36岁偏执型精神分裂症伴药物性QT间期延长1例

N. M. Zhuravlev, A. P. Otmachov, A. E. Bartasinskaya
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引用次数: 0

摘要

心律和传导障碍是精神分裂症慢性精神药物治疗中的一个严重问题。一种潜在致命的抗精神病药物引起的不良反应是药物[1]诱导的长QT综合征,这是一种延长心脏复极的现象,在给予药物[1]的情况下,会导致室性心动过速(称为点扭转)的风险增加。这种药物不良反应的临床诊断是困难的,然而,心电图和动态心电图监测是长QT综合征功能诊断的金标准,尽管它们不能给精神科医生一个关于特定患者的精神分裂症的单一或多种治疗的可能纠正的答案。药物遗传学检测是现代精神病学个性化精神药物治疗策略的重要组成部分。减缓抗精神病药物通过组织血屏障和神经元、心肌细胞膜的外排,同时减缓抗精神病药物在肝脏细胞色素P450酶参与下的代谢,可显著增加抗精神病药物诱导的长QT综合征和猝死综合征的风险。本临床病例旨在更新现实精神病学实践中存在的药物遗传检测问题,并为解决一名偏执型精神分裂症青年患者抗精神病药物诱导的长QT综合征提供可能的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Case of a 36-year-old Patient with Paranoid Schizophrenia and Drug-Induced QT Prolongation
Heart rhythm and conduction disorders are a serious problem in chronic psychopharmacotherapy of schizophrenia. One potentially fatal antipsychotic-induced adverse reaction is drug[1]induced long QT syndrome, which is a phenomenon of prolongation of cardiac repolarization and leads to an increased risk of ventricular tachycardia, known as Torsades de pointes, in the presence of an administered drug [1]. The clinical diagnosis of this adverse drug reaction is difficult, however, electrocardiography and Holter ECG monitoring are the gold standard for the functional diagnosis of long QT syndrome, although they do not give the psychiatrist an answer about the possible correction of mono- or polytherapy for schizophrenia in a particular patient. Pharmacogenetic testing is an integral part of the personalized strategy of psychopharmacotherapy in modern psychiatry. Slowing the efflux of antipsychotics through the histohematic barriers and the membrane of neurons and cardiomyocytes, along with slowing down the metabolism of antipsychotics in the liver with the participation of cytochrome P450 enzymes, can significantly increase the risk of antipsychotics induced long QT syndrome and sudden death syndrome. The purpose of this clinical case is to update the existing problem of pharmacogenetic testing in real psychiatric practice and demonstrate possible ways to solve the problem of antipsychotic-induced long QT syndrome in a young man with paranoid schizophrenia.
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