、血压和血脂情况对早期发现和干预至关重要,有可能改善这一弱势群体的临床预后。
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引用次数: 0
Reversible Lithium-induced Bradycardia in a Patient With Wolff-Parkinson-White Syndrome 一名沃尔夫-帕金森-怀特综合征患者因锂引起的可逆性心动过缓。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2024.09.007
Kristen Dzeda M.D., Yang Liu B.A., Rocksheng Zhong M.D., M.H.S.
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引用次数: 0
Novel Use of a Tricyclic Antidepressant to Address Depression and Quality of Life in a Case of Radiation Proctitis 在一例放射性直肠炎病例中使用三环类抗抑郁药解决抑郁和生活质量问题的新方法。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2024.09.002
Elizabeth Hale M.D., Patrick Buckley M.D., MBA
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引用次数: 0
2024 ACLP Recommendations for Training Residents in Consultation-Liaison Psychiatry 2024 ACLP 关于培训咨询联络精神病学住院医师的建议。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2024.11.001
Scott R. Beach M.D. , Carrie L. Ernst M.D. , David C. Fipps D.O. , Thomas M. Soeprono M.D. , Mallika Lavakumar M.D. , Samuel P. Greenstein M.D. , Thomas W. Heinrich M.D. , Ann C. Schwartz M.D.

Background

Despite rapid shifts in consultation-liaison psychiatry (CLP) training in residency, including increasing general residency training requirements from the Accreditation Council for Graduate Medical Education, greater utilization of advanced practice providers, and effects of the coronavirus-2019 pandemic, the Academy of Consultation-Liaison Psychiatry has not updated recommendations for residency training in CLP since 2014. A national survey of residency program directors in 2021 suggested many changes to the structure of CLP rotations at individual programs over the past decade.

Objective

These recommendations are intended to guide residency program directors toward optimizing CLP training for all residents, including those who will eventually pursue CLP fellowship.

Methods

We convened a workgroup of 8 Academy of Consultation-Liaison Psychiatry members holding leadership positions in residency and fellowship education on local and national levels. The project was approved by the Academy of Consultation-Liaison Psychiatry Executive Council and conducted via a three-stage iterative process.

Results

Consensus was reached on 34 recommendations across four domains, including structural issues, faculty supervision, formal curriculum and evaluations, and elective experiences. Residents must spend sufficient time on CLP rotations to achieve relevant milestones. Given that consultants are expected to offer unique insight, the ideal placement of core CLP rotations comes at a time in residency where residents are able to provide expert opinion and lead teams. Faculty expertise in CLP and availability to provide direct supervision and oversight to trainees are essential. A separate and formal CLP didactic curriculum should exist, and elective opportunities should be offered to supplement training.

Conclusions

Establishing a strong CLP foundation for all residents is essential for ensuring competency in providing psychiatric care for medically complex patients and collaborating with our colleagues in other specialties, as well as fostering trainee interest in pursuing a career in CLP.
导言:尽管住院医师会诊联络精神病学(CLP)培训发生了快速变化,包括毕业后医学教育认证委员会对普通住院医师培训要求的提高、高级实践提供者的更多利用以及冠状病毒-2019大流行的影响,但自2014年以来,会诊联络精神病学学会(ACLP)一直没有更新CLP住院医师培训的建议。2021 年对住院医师培训项目主任进行的一项全国性调查显示,过去十年中,各个项目的 CLP 轮转结构发生了许多变化:我们召集了一个由8名在地方和国家层面的住院医师和研究员教育中担任领导职务的ACLP成员组成的工作组。该项目获得了ACLP执行委员会的批准,并通过三个阶段的迭代过程进行:结果:就四个领域的34项建议达成了共识,包括结构问题、教师监督、正式课程和评估以及选修经验:住院医师必须花足够的时间进行CLP轮转,以达到相关的里程碑。鉴于顾问应提供独到的见解,因此,在住院医师能够提供专家意见并领导团队时,才是安排核心 CLP 轮转的理想时机。教员必须具备 CLP 方面的专业知识,并能对受训者进行直接指导和监督。应开设单独和正式的 CLP 教学课程,并提供选修机会以补充培训:这些建议旨在指导住院医师培训项目主任优化所有住院医师的 CLP 培训,包括那些最终将获得 CLP 研究金的住院医师。为所有住院医师打下坚实的 CLP 基础,对于确保他们有能力为病情复杂的患者提供精神科护理、与其他专科的同事合作以及培养学员对从事 CLP 职业的兴趣至关重要。
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引用次数: 0
Preoperative Neurofilament Light Associated With Postoperative Delirium in Hip Fracture Repair Patients Without Dementia 术前神经丝光与无痴呆症的髋部骨折修复患者术后谵妄有关。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2024.10.002
Mfon E. Umoh M.D., Ph.D. , Haijuan Yan M.S. , Jeannie-Marie Leoutsakos Ph.D. , Alexandria Lewis B.A. , Edward R. Marcantonio M.D., S.M. , Constantine G. Lyketsos M.D. , Sharon K. Inouye M.D., M.P.H. , Abhay Moghekar M.D. , Karin J. Neufeld M.D., M.P.H. , Paul B. Rosenberg M.D. , Frederick Sieber M.D. , Esther S. Oh M.D., Ph.D.

