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拉莫三嗪单药治疗孕中期贫血且患有双相抑郁症合并强迫症的孕妇。

Lamotrigine monotherapy for management of bipolar depression with comorbid obsessive-compulsive disorder in a second trimester anemic pregnant female.

作者信息

Sharma Anjali, Thakur Manish Roshan, Prasad Shiv

机构信息

Department of Psychiatry, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India.

出版信息

Ind Psychiatry J. 2025 May-Aug;34(2):345-347. doi: 10.4103/ipj.ipj_185_24. Epub 2025 Jul 18.

DOI:10.4103/ipj.ipj_185_24
PMID:40861159
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12373342/
Abstract

This text discusses a case report of a pregnant anemic female in her second trimester with a diagnosis of bipolar depression and comorbid obsessive compulsive disorder (OCD). Managing both mood stabilization and obsessive compulsive symptoms simultaneously in a pregnant female presents a real challenge, especially considering that serotonin reuptake inhibitors (SSRI), the first-line treatment for OCD, can induce manic or mixed mood states in bipolar disorder patients. This case is unique in view of limited options left with pregnancy in place. Lamotrigine was chosen as an agent and was introduced in this patient which is rated as FDA pregnancy risk category C which amounts to risk cannot be ruled out (human data lacking, animal studies positive or not done). Patient responded well and maintained well on monotherapy of lamotrigine and showed significant improvement in both symptoms of depression and OCD. USG-level II examination shows no abnormality on repeated scans.

摘要

本文讨论了一例孕中期贫血女性的病例报告,该女性被诊断为双相抑郁症并伴有强迫症(OCD)。在孕期女性中同时管理情绪稳定和强迫症状是一项真正的挑战,特别是考虑到强迫症的一线治疗药物5-羟色胺再摄取抑制剂(SSRI)可在双相情感障碍患者中诱发躁狂或混合情绪状态。鉴于孕期可选择的治疗方法有限,该病例具有独特性。选择拉莫三嗪作为治疗药物并应用于该患者,其被美国食品药品监督管理局(FDA)列为妊娠风险C类药物,即不能排除风险(缺乏人类数据,动物研究结果为阳性或未开展)。患者对拉莫三嗪单一疗法反应良好且维持效果良好,抑郁和强迫症症状均有显著改善。超声二级检查显示多次扫描均无异常。

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本文引用的文献

1
Obsessive-Compulsive Disorder as an Epiphenomenon of Comorbid Bipolar Disorder? An Updated Systematic Review.强迫症作为双相情感障碍共病的一种附带现象?一项最新的系统评价。
J Clin Med. 2024 Feb 21;13(5):1230. doi: 10.3390/jcm13051230.
2
Risk of Major Congenital Malformations and Exposure to Antiseizure Medication Monotherapy.抗癫痫药物单药治疗的主要先天畸形风险。
JAMA Neurol. 2024 May 1;81(5):481-489. doi: 10.1001/jamaneurol.2024.0258.
3
Comorbidity of obsessive-compulsive disorder in bipolar spectrum disorders: Systematic review and meta-analysis of its prevalence.
双相谱系障碍中强迫症共病:患病率的系统评价和荟萃分析。
J Affect Disord. 2020 Feb 15;263:193-208. doi: 10.1016/j.jad.2019.11.136. Epub 2019 Dec 2.
4
Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder.加拿大心境与焦虑治疗网络(CANMAT)和国际双相障碍学会(ISBD)2018 年双相障碍患者管理指南。
Bipolar Disord. 2018 Mar;20(2):97-170. doi: 10.1111/bdi.12609. Epub 2018 Mar 14.
5
Clinical practice guidelines for Obsessive-Compulsive Disorder.强迫症临床实践指南。
Indian J Psychiatry. 2017 Jan;59(Suppl 1):S74-S90. doi: 10.4103/0019-5545.196976.
6
Management of obsessive-compulsive disorder comorbid with bipolar disorder.强迫症合并双相情感障碍的管理。
Indian J Psychiatry. 2016 Jul-Sep;58(3):259-269. doi: 10.4103/0019-5545.192001.
7
Content and format of labeling for human prescription drug and biological products; requirements for pregnancy and lactation labeling. Final rule.人用处方药和生物制品标签的内容与格式;妊娠和哺乳期标签要求。最终规则。
Fed Regist. 2014 Dec 4;79(233):72063-103.
8
Atypical antipsychotic augmentation in SSRI treatment refractory obsessive-compulsive disorder: a systematic review and meta-analysis.难治性强迫症的选择性5-羟色胺再摄取抑制剂治疗中使用非典型抗精神病药物增效治疗:一项系统评价与荟萃分析
BMC Psychiatry. 2014 Nov 29;14:317. doi: 10.1186/s12888-014-0317-5.
9
Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis.孕期和产后妇女强迫症发病风险:一项荟萃分析。
J Clin Psychiatry. 2013 Apr;74(4):377-85. doi: 10.4088/JCP.12r07917.