双相躁狂症复发引起的脑损伤:早期使用LAI的呼吁

Q4 Medicine
H. Nasrallah
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引用次数: 0

摘要

正如我一直主张通过在第一次躁狂发作后立即使用长效注射(LAI)抗精神病药物来预防精神分裂症复发,以防止精神病复发和进行性脑损伤一样,3我强烈建议在第一次躁狂发作出院后立即使用LAI。考虑到多发发作的严重后果,这是双相躁狂最合理的治疗方法,由于药物依从性差,多发发作在这种精神病性情绪障碍中很常见。与BD I的抑郁发作不同,在BD I中,患者可以洞察自己的抑郁并寻求精神治疗,而在躁狂发作期间,患者通常没有意识到自己患有严重的大脑疾病(嗅觉缺失),并拒绝治疗。4此外,患有BD I的年轻患者经常停止口服情绪稳定剂或第二代抗精神病药物(已被批准用于治疗躁狂),因为他们错过了躁狂发作时的幸福快感和旺盛的身心能量。他们完全没有意识到(也不知道)进一步躁狂发作对神经生物学的严重损害,这可能会导致他们的临床、功能和认知退化。这些患者也可能对治疗产生耐药性,这被称为“双相情感障碍的恶性转化”。5进行性脑组织丢失、临床恶化、功能下降的证据,6我是第一项报告双相躁狂患者心室扩张(代表皮质萎缩)的研究的首席研究员,7这一发现随后被20多名研究人员复制。随后进行了大量神经影像学研究,报告了包括额叶在内的多个大脑区域的体积损失。在双相情感障碍I中早期使用长效注射型抗精神病药物可以预防严重后果Henry a.Nasrallah,医学博士,DLFAPA主编
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Brain damage from recurrent relapses of bipolar mania: A call for early LAI use
Just as I have always advocated preventing recurrences in schizophrenia by using long-acting injectable (LAI) antipsychotic formulations immediately after the first episode to prevent psychotic relapses and progressive brain damage,3 I strongly recommend using LAIs right after hospital discharge from the first manic episode. It is the most rational management approach for bipolar mania given the grave consequences of multiple episodes, which are so common in this psychotic mood disorder due to poor medication adherence. In contrast to the depressive episodes of BD I, where patients have insight into their depression and seek psychiatric treatment, during a manic episode patients often have no insight (anosognosia) that they suffer from a serious brain disorder, and refuse treatment.4 In addition, young patients with BD I frequently discontinue their oral mood stabilizer or second-generation antipsychotic (which are approved for mania) because they miss the blissful euphoria and the buoyant physical and mental energy of their manic episodes. They are completely oblivious to (and uninformed about) the grave neurobiological damage of further manic episodes, which can condemn them to clinical, functional, and cognitive deterioration. These patients are also likely to become treatment-resistant, which has been labeled as “the malignant transformation of bipolar disorder.”5 The evidence for progressive brain tissue loss, clinical deterioration, functional decline, and treatment resistance is abundant.6 I was the lead investigator of the first study to report ventricular dilatation (which is a proxy for cortical atrophy) in bipolar mania,7 a discovery that was subsequently replicated by 2 dozen researchers. This was followed by numerous neuroimaging studies reporting a loss of volume across multiple brain regions, including the frontal lobe, Early use of a longacting injectable antipsychotic in bipolar I disorder can prevent grave consequences Henry A. Nasrallah, MD, DLFAPA Editor-in-Chief
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来源期刊
Current psychiatry
Current psychiatry Medicine-Psychiatry and Mental Health
CiteScore
0.50
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