Bigman Daniel, Kunaparaju Sindhura, Bobrin Bradford
Department of Psychiatry, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA.
BMJ Case Rep. 2017 Nov 12;2017:bcr-2017-222059. doi: 10.1136/bcr-2017-222059.
Ketamine is a standard anaesthetic drug that has been studied as a possible treatment for acute suicidal ideation. Aside to the potential psychotropic effects of ketamine, a Cochrane review reported that available studies suggest a modest effect of ketamine for chronic pain months to years after surgical intervention. We present a patient with acute suicidal ideation who required immediate inpatient psychiatric admission in the setting of concurrent chronic pain on cannabinoids which could not be prescribed within our inpatient hospital setting. This presented a clinical dilemma to rapidly reverse the patient's suicidality while substituting the patient's prescribed cannabinoid products with an alternative pain regimen. Since there is emerging support in the use of ketamine in suicidality and chronic pain, we administered ketamine while withholding cannabinoid products and found evidence to support its use in rapid reversal of suicidal ideation and temporary chronic pain relief.
氯胺酮是一种标准麻醉药物，已被作为急性自杀意念的一种可能治疗方法进行研究。除了氯胺酮潜在的精神otropic作用外，一项Cochrane综述报告称，现有研究表明，在手术干预数月至数年之后，氯胺酮对慢性疼痛有一定疗效。我们报告一名患有急性自杀意念的患者，该患者因同时患有慢性疼痛且正在服用大麻素类药物而需要立即住院接受精神科治疗，但在我们的住院环境中无法开具此类药物。这带来了一个临床难题，即要迅速扭转患者的自杀倾向，同时用替代疼痛治疗方案取代患者开具的大麻素类产品。由于越来越多的证据支持氯胺酮用于治疗自杀倾向和慢性疼痛，我们在停用大麻素类产品的同时给予氯胺酮治疗，发现有证据支持其用于快速扭转自杀意念和暂时缓解慢性疼痛。
