Skokou Maria, Gourzis Philippos
Department of Psychiatry, University Hospital of Patras, School of Medicine, University of Patras, University Campus, 26504 Rio, Greece.
Case Rep Psychiatry. 2013;2013:718950. doi: 10.1155/2013/718950. Epub 2013 Feb 28.
Venous thromboembolism has been associated with antipsychotic drugs, but the underlying mechanisms are largely unknown. Hypotheses that have been made include body weight gain, sedation, enhanced platelet aggregation, increased levels of antiphospholipid antibodies, hyperhomocysteinemia, whereas hyperprolactinemia has recently attracted attention as a potential contributing factor. The highest risk has been demonstrated for clozapine, olanzapine, and low-potency first-generation antipsychotics; however, presently there is no data for amisulpride. In the present paper we describe a case of pulmonary embolism in a female bipolar patient, receiving treatment with amisulpride, aripiprazole, and paroxetine. Although a contribution of aripiprazole and paroxetine cannot completely be ruled out, the most probable factor underlying the thromboembolic event seems to be hyperprolactinemia, which was caused by amisulpride treatment. Increased plasma levels of prolactin should probably be taken into account during the monitoring of antipsychotic treatment as well as in future research concerning venous thromboembolism in psychiatric settings.
静脉血栓栓塞与抗精神病药物有关，但其潜在机制大多未知。已提出的假说包括体重增加、镇静作用、血小板聚集增强、抗磷脂抗体水平升高、高同型半胱氨酸血症，而高催乳素血症最近作为一个潜在的促成因素受到关注。氯氮平、奥氮平和低效第一代抗精神病药物的风险最高；然而，目前尚无关于氨磺必利的数据。在本文中，我们描述了一例女性双相情感障碍患者发生肺栓塞的病例，该患者正在接受氨磺必利、阿立哌唑和帕罗西汀治疗。虽然不能完全排除阿立哌唑和帕罗西汀的作用，但血栓栓塞事件最可能的因素似乎是氨磺必利治疗引起的高催乳素血症。在抗精神病治疗监测以及未来关于精神科环境中静脉血栓栓塞的研究中，可能应考虑血浆催乳素水平升高的情况。
