Breden Ericka L, Kirkwood Cynthia K
Department o Pharmacy, Virginia Commonwealth University Health-Systems, Richmond, Virginia, USA.
Consult Pharm. 2006 Mar;21(3):229-34. doi: 10.4140/tcp.n.2006.229.
A 75-year-old white female with schizoaffective disorder was admitted to an inpatient psychiatry unit for uncooperativeness in refusing to take scheduled medications. She complained of anticholinergic adverse effects and had abnormal involuntary movements in the oral/buccal region. The patient had been prescribed six psychotropic medications (i.e., thiothixene, lithium, divalproex sodium, amitriptyline, benztropine, and trazodone effects. The treatment team determined that the patient was noncompliant and experienced the effects of polypharmacy. She had been prescribed two mood stabilizers and suffered from anticholinergic adverse effects and the movement disorder tardive dyskinesia (TD). Four medications were discontinued: thiothixene, amitriptyline, lithium, and benztropine. Quetiapine, a second-generation antipsychotic, was recommended, with a daily titration schedule to reach a target dose of 600 mg per day in divided doses. This agent has less propensity to cause movement disorders compared with first-generation antipsychotics. All medications with additive anticholinergic properties also were discontinued. Lithium was stopped secondary to subtherapeutic levels and potential drug interactions. The pharmacist educated the inpatient team on the additive anticholinergic effects of each medication, reduced the total number of medications prescribed, and assisted in appropriate conversion to quetiapine to reduce TD symptoms.
一名75岁患有分裂情感障碍的白人女性因拒绝服用规定药物而不合作，被收治入院至精神科住院部。她抱怨有抗胆碱能不良反应，且口腔/颊部区域有异常不自主运动。该患者曾被开具六种精神药物（即硫利达嗪、锂盐、丙戊酸钠、阿米替林、苯海索和曲唑酮）。治疗团队确定该患者不依从治疗且经历了多种药物联用的影响。她被开具了两种心境稳定剂，且患有抗胆碱能不良反应和运动障碍迟发性运动障碍（TD）。停用了四种药物：硫利达嗪、阿米替林、锂盐和苯海索。推荐使用第二代抗精神病药物喹硫平，采用每日滴定方案，分剂量达到每日600毫克的目标剂量。与第一代抗精神病药物相比，该药物引起运动障碍的倾向较小。所有具有相加抗胆碱能特性的药物也都停用了。由于血药浓度低于治疗水平和潜在的药物相互作用，停用了锂盐。药剂师就每种药物的相加抗胆碱能作用对住院团队进行了培训，减少了所开药物的总数，并协助适当转换为喹硫平以减轻TD症状。
