妊娠和产后双相情感障碍患者的情绪稳定剂、抗精神病药物和电休克治疗:叙述性综述。

IF 1.3 4区 医学 Q3 PSYCHIATRY
Amaury Cantilino, Aldo Vilar
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引用次数: 0

摘要

目的:双相情感障碍女性在怀孕期间并发症的风险较高,这可能与母亲的危险行为during急性发作有关,以及药物治疗对母亲和/或婴儿的固有风险。这篇叙述性综述的目的是讨论怀孕和哺乳期间双相情感障碍的治疗。方法:使用PubMed数据库检索2023年10月至2024年7月期间的文献,MeSH术语“双相情感障碍”和“怀孕”与布尔运算符“and”相结合。考虑了2014年至2024年的出版物,结果确定了573篇文章。题目评审后,筛选出84篇论文进行全文评审,其中33篇纳入本研究。结果:早在20世纪70年代就有婴儿怀孕期间使用锂相关的心脏病的报道,但最近的病例对照和队列研究表明,这种风险远低于之前的报道。然而,由于肾功能的生理适应,在怀孕期间维持锂水平是具有挑战性的。已发现丙戊酸暴露与婴儿神经管缺陷、颅面、心脏、生殖器和肌肉骨骼异常的风险增加有关。与拉莫三嗪相关的畸形风险似乎没有增加,关于卡马西平和奥卡西平的研究结果也存在分歧。关于先天性畸形的风险和产前抗精神病药物暴露作为一个群体以及非典型抗精神病药物亚组没有统计学上显著的关联报道。然而,利培酮可能会略微增加心脏畸形的风险。妊娠期电休克治疗似乎是一种相对安全的治疗方法;然而,文献中报道的小样本量限制了更可靠的结论。结论:妊娠和哺乳期的药物治疗需要仔细讨论和记录,以便开处方者和患者能够了解其风险和益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mood Stabilizers, Antipsychotics, and Electroconvulsive Therapy in Patients With Bipolar Disorder During Pregnancy and Postpartum: A Narrative Review.

Objective: Women with bipolar disorder are at higher risk of complications during pregnancy, which may be associated with risky behaviors by the mother during acute episodes, as well as pharmacotherapy's inherent risks to mother and/or infant. The goal of this narrative review is to discuss the treatment of bipolar disorder during pregnancy and breastfeeding.

Methods: A literature search was conducted between October 2023 and July 2024 using the PubMed database, with MeSH terms "bipolar disorder" and "pregnancy" combined with the Boolean operator "AND." Publications from 2014 to 2024 were considered, resulting in the identification of 573 articles. After titles were reviewed, 84 papers were selected for full-text review, 33 of which were included in the study.

Results: Cardiopathies associated with lithium use during pregnancy in infants were reported in the 1970s, but more recent case-control and cohort studies have shown that this risk is much lower than was previously reported. However, maintaining lithium levels during pregnancy can be challenging due to physiological adaptations in renal function. Valproate exposure has been found to be associated with increased risk of neural tube defects, craniofacial, cardiac, genital, and musculoskeletal abnormalities in infants. There does not appear to be an increased risk of malformations associated with lamotrigine, and results of studies diverge concerning carbamazepine and oxcarbazepine. No statistically significant association has been reported concerning the risk of congenital malformations and prenatal exposure to antipsychotics as a group, as well as for the subgroup of atypical antipsychotics. However, it is possible that risperidone slightly increases the risk of cardiac malformations. Electroconvulsive therapy during pregnancy appears to be a relatively safe treatment; however, the small sample size reported in the literature limits more robust conclusions.

Conclusions: Pharmacotherapy during pregnancy and lactation requires careful discussion and documentation so that the prescriber and the patient can be aware of its risks and benefits.

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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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