Egashira Toshiaki, Inoue Takeshi, Shirai Yasuyuki, Iwata Kazuya, Honma Jiro, Koyama Tsukasa
Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Clin Neuropharmacol. 2011 May-Jun;34(3):129-30. doi: 10.1097/WNF.0b013e318213b9cd.
We report a case with bipolar II disorder having mixed features, in which refractory insomnia persisted. We diagnosed his case as mixed depression with mood fluctuations because increased impulsivity and buying sprees became remarkable, with diminished ability to think or concentrate. Switching to carbamazepine and risperidone improved his mood fluctuations and impulsivity. Nevertheless, his intermittent awakening (fragmentation of the sleep-wake rhythm), related dysfunctional beliefs, anxiety about sleep, and mild impulsivity persisted. The addition of various benzodiazepine sleeping drugs, bromovalerylurea, and antipsychotics did not improve insomnia. His intractable insomnia was markedly responsive to gabapentin, engendering further improvement of mood symptoms. Eventually, its efficacy achieved his reinstatement at work. Results of this case suggest the clinical use of gabapentin for treating bipolar disorder, especially in cases with intractable insomnia, which is a very important point in the symptoms and therapeutics of bipolar disorder.
我们报告一例伴有混合特征的双相II型障碍病例，该病例中难治性失眠持续存在。我们将其病例诊断为伴有情绪波动的混合性抑郁，因为冲动增加和疯狂购物变得显著，同时思维或集中注意力的能力下降。换用卡马西平和利培酮改善了他的情绪波动和冲动。然而，他的间歇性觉醒（睡眠-觉醒节律紊乱）、相关的功能失调信念、对睡眠的焦虑以及轻度冲动仍然存在。添加各种苯二氮䓬类助眠药物、溴戊酰脲和抗精神病药物均未改善失眠。他的顽固性失眠对加巴喷丁有显著反应，情绪症状也进一步改善。最终，其疗效使他得以重返工作岗位。该病例结果提示加巴喷丁在双相情感障碍治疗中的临床应用，尤其是在伴有顽固性失眠的病例中，这在双相情感障碍的症状和治疗中是非常重要的一点。
