Algin Sultana, Banik Debasish, Rahman Sm Atikur, Mahmud Tusher Saiful, Tuj Johora Fatema, Akter Asha, Ahmed Tanbir, Biswas Md Abdul Monib, Sinha Susmita, Haque Mainul
Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD.
Anesthesia, Analgesia, and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD.
Cureus. 2024 Apr 8;16(4):e57877. doi: 10.7759/cureus.57877. eCollection 2024 Apr.
Treatment of resistant obsessive-compulsive disorder (OCD) typically results in insufficient symptom alleviation, and even long-term medication often fails to have the intended effect. Ketamine is a potent non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor. Studies have shown that low-dose ketamine infusion results in a considerable reduction in obsessive-compulsive symptoms and a rapid resolution of suicidal ideation. This is a case report on the effect of intravenous ketamine infusion on a patient with resistant OCD and severe suicidal ideation. Intravenous (IV) ketamine was given once a week over consecutive three weeks with necessary precautions. Psychometric tools such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Clinical Global Impressions Scale (CGI-S), the Beck Scale for Suicidal Ideations (BSSI), and Depression Anxiety and Stress Scale 21 (DASS-21) were applied before and after infusions. Obsessive-compulsive symptoms and suicidal severity started to decrease rapidly after the first infusion. However, after a transient improvement, these symptoms again began to increase after a stressful incident on the second day of the first infusion. All the symptoms measured by validated rating scales showed continued improvement after the following two infusions. The improvement was sustained until discharge (one week after the last infusion) and subsequent follow-up in the sixth and 12 weeks. The role of ketamine in reducing suicidal thoughts and behavior is already established. Very few studies emphasized its effectiveness in improving severe/resistant obsessive-compulsive symptoms. This pioneering work may offer scope for similar research in the relevant field.
难治性强迫症（OCD）的治疗通常只能使症状得到部分缓解，即便长期用药往往也无法达到预期效果。氯胺酮是一种强效的N-甲基-D-天冬氨酸（NMDA）受体非竞争性拮抗剂。研究表明，低剂量静脉输注氯胺酮可显著减轻强迫症状，并迅速消除自杀念头。本文报告了一例静脉输注氯胺酮对一名患有难治性OCD及严重自杀念头患者的疗效。在连续三周内，每周进行一次静脉注射氯胺酮，并采取必要的预防措施。在输注前后使用了多种心理测量工具，如耶鲁-布朗强迫量表（Y-BOCS）、临床总体印象量表（CGI-S）、贝克自杀意念量表（BSSI）以及抑郁焦虑压力量表21（DASS-21）。首次输注后，强迫症状和自杀严重程度迅速开始下降。然而，在短暂改善后，这些症状在首次输注第二天发生应激事件后再次开始增加。经过后续两次输注后，所有经过验证的评定量表所测量的症状均持续改善。这种改善一直持续到出院（最后一次输注后一周）以及随后第六周和第十二周的随访。氯胺酮在减少自杀念头和行为方面的作用已经得到证实。很少有研究强调其在改善严重/难治性强迫症状方面的有效性。这项开创性工作可能为相关领域的类似研究提供空间。