Background

Delirium commonly occurs in older adults following surgery; although its pathophysiology is not fully understood, underlying neurodegeneration is a risk factor.

Objective

Examine the association of preoperative levels of markers of neuronal damage, neurofilament light (NfL) and phosphorylated tau (p-tau)181, with postoperative delirium.

Methods

Preoperative cerebrospinal fluid (CSF) and plasma were obtained from 158 patients undergoing hip fracture repair and enrolled in the clinical trial “A STrategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients.” Delirium diagnosis was adjudicated by a consensus panel. The association of plasma and CSF NfL and p-tau181 levels with delirium incidence and severity were examined for the overall cohort and for a subgroup (n = 134) of patients without dementia.

Results

Patients who developed delirium were older, had lower Mini-Mental State Exam score, higher Clinical Dementia Rating and Geriatric Depression Scale scores at baseline; the overall incidence of delirium was 37.6% and 31.1% for the subgroup without dementia. Plasma and CSF p-tau181 levels were not associated with delirium incidence or severity. CSF NfL levels were significantly associated with delirium severity, but not with incidence in the overall cohort. In the subgroup of patients without dementia, CSF NfL levels were significantly associated with increased odds of delirium incidence (odds ratio 4.74, 95% confidence level 1.21–18.59, P = 0.03) adjusted for age, sex, and Clinical Dementia Rating.

Conclusions

CSF NfL was significantly associated with delirium incidence and severity in patients without dementia undergoing hip fracture repair. Results confirm prior studies suggesting NfL as an important marker of delirium risk and supports an association between pre-existing axonal injury and delirium. These results highlight delirium vulnerability in older hip fracture patients, even when clinical dementia is not identified.
背景:谵妄通常发生在手术后的老年人身上;虽然其病理生理学尚未完全清楚,但潜在的神经变性是一个风险因素:谵妄通常发生在手术后的老年人身上;尽管其病理生理学尚不完全清楚,但潜在的神经变性是一个风险因素:目的:研究术前神经元损伤标志物神经丝光(NfL)和磷酸化 tau(p-tau)181 的水平与术后谵妄的关系:方法:从 158 名接受髋部骨折修补术并加入 "降低老年患者术后谵妄发生率的策略"(STRIDE)临床试验的患者中获取术前 CSF 和血浆。谵妄诊断由共识小组裁定。对整个队列和无痴呆患者亚组(n=134)的血浆和脑脊液NfL和p-tau181水平与谵妄发生率和严重程度的关系进行了研究:出现谵妄的患者年龄较大,迷你精神状态检查(MMSE)评分较低,基线时临床痴呆评分(CDR)和老年抑郁量表(GDS)评分较高;谵妄的总体发生率为37.6%,无痴呆亚组的发生率为31.1%。血浆和脑脊液p-tau181水平与谵妄发生率或严重程度无关。CSF中的NfL水平与谵妄严重程度显著相关,但与整个队列中的谵妄发生率无关。在无痴呆症患者亚组中,CSF NfL水平与谵妄发生率的增加显著相关(OR 4.74,95% CI 1.21-18.59,p=0.03),已对年龄、性别和CDR进行调整:在接受髋部骨折修补术的无痴呆患者中,CSF NfL与谵妄的发生率和严重程度密切相关。研究结果证实了之前的研究提示NfL是谵妄风险的重要标志物,并支持已有的轴突损伤与谵妄之间存在关联。这些结果凸显了老年髋部骨折患者的谵妄易感性,即使在未发现临床痴呆的情况下也是如此。
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引用次数: 0
Optimizing and Enabling Patient Communication: Getting Ventilated Patients Talking 优化和促进患者交流:让通气患者开口说话。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2024.11.004
Amy Freeman-Sanderson BAppSc [Speech Pathology], Ph.D. , Anna-Liisa Sutt B.A., M.A., Ph.D.
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引用次数: 0
Catatonia Associated with Hyperthyroidism: An Illustrative Case and Systematic Review of Published Cases 甲状腺风暴期间低剂量氟哌啶醇后的紧张症:一例报告和已发表病例的系统回顾。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2024.11.005
Jeremy R. Chaikind M.D. , Hannah L. Pambianchi B.A. , Catherine Bledowski M.D.

