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Manic Episode Associated with an Abrupt Shift from Sulpiride to Quetiapine in a Young Man with Schizophrenia
Sulpiride快速轉換成Quetiapine出現的躁症發作
摘要
目的：報告一精神分裂症個案藥物由sulpiride轉換成quetiapine時出現躁症症狀，並討論可能機轉。病例報告：二十歲男性精神分裂症患者。十八歲時，精神症狀持續且出現錐體外路徑副作用，故立即停用sulpiried，轉用quetiapine。使用quetiapine七天後，個案出現躁症症狀。以楊氏躁症量表量(Young Mania Rating Scale)及活性與負性症狀評量表量(Positive and Negatives Syndrome Scale)的活性量尺評分，起始分數分別爲25及19分。出現躁症症狀兩週後，停用quetiapine。停用quetiapine兩週後，躁症症狀完全消失，追踪二十一個月，亦未再出現。結論：非典型抗精神病藥物的抗血清素作用會增加dopamine分泌，而quetiapine對D2 receptors的抑制作用較弱，可能與發生躁症的表現相關。而sulpiride立即轉換爲quetiapine, D2 receptors抑制減低，也可能導致dopamine rebound產生躁症症狀。
並列摘要
Introduction: We report a case of manic episode associated with an abrupt shift from sulpiride to quetiapine in a young man with schizophrenia. Case report: This 20-year-old schizophrenic male had persistent psychotic despite sulpiride 2000 mg/d treatment. Extrapyramidal symptoms were noted after sulpiride was administrated for one week. Sulpiride was abruptly discontinued and replaced by quetiapine, which was titrated to 600 mg/d on the 6th day after starting quetiapine. On the 7th day after starting quetiapine, manic symptoms were noted with a Young Mania Rating Scale score of 25 and a Positive and Negative Syndrome Scale score on the positive scales of 19. Quetiapine was discontinued and replaced by haloperidol 10 mg/d two weeks after the onset of manic symptoms. Two weeks after switching to haloperidol, the manic symptoms remitted completely. There was no recurrence of manic symptoms during 21 months follow up. Discussion: Quetiapine has relatively lower potency on D2 receptors blockade compared to other atypical antipsychotics. The anti-serotoninergic effect of atypical anti- psychotics might induce dopamine secretion. Inadequate suppression D2 receptors might increase the likelihood of manic symptoms. The abrupt switch from sulpiride to quetiapine in this patient may also have resulted in a rebounding of dopaminergic activity, which might have contributed to the development of manic symptoms.
參考文獻
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