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[电休克治疗在癫痫相关性精神病中的效用]

[Utility of electroshock therapy in epilepsy-associated psychosis].

作者信息

Farkas Márta, Baran Brigitta, Kárpáti Róbert, Rajna Péter

机构信息

Semmelweis Egyetem, Altalános Orvosi Kar, Pszichiátriai és Pszichoterápiás Klinika, H-1083 Budapest, Balassa utca 6.

出版信息

Ideggyogy Sz. 2002 Nov 20;55(11-12):400-5.

Abstract

Psychiatric disorders which indicate the use of electroconvulsive therapy (ECT) also occur in epileptic patients, but there is a lack of medical authority concerning the use of ECT in epileptic patients. This is surprising because in recent years it has been proved that ECT has an anti-convulsive effect to some degree. A case study of an epileptic patient is presented whose progress has been monitored for several years. Antiepileptic drugs were seemingly able to control his epilepsy but at the same time progressive behavioural disturbance (schizophreniform psychosis) accompanied by agitation and violent behaviour developed. Considering the recurrent psychotic decompensations and the relative ineffectiveness of antipsychotics, the authors decided to administer ECT. As a result they were able to bring about the longest symptom free balanced period in the patient. According to the data based on previous medical studies and the experience they can suppose that ECT is not immediately contraindicated by the presence of epilepsy with active interictal focus if the psychopathological condition makes it necessary. In view of the epileptogenic risk factors of classical neuroleptics, the epileptogenic effects of accompanying psychosis and the probable anticonvulsive potential of ECT in cases of severe psychiatric complications accompanying epilepsy ECT could be used more frequently.

摘要

表明可使用电休克治疗(ECT)的精神障碍在癫痫患者中也会出现,但在癫痫患者中使用ECT缺乏医学权威依据。这令人惊讶,因为近年来已证明ECT在一定程度上具有抗惊厥作用。本文介绍了一名癫痫患者的病例研究,对其病情进展进行了数年监测。抗癫痫药物似乎能够控制他的癫痫发作,但与此同时,逐渐出现了伴有激越和暴力行为的进行性行为障碍(精神分裂症样精神病)。考虑到反复出现的精神病性失代偿以及抗精神病药物相对无效,作者决定给予ECT治疗。结果,他们使患者实现了最长的无症状平衡期。根据以往医学研究的数据和经验,他们推测,如果心理病理状况有必要,ECT并非因存在伴有发作间期活跃病灶的癫痫而立即被禁忌。鉴于经典抗精神病药物的致癫痫风险因素、伴发精神病的致癫痫作用以及ECT在伴有癫痫的严重精神并发症病例中可能具有的抗惊厥潜力,ECT可以更频繁地使用。

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