Background

Catatonia is a frequently missed diagnosis on medical wards, delaying effective treatment or permitting accidental use of neuroleptics that can exacerbate the condition. Thyroid storm has rarely been associated with catatonia in case reports, with no prior reviews synthesizing this research.

Objective

We present a case of catatonia during thyroid storm following administration of low-dose haloperidol, followed by a review of previously published cases and discussion of their common factors and potential mechanisms.

Methods

We first describe a case of a 37-year-old woman with untreated hyperthyroidism and bipolar disorder admitted for mania in the context of thyroid storm. She developed catatonic symptoms after receiving each of two doses of haloperidol. We then present a systematic review of the literature, drawn from the OVID Medline, PsycINFO, and Embase databases, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify case reports of catatonia presenting in association with hyperthyroidism.

Results

Seventeen cases were identified—10 in published reports and seven in poster abstracts. The degree of evidence for catatonia varied, with few cases using formal scales. Several cases, including ours, reported recent administration of neuroleptics with dopamine antagonism (29%), usually at relatively low doses or with subsequent tolerance of neuroleptics when euthyroid. Other common factors included a history of psychiatric symptoms (41%) or presence of thyroid autoantibodies (41%).

Conclusions

These results are consistent with clinical and preclinical evidence that hyperthyroidism might potentiate dopamine blockade, and they encourage clinicians to minimize neuroleptic use in this population. Other theories have also been proposed for catatonia's association with hyperthyroidism, including direct thyrotoxic effect, autoimmune reaction, and mediation via another secondary psychiatric syndrome (e.g., mania). Clinicians should be aware of the potential for catatonia in thyroid storm, with or without neuroleptic use.
简介:紧张症是一个经常错过的诊断在医疗病房,延误有效的治疗或允许意外使用的抗精神病药,可以加剧病情。甲状腺风暴在病例报告中很少与紧张症相关,没有先前的综述综合了这一研究。我们提出了一个病例紧张症甲状腺风暴后低剂量氟哌啶醇的管理,然后回顾以前发表的病例。方法:作者首先提出了一个37岁的妇女未经治疗的甲状腺功能亢进和双相情感障碍承认躁狂在甲状腺风暴的背景下。她在服用两剂氟哌啶醇后出现紧张性症状。然后,作者对文献进行了系统回顾,包括OVID Medline、PsycINFO和Embase数据库,使用PRISMA指南来识别与甲亢相关的紧张症病例报告。结果:共发现17例,其中报告10例,海报摘要7例。紧张症的证据程度各不相同,很少有案例使用正式的量表。少数病例报告最近服用了多巴胺拮抗剂(29%),有精神症状史(41%)或甲状腺自身抗体(41%)。几个病例,包括我们的病例,在服用抗精神病药后表现出紧张症的发作,通常是在相对低剂量或随后在甲状腺功能正常时耐受抗精神病药。结论:这些结果与甲状腺功能亢进可能增强多巴胺阻断的临床和临床前证据一致,并鼓励临床医生在这一人群中尽量减少抗精神病药的使用。关于紧张症与甲状腺功能亢进的关联,也提出了其他理论,包括直接的甲状腺毒性作用、自身免疫反应和通过另一种继发性精神综合征(如躁狂)介导。临床医生应该意识到甲状腺风暴中潜在的紧张症,使用或不使用抗精神病药。
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引用次数: 0
Acute Onset or Worsening of Psychiatric Symptoms Following Breastfeeding Cessation: An Illustrative Case and Literature Review 停止母乳喂养后精神症状的急性发作或恶化:例证与文献综述。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2024.10.001
Katherine A. Meidl M.D. , Bailey N. Brooks M.D. , Stacey A. Pawlak Ph.D. , Melissa B. Ludgate M.D.

Background

Breastfeeding shares a complex, occasionally contradictory relationship with maternal mental health. Both positive and negative mood impacts have been noted in relation to breastfeeding initiation as well as cessation. Though popular magazines and online forums discuss the onset of psychiatric symptoms following weaning, there is limited medical literature detailing this relationship.

