Karanti Alina, Landén Mikael
Section of Psychiatry, Institution of Clinical Neuroscience, Göteborg University, Mölndal, Sweden.
Psychopharmacol Bull. 2007;40(1):113-7.
Patients refractory, or responding only partially, to antipsychotic drugs are common in clinical practise. Medical diseases can present with psychotic symptoms or add to a psychotic picture and should not be missed. We report on a patient with schizophrenia whose treatment refractory psychosis remitted upon treatment of her obesity-hypoventilation syndrome (OHS).
A 63-year-old women previously diagnosed with hebephrenic schizophrenia developed treatment resistant auditory hallucinations along with extreme daytime fatigue and obesity. She was eventually diagnosed with Pickwickian syndrome or OHS and received treatment with continuous positive airway pressure (CPAP). Restoring the patient's alveolar hypoventilation with nocturnal CPAP led to the complete remission of hallucinations.
We suggest that this case highlights an issue that might become more common in the future with increasing prevalence of overweight. Indeed, some atypical neuroleptics might even counteract their own therapeutic effect by inducing excessive weight gain that increases the risk for OHS. We recommend taking a careful sleep history in schizophrenic patients with obesity and to perform a polysomnography in suspect cases.
在临床实践中，对抗精神病药物难治或仅部分有反应的患者很常见。躯体疾病可表现为精神病性症状或加重精神病表现，不应被漏诊。我们报告了一名精神分裂症患者，其难治性精神病在治疗肥胖低通气综合征（OHS）后得到缓解。
一名63岁女性，先前被诊断为青春型精神分裂症，出现了对治疗耐药的幻听，同时伴有极度日间疲劳和肥胖。她最终被诊断为匹克威克综合征或OHS，并接受了持续气道正压通气（CPAP）治疗。通过夜间CPAP恢复患者的肺泡低通气后，幻觉完全缓解。
我们认为，随着超重患病率的增加，这个问题在未来可能会变得更加普遍。事实上，一些非典型抗精神病药物甚至可能通过导致体重过度增加而增加OHS风险，从而抵消其自身的治疗效果。我们建议对肥胖的精神分裂症患者仔细询问睡眠史，并对可疑病例进行多导睡眠图检查。
