Nishikawa Tadashi, Araki Yoichiro, Hayashi Teruo
Seiwakai Nishikawa Hospital, 293-2 Minato-machi, Hamada, Shimane 697-0052 Japan.
Ann Gen Psychiatry. 2015 Mar 5;14:13. doi: 10.1186/s12991-015-0051-5. eCollection 2015.
Hiccups or singulata are rhythmic involuntary movements of the diaphragm, caused by a variety of conditions that interfere with the functions of the nerve nuclei in the medulla and supra-spinal hiccup center. Although neurotransmitters and receptors involved in the pathophysiology of hiccups are not defined well, dopamine has been considered to play an important role. In some cases, chlorpromazine or other antipsychotics are used for the treatment of intractable hiccups but their efficacy is often limited. This report involves an 18-year-old patient who experienced two episodes of intractable hiccups triggered by stress, which lasted for weeks or even months. In both episodes, haloperidol was initially used, but there was no significant effect. In contrast, risperidone, the second-generation antipsychotic that possesses a dopamine-serotonin antagonist property, completely abolished the hiccups 6 hours after administration. This is one of few case reports in which two antipsychotics were challenged for a single patient with hiccups, and the effects of the drugs were obviously different. Our finding suggests that, in addition to dopaminergic system, the serotonergic systems may be involved in the pathophysiology of some hiccup cases and that the serotonin-acting antipsychotics such as risperidone should be considered as a choice in the drug treatment of intractable hiccups.
呃逆或膈肌痉挛是膈肌的节律性不自主运动，由多种干扰延髓神经核和脊髓上呃逆中枢功能的情况引起。尽管呃逆病理生理学中涉及的神经递质和受体尚未明确界定，但多巴胺被认为起重要作用。在某些情况下，氯丙嗪或其他抗精神病药物用于治疗顽固性呃逆，但其疗效往往有限。本报告涉及一名18岁患者，该患者经历了两次由压力引发的顽固性呃逆发作，持续数周甚至数月。在两次发作中，最初使用了氟哌啶醇，但没有显著效果。相比之下，具有多巴胺 - 血清素拮抗剂特性的第二代抗精神病药物利培酮在给药6小时后完全消除了呃逆。这是少数关于一名呃逆患者使用两种抗精神病药物进行挑战且药物效果明显不同的病例报告之一。我们的发现表明，除了多巴胺能系统外，血清素能系统可能也参与了某些呃逆病例的病理生理学过程，并且像利培酮这样作用于血清素的抗精神病药物应被视为顽固性呃逆药物治疗的一种选择。