Objective

To increase awareness regarding psychiatric symptom development in the context of breastfeeding cessation.

Methods

We describe the case of a patient who developed psychiatric symptoms shortly after weaning, including acute-onset insomnia and worsening anxiety. A literature review of psychiatric symptom development following breastfeeding cessation was conducted using the search engines PubMed, PsycINFO (EBSCOhost), and Embase. Search terms included controlled vocabulary, keywords (within title and abstract fields), synonyms, and related concepts for postpartum period, postpartum depression, postpartum anxiety, breastfeeding cessation, breastfeeding weaning, lactation, dysphoric milk ejection reflex, and insomnia. Relevant case reports were reviewed and compared to this case. Information including the patient's age, psychiatric symptoms, past psychiatric history, medical workup, treatment, and outcome was extracted from each article.

Results

Nine patients who developed psychiatric symptoms following breastfeeding cessation were identified in six case reports. Three patients experienced recurrent symptoms in multiple pregnancies. This led to documentation of 13 discrete postweaning syndromes. All cases involved either first-time parents, those new to breastfeeding, or those experiencing symptoms during multiple weaning periods. Synthesizes data from the article review. As with our case, 11 clinical cases describe sleep changes (primarily insomnia) and 4 discuss anxiety symptoms. Treatment varied based upon symptoms experienced, with no consistently effective treatments identified across cases.

Conclusions

This case of unspecified insomnia and anxiety disorders following abrupt weaning adds to the limited literature in the field and suggests that physiologic and psychologic factors associated with breastfeeding cessation may play a role in the development or worsening of postpartum mood disorders. Intensive psychiatric treatment resulted in resolution of the patient's symptoms. The relationship between weaning and psychiatric disorders is evident in the lay press but is underrepresented in medical literature. Additional research is needed to better understand this relationship so that physicians can counsel, diagnose, and treat patients more effectively.
背景:母乳喂养与产妇的心理健康有着复杂的关系,有时甚至是相互矛盾的。人们注意到,母乳喂养的开始和停止都会对情绪产生积极和消极的影响。尽管流行杂志和在线论坛讨论了断奶后精神症状的出现,但详细阐述这种关系的医学文献却很有限:我们描述了一例断奶后不久即出现精神症状的患者,包括急性失眠和焦虑加重。我们使用 PubMed、PsycINFO (EBSCOhost) 和 Embase 等搜索引擎对停止母乳喂养后出现精神症状的文献进行了综述。检索词包括控制词汇、关键词(在标题和摘要字段内)、同义词和相关概念:产后时期、产后抑郁、产后焦虑、停止母乳喂养、断母乳喂养、泌乳、排乳反射障碍和失眠。我们查阅了相关病例报告,并与本病例进行了比较。从每篇文章中提取了包括患者年龄、精神症状、既往精神病史、医学检查、治疗和结果在内的信息:结果:在六篇病例报告中发现了九名在停止母乳喂养后出现精神症状的患者。其中有三位患者在多次妊娠中反复出现症状。由此记录了 13 种不同的断奶后综合征。所有病例均涉及初次为人父母者、刚开始母乳喂养者或在多次断奶期间出现症状者。表 1 综合了文章综述中的数据。与我们的病例一样,11 个临床病例描述了睡眠变化(主要是失眠),4 个病例讨论了焦虑症状。根据症状的不同,治疗方法也不尽相同,在不同病例中没有发现一致有效的治疗方法:本病例在突然断奶后出现不明原因的失眠和焦虑症,为该领域有限的文献资料增添了新的内容,并表明与停止母乳喂养相关的生理和心理因素可能在产后情绪障碍的发展或恶化中起作用。强化精神治疗后,患者的症状得到了缓解。断奶与精神障碍之间的关系在非专业媒体中很明显,但在医学文献中却很少见。需要进行更多的研究来更好地了解这种关系,以便医生能更有效地为患者提供咨询、诊断和治疗。
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引用次数: 0
Zolpidem for the Management of Catatonia: A Systematic Review 唑吡坦用于治疗卡他性精神障碍:系统综述。
IF 2.7 4区 心理学 Q2 PSYCHIATRY Pub Date : 2025-01-01 DOI: 10.1016/j.jaclp.2024.10.004
Matthew Gunther M.D., M.A. , Nathan Tran B.S. , Shixie Jiang M.D.

