Almeida Jaime, Serrão Eva Mendes, Almeida Andre Traça, Afonso Joana Gois
CEDOC, Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal.
Clin Neuropharmacol. 2011 May-Jun;34(3):131-2. doi: 10.1097/WNF.0b013e31821f4d91.
The cerebellum has traditionally been regarded as an organ of motor coordination. However, the importance of the cerebellum in psychiatric disorders, behavior, and cognition is increasingly being recognized. There is no consensus concerning treatment of schizophrenia-like psychosis after cerebellar pathology. Reports describe the use of several antipsychotics, either alone or in combination with antidepressants or lithium. Clozapine is used for the treatment of refractory schizophrenia, but there are no reports of its use in the above-mentioned situation.
We report the case of a 20-year-old woman who developed a schizophrenia-like psychosis after rupture of arteriovenous malformation at 13 years of age. The psychotic symptoms proved to be resistant to treatment, and several psychopharmacological schemas were tried. The clinical picture only showed consistent improvement with the combined use of clozapine and valproate.
The relationship between chronic psychosis and cerebellar pathology remains poorly understood. Cases like the present one suggest that clozapine and valproate may be used safely and effectively in refractory schizophrenia-like psychosis associated with cerebellar pathology.
传统上，小脑被视为运动协调器官。然而，小脑在精神疾病、行为和认知方面的重要性正日益得到认可。关于小脑病变后类精神分裂症性精神病的治疗尚无共识。报告描述了几种抗精神病药物的使用情况，这些药物单独使用或与抗抑郁药或锂联合使用。氯氮平用于治疗难治性精神分裂症，但尚无其在上述情况下使用的报告。
我们报告一例20岁女性病例，该患者13岁时因动静脉畸形破裂后出现类精神分裂症性精神病。事实证明，该精神病症状对治疗有抵抗性，尝试了多种精神药理学方案。仅在联合使用氯氮平和丙戊酸盐时，临床症状才持续改善。
慢性精神病与小脑病变之间的关系仍知之甚少。像本病例这样的情况表明，氯氮平和丙戊酸盐可安全有效地用于与小脑病变相关的难治性类精神分裂症性精神病。
