Dryden-Edwards R C, Reiss A L
Kennedy Krieger Institute, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21231, USA.
J Child Adolesc Psychopharmacol. 1996 Summer;6(2):139-45. doi: 10.1089/cap.1996.6.139.
A 13-year-old boy with psychotic, depressive, and obsessive-compulsive symptoms initially presented with auditory and visual hallucinations and a lifetime of excessive worries about contamination. Family history was significant for schizophrenia and compulsive behavior. When treated with clomipramine 100 mg daily (plasma level 85 ng/mL), obsessive-compulsive symptoms but not the hallucinations improved significantly, and racing thoughts and grandiosity developed later. Haloperidol 0.5 mg daily reduced the psychotic symptoms but was poorly tolerated, and then trifluoperazine 3 mg daily was ineffective, so clomipramine was discontinued (without worsening of OCD symptoms). Trifluoperazine in combination with lithium 1500 mg daily (0.9 meq/L), and then with the addition of carbamazepine 250 mg daily (3.7 micrograms/mL), was only partially helpful. Dose reductions in any medication led to increased psychotic symptoms within days. Trifluoperazine was then replaced by risperidone 3 mg twice daily. Within 2 weeks of starting risperidone, psychotic symptoms ceased but the patient experienced an incapacitating exacerbation of obsessive-compulsive symptoms, experiencing the most severe symptoms in his illness. Sertraline 50 mg reduced the OCD symptoms only briefly. After 5 months on risperidone, risperidone and sertraline were discontinued, and the obsessive-compulsive symptoms significantly decreased within 2 weeks. These clinical observations suggest that even when risperidone has a therapeutic antipsychotic effect, it may exacerbate obsessive-compulsive symptoms in predisposed adolescents.
一名患有精神病性、抑郁和强迫症状的13岁男孩，最初出现听觉和视觉幻觉，且一生都过度担心受到污染。家族史中有精神分裂症和强迫行为。每日服用100毫克氯米帕明（血药浓度85纳克/毫升）治疗时，强迫症状明显改善，但幻觉未改善，随后出现思维奔逸和夸大观念。每日服用0.5毫克氟哌啶醇可减轻精神病性症状，但耐受性差，之后每日服用3毫克三氟拉嗪无效，于是停用氯米帕明（强迫症状未恶化）。三氟拉嗪与每日1500毫克锂盐（0.9毫当量/升）联合使用，随后加用每日250毫克卡马西平（3.7微克/毫升），仅部分有效。任何一种药物剂量减少都会在数天内导致精神病性症状加重。随后将三氟拉嗪换为每日两次、每次3毫克的利培酮。开始使用利培酮后2周内，精神病性症状消失，但患者的强迫症状出现致残性加重，达到其患病以来最严重的程度。每日服用50毫克舍曲林仅短暂减轻了强迫症状。使用利培酮5个月后，停用利培酮和舍曲林，强迫症状在2周内显著减轻。这些临床观察结果表明，即使利培酮具有治疗性抗精神病作用，它也可能使易感青少年的强迫症状加重。
