Kajiya Tomoko, Sugawara Hiroko, Kajio Yusuke, Morieda Satoru, Tanaka Hibiki, Jono Tadashi, Fujise Noboru, Hashimoto Mamoru
Department of Neuropsychiatry, Faculty of Life Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-Shi, Kumamoto 860-8556 Japan.
Kumamoto University Healthcare Center, Kumamoto, Japan.
Ann Gen Psychiatry. 2017 Aug 9;16:31. doi: 10.1186/s12991-017-0154-2. eCollection 2017.
Major depressive episodes with psychotic features are more common in bipolar disorder than in major depressive disorder; however, there is little information on the optimal treatment for bipolar depression with psychotic features.
The patient was a 69-year-old man. At the age of 66, he was admitted to the hospital for the treatment of bipolar depression with psychotic features. He was treated with a combination therapy of antipsychotics and antidepressants during long-term hospitalization. At the age of 69, he relapsed and was admitted to the hospital again. He was initially treated with olanzapine and lithium for the treatment of bipolar depression with psychotic features. He partially responded to the combination therapy, and psychomotor retardation and delusion of guilt disappeared; however, he developed psychomotor agitation and delusion of persecution, which was a mood-incongruent psychotic feature. Finally, he fully recovered with an additional dosage of lamotrigine, and had no experience of relapse after discontinuation of olanzapine.
This case report implicates the utility of lamotrigine for bipolar depression with psychotic features, and further studies are needed to establish the optimal treatment.
伴有精神病性特征的重度抑郁发作在双相情感障碍中比在重度抑郁症中更常见；然而，关于伴有精神病性特征的双相抑郁的最佳治疗方法的信息很少。
患者为一名69岁男性。66岁时，他因治疗伴有精神病性特征的双相抑郁入院。在长期住院期间，他接受了抗精神病药物和抗抑郁药物的联合治疗。69岁时，他复发并再次入院。他最初接受奥氮平和锂治疗伴有精神病性特征的双相抑郁。他对联合治疗有部分反应，精神运动迟缓及罪恶妄想消失；然而，他出现了精神运动性激越和被害妄想，这是一种与心境不相符的精神病性特征。最后，增加拉莫三嗪剂量后他完全康复，停用奥氮平后未再复发。
本病例报告提示拉莫三嗪对伴有精神病性特征的双相抑郁有用，需要进一步研究以确定最佳治疗方法。