Background

Catatonia is a psychomotor syndrome associated with neurotransmitter disturbances, common in both psychiatric and medical settings. Hypoactivity of the GABAA receptor is one of the predominant theories behind the pathophysiology of catatonia, affecting both motor functioning and emotional regulation. Benzodiazepines such as lorazepam are considered the first-line treatment for catatonia. However, up to 27% of catatonia cases fail to respond to benzodiazepines alone. Zolpidem, which can be used as a challenge, monotherapy, or augmentation agent, serves as a promising pharmacological agent for catatonia due to its unique pharmacodynamic and pharmacokinetic profile.

Objective

We sought to systematically examine the evidence behind zolpidem's use among adult patients to understand its clinical utility in the management of catatonia against prevailing treatments such as lorazepam and electroconvulsive therapy.

Methods

We conducted a systematic review using search terms related to zolpidem and catatonia in PubMed, EMBASE, and Web of Science. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and identified 29 studies, including case studies and case series that met inclusion criteria.

Results

We reviewed 35 cases in which zolpidem was used for catatonia management (age: mean = 51.5 ± 21.0 standard deviation years; 68.6% female; Bush Francis Catatonia Rating Scale: mean = 22.2 ± 9.0 standard deviation). Proportions of positive responses for zolpidem on catatonia varied by treatment approach: 91% as a challenge agent (n = 10), 100% as a first-line monotherapy agent (n = 3), 57% as a first-line combination therapy agent (n = 4), 70% as a second-line monotherapy agent (n = 7), and 100% as a second-line augmentation agent (n = 4). In total, 28 out of the 35 reported cases of catatonia (80%) responded positively to zolpidem.

Conclusions

An 80% positive response rate for zolpidem in lysing catatonia is encouraging but may be an overestimate due to reporting bias of case-level data. Results may be explained by zolpidem's selectivity for the α1 subunit of the GABAA receptor. Thus, zolpidem may be an underutilized catatonia treatment and prove useful in situations when benzodiazepines fail or when electroconvulsive therapy access is limited. Given that current literature on the use of zolpidem for catatonia is limited to case reports, more robust research in this area is warranted.
背景:紧张症是一种与神经递质紊乱有关的精神运动综合征,在精神病和医疗环境中都很常见。GABAA 受体功能减退是紧张症病理生理学的主要理论之一,它会影响运动功能和情绪调节。劳拉西泮等苯二氮卓类药物被认为是紧张症的一线治疗药物。然而,高达 27% 的紧张性精神障碍患者对苯二氮卓类药物无效。唑吡坦可作为挑战药、单药或增效药使用,由于其独特的药效学和药代动力学特征,唑吡坦有望成为治疗紧张性精神障碍的一种药理药剂:我们试图系统研究唑吡坦在成年患者中使用的证据,以了解其在治疗紧张症方面的临床效用,并与劳拉西泮和电休克疗法(ECT)等主流疗法进行对比:我们使用 PubMed、EMBASE 和 Web of Science 中与唑吡坦和紧张症相关的检索词进行了系统性综述。我们遵循 PRISMA 指南,确定了 29 项符合纳入标准的研究,包括病例研究和系列病例:我们回顾了 35 例使用唑吡坦治疗紧张症的病例(年龄:男 =51.5 ± 21.0 SD 岁;68.6% 为女性;布什-弗朗西斯紧张症评定量表:男 =22.2 ± 9.0 SD 岁;68.6% 为女性):M=22.2±9.0SD)。唑吡坦对紧张症的阳性反应比例因治疗方法而异:91%作为挑战药物(10 人),100%作为一线单药治疗药物(3 人),57%作为一线联合治疗药物(4 人),70%作为二线单药治疗药物(7 人),100%作为二线增强药物(4 人)。在报告的35例紧张性精神分裂症病例中,共有28例(80%)对唑吡坦有阳性反应:结论:唑吡坦对失张力症的阳性反应率为 80%,这一结果令人鼓舞,但由于病例数据的报告偏差,这一结果可能被高估了。唑吡坦对 GABAA 受体的 α1 亚基具有选择性,这或许可以解释这一结果。因此,唑吡坦可能是一种未被充分利用的紧张症治疗方法,在苯二氮卓类药物失效或电痉挛疗法使用受限的情况下,唑吡坦可能会被证明是有用的。鉴于目前关于使用唑吡坦治疗紧张症的文献仅限于病例报告,因此有必要在这一领域开展更深入的研究。
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引用次数: 0
期刊
Journal of the Academy of Consultation-Liaison Psychiatry
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