可逆性脑血管收缩综合征的精神诊断管理:使用羟色胺能药物导致病理恶化的危险:病例报告和文献综述。

IF 1.3 4区 医学 Q3 PSYCHIATRY
Chris Wang, Anika Iftekharuddin, David C Fipps
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引用次数: 0

摘要

可逆性脑血管收缩综合征(RCVS)是一组表现为向大脑供血的脑动脉可逆性多灶性狭窄或收缩的疾病。RCVS 的最初表现通常包括 "雷鸣般 "的头痛,这种头痛突发性强、剧烈,通常会使人丧失工作能力。兴奋剂、选择性血清素再摄取抑制剂、血清素-去甲肾上腺素再摄取抑制剂和具有血清素能活性的抗精神病药物会改变脑动脉张力,引发血管收缩,使患者面临脑血管意外的风险。因此,RCVS 患者入院时通常会停用精神科药物,并经常向精神科咨询急性用药管理和纵向治疗方案。目前,有关 RCVS 精神科药物管理的文献十分匮乏,导致实践模式多变,使患者面临停药、失代偿和复发的风险。在本文中,我们提供了一个病例,旨在通过讨论整合有关合并 RCVS 的精神疾病管理的有限数据。无论是在急性发作期间,还是在 RCVS 的长期治疗过程中,人们都明显担心血清素或兴奋剂诱发的血管痉挛会导致病情恶化,甚至可能造成致命后果。我们将讨论血清素能、去甲肾上腺素能和多巴胺能诱发脑血管痉挛的潜在病理生理机制,以及这与服用精神类药物的患者的临床治疗之间的关联。然后将对这些数据进行整理,以创建一个风险与收益对比大纲,使精神科医生能够在出现 RCVS 时决定何时停止和何时重新开始服用精神科药物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Management of Psychiatric Diagnoses in Reversible Cerebral Vasoconstriction Syndrome: The Dangers of Worsening Pathology with Serotonergic Medications: A Case Report and Literature Review.

Reversible cerebral vasoconstriction syndrome (RCVS) represents a group of conditions that show reversible multifocal narrowing or constriction of the cerebral arteries that supply blood to the brain. The initial manifestation of RCVS often includes a "thunderclap" headache that is sudden, severe, and often disabling. Stimulants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and antipsychotics with serotonergic activity can alter the cerebral arterial tone, trigger vasoconstriction, and place patients at risk of a cerebrovascular accident. Thus, psychiatric medications are commonly discontinued on admission for RCVS, and psychiatry is often consulted for input on acute medication management and longitudinal treatment options. Currently, there is a dearth of literature on managing psychiatric medications in RCVS, resulting in variable practice patterns that place patients at risk of withdrawal, decompensation, and relapse. In this article, we provide a case example and aim to consolidate the limited data surrounding the management of psychiatric illness with comorbid RCVS in our discussion. There is a clear concern about worsening and even potentially lethal consequences due to serotonin or stimulant-induced vasospasm both during an acute episode and in long-term management of RCVS. We discuss the underlying pathophysiologic mechanisms proposed for serotonergic-, noradrenergic-, and dopaminergic-induced cerebral vasospasm and how this correlates with the clinical management of patients on psychiatric medications. These data will then be organized to create a risks versus benefits outline to equip psychiatrists to make decisions about when to stop and when to restart psychiatric medications in the setting of RCVS.

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来源期刊
CiteScore
2.30
自引率
10.50%
发文量
159
审稿时长
>12 weeks
期刊介绍: Journal of Psychiatric Practice® seizes the day with its emphasis on the three Rs — readability, reliability, and relevance. Featuring an eye-catching style, the journal combines clinically applicable reviews, case studies, and articles on treatment advances with practical and informative tips for treating patients. Mental health professionals will want access to this review journal — for sharpening their clinical skills, discovering the best in treatment, and navigating this rapidly changing field. Journal of Psychiatric Practice combines clinically applicable reviews, case studies, and articles on treatment advances with informative "how to" tips for surviving in a managed care environment.
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