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哌甲酯致注意缺陷障碍患儿短暂性精神病性障碍:1例报告及文献复习

Brief psychosis induced by methylphenidate in a child with attention deficit disorder: a case report and literature review.

作者信息

Martínez-Aguayo Juan Carlos, Arancibia Marcelo, Meza-Concha Nicolás, Bustamante Camila, Pérez-Bracchiglione Javier, Madrid Eva

机构信息

Departamento de Pediatría, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile. Address: Angamos 655, Reñaca, Viña del Mar, Región de Valparaíso, Chile. Email:

Centro de Investigaciones Biomédicas, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile; Departamento de Salud Pública, Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile; Centro Colaborador Red Cochrane, Escuela de Medicina, Universidad de Valparaíso, Chile.

出版信息

Medwave. 2017 Jun 21;17(5):e6980. doi: 10.5867/medwave.2017.05.6980.

Abstract

Methylphenidate-induced psychosis has been scarcely studied due to bioethical and neurobiological issues regarding its research. Although some authors have hypothesized that there might be a vulnerability for the development of a major psychiatric disorder in the long term, there is no agreement about the predictive value of this type of psychosis in children and adolescents, and its origin is also uncertain. It has been suggested that higher dopamine levels in some cerebral regions and a family history of mental disorders might increase the risk of psychosis secondary to psychostimulants. We present the case of a nine-year-old child diagnosed with attention deficit disorder and oppositional defiant disorder, who exhibited visual and auditory hallucinations and delirious ideas about harm during methylphenidate treatment. The patient’s symptoms regressed after drug removal. We discuss the key issues related to the origin, causality, management, and prognosis of psychostimulant-induced psychosis.

摘要

由于有关哌醋甲酯研究的生物伦理和神经生物学问题,对其所致精神病的研究很少。尽管一些作者推测长期来看可能存在患重大精神障碍的易感性,但对于这类精神病在儿童和青少年中的预测价值尚无共识,其病因也不确定。有人提出,某些脑区多巴胺水平升高以及精神障碍家族史可能会增加精神兴奋剂所致精神病的风险。我们报告一例9岁儿童,诊断为注意力缺陷障碍和对立违抗障碍,在哌醋甲酯治疗期间出现视幻觉、听幻觉以及关于伤害的谵妄性想法。停药后患者症状消退。我们讨论了与精神兴奋剂所致精神病的病因、因果关系、管理及预后相关的关键问题。

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