Kawai Mihoko, Aratake Ryosuke, Ogawa Tadashi
Department of Neuropsychiatry Aichi Medical University Nagakute Aichi Japan.
Department of Legal Medicine Aichi Medical University School of Medicine Nagakute Aichi Japan.
PCN Rep. 2024 Dec 9;3(4):e70043. doi: 10.1002/pcn5.70043. eCollection 2024 Dec.
The population of pregnant women with schizophrenia is increasing. Managing schizophrenia during pregnancy poses unique challenges due to the potential effects of second-generation antipsychotics on maternal mental health and fetal development and changes in drug pharmacokinetics. Evidence on how physiological changes during pregnancy affect the levels of second-generation antipsychotics, particularly lurasidone, is limited. There are no data on effectively managing medications and decreasing side-effects during pregnancy.
We presented the case of a 34-year-old pregnant woman with schizophrenia who had a stable condition with lurasidone therapy before conception. However, she exhibited worsening psychiatric symptoms during the third trimester of pregnancy. Serial measurements of serum lurasidone levels were performed during late pregnancy. Despite maintaining the same dosage, her serum lurasidone levels significantly decreased during the third trimester (maximum decrease of ~65% compared with baseline) and rapidly increased during the postpartum period, coinciding with an improvement in psychiatric symptoms.
Decreased serum lurasidone levels during pregnancy may increase the risk of symptom worsening in patients with schizophrenia. Hence, clinicians should be knowledgeable about the risk of decreased drug levels and the need for therapeutic monitoring and dosage adjustments during pregnancy to maintain treatment efficacy and maternal and fetal health.
患精神分裂症的孕妇人数正在增加。由于第二代抗精神病药物对孕产妇心理健康和胎儿发育的潜在影响以及药物药代动力学的变化，在孕期管理精神分裂症带来了独特的挑战。关于孕期生理变化如何影响第二代抗精神病药物水平，尤其是鲁拉西酮水平的证据有限。目前尚无关于孕期有效管理药物和减少副作用的数据。
我们报告了一名34岁患精神分裂症的孕妇病例，她在受孕前接受鲁拉西酮治疗时病情稳定。然而，她在妊娠晚期出现了精神症状恶化。在妊娠晚期对血清鲁拉西酮水平进行了连续测量。尽管维持相同剂量，但她的血清鲁拉西酮水平在妊娠晚期显著下降（与基线相比最大降幅约为65%），并在产后迅速上升，同时精神症状有所改善。
孕期血清鲁拉西酮水平降低可能会增加精神分裂症患者症状恶化的风险。因此，临床医生应了解药物水平降低的风险以及孕期进行治疗监测和剂量调整以维持治疗效果及母婴健康的必要性。
