Juvenile Bipolar Research Foundation, Maplewood, NJ, USA.
J Affect Disord. 2013 May;147(1-3):431-6. doi: 10.1016/j.jad.2012.08.040. Epub 2012 Nov 30.
Intravenous ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, has been shown to exert a rapid antidepressant effect in adults with treatment resistant depression. Children with bipolar disorder (BD) often respond poorly to pharmacotherapy, including polypharmacy. A pediatric-onset Fear of Harm (FOH) phenotype has been described, and is characterized by severe clinical features and resistance to accepted treatments for BD. The potential efficacy and safety of intranasal ketamine in children with BD with FOH-phenotype were assessed by a systematic retrospective chart review of a case series from the private practice of one of the authors, including cases with clear refractoriness to mood stabilizers, antipsychotics and benzodiazepines.
A comparison was made between routinely collected symptom measures 1-2 weeks prior to and after the administration of ketamine, in 12 treatment-refractory youth, 10 males 2 females ages 6-19years.
Ketamine administration was associated with a substantial reduction in measures of mania, fear of harm and aggression. Significant improvement was observed in mood, anxiety and behavioral symptoms, attention/executive functions, insomnia, parasomnias and sleep inertia. Treatment was generally well-tolerated.
Intranasal ketamine administration in treatment-resistant youth with BD-FOH produced marked improvement in all symptomatic dimensions. A rapid, substantial therapeutic response, with only minimal side effects was observed. Formal clinical trials to assess safety and efficacy are warranted.
静脉注射氯胺酮是一种谷氨酸 N-甲基-D-天冬氨酸（NMDA）受体拮抗剂，已被证明对治疗抵抗性抑郁症的成年人具有快速抗抑郁作用。双相情感障碍（BD）的儿童通常对药物治疗反应不佳，包括联合用药。已经描述了一种儿科发病的伤害恐惧（FOH）表型，其特征是严重的临床特征和对 BD 的公认治疗方法的耐药性。通过对一位作者的私人执业中的一系列病例进行系统回顾性图表审查，评估了鼻内氯胺酮在具有 FOH 表型的 BD 儿童中的潜在疗效和安全性，包括对心境稳定剂、抗精神病药和苯二氮䓬类药物明确耐药的病例。
在 12 名治疗抵抗性青少年（10 名男性，2 名女性，年龄 6-19 岁）中，比较了在给予氯胺酮前 1-2 周和给予氯胺酮后常规收集的症状测量值。
氯胺酮给药与躁狂、伤害恐惧和攻击行为的显著减少相关。情绪、焦虑和行为症状、注意力/执行功能、失眠、睡眠障碍和睡眠惯性都有显著改善。治疗通常耐受性良好。
鼻内氯胺酮给药可显著改善 BD-FOH 治疗抵抗性青少年的所有症状维度。观察到快速、显著的治疗反应，仅有最小的副作用。需要进行正式的临床试验来评估安全性和疗效。
