Positive treatment effect of estradiol in postpartum psychosis:: A pilot study
Positive treatment effect of estradiol in postpartum psychosis:: A pilot study
复制标题
DOI：
10.4088/jcp.v61n0303
复制
发表时间：
2000-03-01
影响因子：
5.3
通讯作者：
Rimón, R
中科院分区：
文献类型：
--
作者：
Ahokas, A;Aito, M;Rimón, R
背景：产后疾病伴精神症状及严重不良后遗症在育龄期非常普遍。尽管有多次医疗接触，但这些疾病往往无法确诊，也得不到治疗。为了研究雌二醇与产后精神病之间的关系，我们测量了血清雌二醇浓度，并在患有这种疾病的妇女中进行了一项开放标签的生理性17 -雌二醇试验。方法：对10例产后发病的ICD-10型精神病患者进行研究。在舌下17 -雌二醇治疗6周期间，在基线和每周测量血清雌二醇浓度。采用临床医师评定的精神症状量表（简明精神病学评定量表[BPRS]）评估治疗效果。结果：基线血清雌二醇水平（平均值49.5 pmol/L，范围13 ~ 90 pmol/L）甚至低于性腺功能衰竭的阈值，且患者精神症状量表得分较高（BPRS总分平均值78.3，范围65 ~ 87）。在17 -雌二醇治疗的第一周，精神症状明显减轻（BPRS评分降至平均18.8分，p < 0.001）。直到治疗第二周结束时，血清雌二醇浓度上升到接近卵泡期正常水平，患者几乎没有精神症状。结论：所有患者通过治疗记录的雌二醇缺乏症均能逆转精神症状，这表明雌二醇在病理生理中起作用，并可能在治疗这种疾病中起作用。1例停止雌二醇治疗的患者出现精神病症状反弹。由于患者数量少，这一领域值得进一步研究。
Background: Postpartum illnesses with psychiatric symptoms and serious adverse sequelae are highly prevalent during the childbearing years. Despite multiple medical contacts, these illnesses often remain unidentified and untreated. To study the association between estradiol and puerperal psychosis, we measured serum concentration of estradiol and performed an open-label trial of physiologic 17 beta-estradiol in women with this disorder.Method: Ten women with ICD-10 psychosis with postpartum onset consecutively recruited from a psychiatric duty unit were studied. Serum estradiol concentration was measured at baseline and weekly during sublingual 17 beta-estradiol treatment for 6 weeks. The treatment effect was evaluated by a clinician-rated psychiatric symptom scale (the Brief Psychiatric Rating Scale [BPRS]).Results: The baseline serum estradiol levels (mean = 49.5 pmol/L; range, 13-90 pmol/L) were even lower than the threshold value of gonadal failure, and the patients exhibited high scores on the psychiatric symptom scale (mean BPRS total score = 78.3; range, 65-87). During the first week of 17 beta-estradiol treatment, psychiatric symptoms diminished significantly (BPRS score decreased to a mean of 18.8, p < .001). Until the end of the second week of treatment, serum estradiol concentrations rose to near the values normally found during the follicular phase, and the patients became almost free of psychiatric symptoms.Conclusion: The reversal of psychiatric symptoms in all patients by treating documented estradiol deficiency suggests that estradiol plays a role in the pathophysiology and may have a role in the treatment of this condition. There was a rebound of psychotic symptoms in the 1 patient who discontinued estradiol treatment. Given the small number of patients, this area deserves further study.