精神药物多药合用导致可逆性痴呆:病例报告。

IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES
Durjoy Lahiri, Bruna Seixas-Lima, Carlos Roncero, Kathryn Stokes, Swayang Sudha Panda, Howard Chertkow
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引用次数: 0

摘要

精神药物的多重作用给诊断带来了挑战,而不充分的用药史和对这种多重作用的认知影响认识不足可能会使诊断变得更加复杂。在此,我们介绍一例 57 岁的男性病例,他因认知能力逐渐下降到我们的记忆门诊就诊,之前的神经心理学评估支持神经退行性疾病的诊断。他当时正在服用多种精神药物,但由于缺乏旁系病史,具体剂量并不清楚。他还在服用处方阿片类药物以及丁丙诺啡和纳洛酮的复合制剂来缓解疼痛,但在就诊时剂量也不清楚。脑成像和脑脊髓液生物标志物检测均为阴性,未发现阿尔茨海默病的病理生理过程。几个月后,患者因过度使用阿片类药物导致用药过量而被送进急诊室。一旦停用所有精神活性药物,患者的认知功能障碍就完全逆转了,并能独立进行日常生活活动。精神药物的多重药理作用可能会产生无数的认知表现,临床医生需要更好地认识到这一点。只要临床情况允许,就应尝试停用这类药物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Psychotropic Polypharmacy Leading to Reversible Dementia: A Case Report.

Psychotropic polypharmacy presents a diagnostic challenge that may be further complicated by inadequate medication history and underappreciation of the cognitive effects of such polypharmacy. Here we present the case of a 57-year-old man who presented to our memory clinic with progressive cognitive decline and a prior neuropsychological evaluation supporting the diagnosis of a neurodegenerative disorder. He was taking multiple psychotropic medications at the time, but the exact dosages were unclear due to a lack of collateral history. He was also taking prescribed opioids and a combination of buprenorphine and naloxone for pain relief, again with unclear dosages at the time of presentation. Brain imaging and cerebrospinal spinal fluid biomarker testing were negative for Alzheimer pathophysiologic processes. Months later, the patient was taken to the emergency room after an overdose caused by overuse of opioid medications. Once he was taken off all psychoactive medications, the patient's cognitive impairment completely reversed, and he became independent in activities of daily living. Psychotropic polypharmacy can have a myriad of cognitive manifestations which need to be better recognized by clinicians. Deprescription of such medications should be attempted whenever clinically appropriate.

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来源期刊
CiteScore
2.40
自引率
7.10%
发文量
68
审稿时长
>12 weeks
期刊介绍: Cognitive and Behavioral Neurology (CBN) is a forum for advances in the neurologic understanding and possible treatment of human disorders that affect thinking, learning, memory, communication, and behavior. As an incubator for innovations in these fields, CBN helps transform theory into practice. The journal serves clinical research, patient care, education, and professional advancement. The journal welcomes contributions from neurology, cognitive neuroscience, neuropsychology, neuropsychiatry, and other relevant fields. The editors particularly encourage review articles (including reviews of clinical practice), experimental and observational case reports, instructional articles for interested students and professionals in other fields, and innovative articles that do not fit neatly into any category. Also welcome are therapeutic trials and other experimental and observational studies, brief reports, first-person accounts of neurologic experiences, position papers, hypotheses, opinion papers, commentaries, historical perspectives, and book reviews.
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