Aripiprazole Treatment for a Patient with Schizophrenia, Polydipsia and Water Intoxication

以Aripiprazole治療一位煩渴、水中毒與思覺失調症的病人

黃斯聖(Si-Sheng Huang)

《The Changhua Journal of Medicine》 15卷3期 (2017/09) Pp. 154-159

https://doi.org/10.6501/CJM.1503.006

摘要

The aim of this case report was to describe and discuss the case of a 46-year-old man with schizophrenia, polydipsia and water intoxication who had a poor response to clozapine treatment but a relatively satisfactory response to aripiprazole. The patient's psychiatric history is recounted and studied, and the pharmacological mechanism is explored through a literature review. One possible explanation for the occurrence of polydipsia in patients with schizophrenia is supersensitivity of dopamine receptors, which can be induced by the long-term use of antipsychotics, thereby stimulating the thirst center. Chronic D_2 dopamine receptor blockade has been reported to increase sensitivity to angiotensin II and induce thirst. The effectiveness of aripiprazole treatment in this patient may be explained by its D_2 partial agonist properties. The D_2 partial agonist properties of aripiprazole, a third-generation antipsychotic, may stabilize sensitivity to dopamine by regulating compensatory systems of dopamine neurotransmission and offer an alternative treatment for people with schizophrenia and polydipsia.

關鍵字

aripiprazole ； polydipsia ； schizophrenia ； water intoxication

並列摘要

本個案報告描述一位46歲合併煩渴、水中毒的思覺失調症病人，對於clozapine療效不佳但對於aripiprazole療效相對滿意的個案。報告中描述病人之精神病史並以文獻回顧探究相關藥物的作用機轉。思覺失調症病人長期使用抗精神病藥物導致腦中多巴胺受體的過度敏感，從而激化了口渴中樞是病人出現煩渴的可能解釋。慢性多巴胺第二型受體的阻斷已被報告為將增強人體第二型血管張力素的敏感度與引致口渴。Aripiprazole擁有的第二型多巴胺的部分促效劑的特質，可能是治療有效的原因。Aripiprazole是一種第三代的抗精神病藥物，它針對多巴胺第二型受體的部分促效劑的特質可以調控多巴胺傳導及代償系統來穩定腦中多巴胺的敏感度，因此提供了思覺失調病人合併煩渴的另一種替代藥物治療。

並列關鍵字

Aripiprazole ； 煩渴 ； 思覺失調症 ； 水中毒