Antosik-Wójcińska Anna Zofia, Święcicki Łukasz, Bieńkowski Przemysław, Mandat Tomasz, Sołtan Emilia
Oddział Chorób Afektywnych IPiN w Warszawie.
Zakład Farmakologii IPiN w Warszawie.
Psychiatr Pol. 2016;50(2):323-327. doi: 10.12740/PP/34042.
Deep brain stimulation is a therapeutic method used for decades in neurological diseases such as Parkinson's disease or dystonia. Despite many publications concerning DBS, there are few publications on psychotic symptoms after DBS, there are also no standards of dealing with them.
The authors present a case of a patient with Parkinson's disease, in whom psychotic symptoms in the form of Othello-like syndrome appeared after implantation of a stimulator. In this case the strategy of continuation of stimulation and adding antipsychotic drug (quetiapine) was chosen.
Gradual resolution of psychotic symptoms, without worsening of neurological symptoms and no recurrence of psychiatric symptoms was observed.
In recent years, work is underway on the use of DBS in psychiatry, particularly in patients with treatment-resistant depression. It is necessary to set the strategy for dealing with side-effects of DBS. Most of the authors prefer the temporary or permanent switch off the stimulator. In the author's opinion, in some cases it is possible to effectively treat the psychotic symptoms without resignation from the benefits of stimulation. So far, however, such cases were described so rarely that it is difficult on this basis to formulate conclusions that can be applied to the whole population of patients treated with DBS. Only a systematic study including an assessment of psychotic symptoms using scales and analysing the received treatment and stimulation parameters could give an idea of what is the most appropriate strategy in case of psychosis following DBS.
脑深部电刺激术是一种在帕金森病或肌张力障碍等神经系统疾病中应用了数十年的治疗方法。尽管有许多关于脑深部电刺激术的出版物，但关于该术后精神症状的出版物却很少，也没有处理这些症状的标准。
作者介绍了一例帕金森病患者的病例，该患者在植入刺激器后出现了类似奥赛罗综合征形式的精神症状。在这种情况下，选择了继续刺激并添加抗精神病药物（喹硫平）的策略。
观察到精神症状逐渐缓解，神经症状未恶化，精神症状也未复发。
近年来，正在开展将脑深部电刺激术用于精神病学的研究，尤其是用于治疗难治性抑郁症患者。有必要制定应对脑深部电刺激术副作用的策略。大多数作者倾向于暂时或永久关闭刺激器。作者认为，在某些情况下，可以在不放弃刺激益处的情况下有效治疗精神症状。然而，到目前为止，此类病例描述极少，因此很难据此得出可应用于所有接受脑深部电刺激术治疗患者群体的结论。只有通过一项系统研究，包括使用量表评估精神症状以及分析所接受的治疗和刺激参数，才能了解在脑深部电刺激术后出现精神病时最合适的策略是什么。
