Werneke Ursula, Truedson-Martiniussen Petra, Wikström Henrik, Ott Michael
Department of Clinical Sciences - Psychiatry, Sunderby Research Unit, Umeå University, 90187, Umeå, Sweden.
Sunderby Hospital, 97180, Luleå, Sweden.
J Integr Neurosci. 2020 Dec 30;19(4):719-727. doi: 10.31083/j.jin.2020.04.314.
Serotonin syndrome is a state of increased central and peripheral serotonin (5-hydroxytryptamine) activity. Unless recognized and treated early, serotonin syndrome can lead to seizures, shock and death. Both substances with direct and indirect serotonergic activity can precipitate the syndrome. Serotonin syndrome can occur not only in psychiatric but also in non-psychiatric settings. Yet, clinicians may not be familiar with the condition. We explore some of the current controversies regarding serotonin syndrome. Specifically, we tested the following assumptions: (i) Despite being rare, serotonin syndrome is still clinically relevant; (ii) The Hunter criteria are the gold standard for diagnosing serotonin syndrome; (iii) Hyperthermia is common in cases of serotonin syndrome; (iv) Serotonin syndrome usually develops fast; (v) Severe serotonin syndrome usually or almost exclusively involves monoamine oxidase inhibitors. We found that (i) despite being rare, serotonin syndrome was clinically relevant, (ii) the Hunter criteria could not be regarded as the gold standard for the diagnosis of serotonin syndrome since they missed more cases than the other two diagnostic criteria systems (Sternbach and Radomski criteria), (iii) Serotonin syndrome could occur in the absence of an elevated temperature, (iv) fast onset could not be regarded as a reliable clinical sign of serotonin syndrome, and (v) absence of monoamine oxidase inhibitors treatment did not exclude a diagnosis of serotonin syndrome. Clinicians should bear in mind that in the context of relevant drug history, serotonin syndrome may still be possible in these circumstances.
血清素综合征是一种中枢和外周血清素（5-羟色胺）活性增强的状态。除非早期识别并治疗，血清素综合征可导致癫痫发作、休克和死亡。具有直接和间接血清素能活性的物质均可引发该综合征。血清素综合征不仅可发生于精神科环境，也可发生于非精神科环境。然而，临床医生可能并不熟悉这种情况。我们探讨了目前关于血清素综合征的一些争议。具体而言，我们检验了以下假设：（i）尽管血清素综合征罕见，但仍具有临床相关性；（ii）亨特标准是诊断血清素综合征的金标准；（iii）高热在血清素综合征病例中很常见；（iv）血清素综合征通常发展迅速；（v）严重的血清素综合征通常或几乎仅涉及单胺氧化酶抑制剂。我们发现：（i）尽管血清素综合征罕见，但仍具有临床相关性；（ii）亨特标准不能被视为诊断血清素综合征的金标准，因为与其他两个诊断标准系统（斯特恩巴赫和拉多姆斯基标准）相比，它漏诊的病例更多；（iii）血清素综合征可在体温未升高的情况下发生；（iv）快速起病不能被视为血清素综合征的可靠临床体征；（v）未使用单胺氧化酶抑制剂治疗并不能排除血清素综合征的诊断。临床医生应牢记，在有相关用药史的情况下，在这些情形下仍可能发生血清素综合征。
