Moreno Caballero M, Corchos González N, De Antonio Rubio I, Gómez-Río M, Guerrero Velázquez J F, Rodríguez Fernández A, Llamas Elvira J M
Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, España.
Servicio de Psiquiatría, Hospital Universitario Virgen de las Nieves, Granada, España.
Rev Esp Med Nucl Imagen Mol. 2014 Sep-Oct;33(5):299-301. doi: 10.1016/j.remn.2013.09.010. Epub 2014 Apr 1.
We report the case of a patient with a long history of dysthymia and major depressive episodes requiring repeated hospitalization. We describe the most recent episode, associated with catatonia symptomatology and features suggestive of cognitive impairment. The absence of a clear initial psychopharmacological response alongside the clinical severity made the patient a potential candidate for electroconvulsive therapy (ECT). A regional cerebral blood flow SPECT (SPECT-rCBF), performed to rule out concomitant Alzheimer disease (AD), revealed a markedly decreased neocortical uptake, with no definitive pattern of concomitant primary cognitive impairment. Because a gradual clinical improvement was observed in the patient, with evidence of enhanced cerebral reperfusion in a second SPECT-rCBF study at two weeks after admission, the application of ECT was discounted and an expectant attitude was adopted.
我们报告了一例患有心境恶劣障碍和重度抑郁发作病史较长、需要反复住院治疗的患者。我们描述了其最近一次发作，伴有紧张症症状和提示认知障碍的特征。由于临床症状严重且最初没有明确的精神药物反应，该患者成为了电休克治疗（ECT）的潜在候选对象。为排除合并阿尔茨海默病（AD）而进行的局部脑血流单光子发射计算机断层扫描（SPECT-rCBF）显示，新皮质摄取明显减少，没有明确的合并原发性认知障碍模式。由于在患者身上观察到临床逐渐改善，且入院两周后的第二次SPECT-rCBF研究中有脑再灌注增强的证据，因此放弃了ECT治疗并采取了观察等待的态度。
