Memantine Augmentation in a Down's Syndrome Adolescent with Treatment- Resistant Obsessive-Compulsive Disorder.
Memantine Augmentation in a Down's Syndrome Adolescent with Treatment- Resistant Obsessive-Compulsive Disorder.
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美金刚增强治疗患有难治性强迫症的青少年唐氏综合症。
DOI：
--
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发表时间：
2015
影响因子：
1.9
通讯作者：
K. Fitzgerald
中科院分区：
文献类型：
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作者：
Scott R. Pekrul;K. Fitzgerald
[作者单位]斯科特·R·佩克鲁尔 (Scott R. Pekrul)。密歇根大学儿童和青少年精神病学系，密歇根州安娜堡。凯特·D·菲茨杰拉德。密歇根大学儿童和青少年精神病学系，密歇根州安娜堡市。通讯地址：Scott R. Pekrul, MD, Department of Psychiatry, University of Michigan, 4250 Plymouth Rd. SPC 5766, Ann Arbor, MI 48109，电子邮件：scottpek@med.umich.edu致编辑：唐氏综合症 (DS) 是一种染色体疾病，是智力障碍（精神发育迟滞 [MR]）的最常见原因。精神科合并症在唐氏综合症人群中相对常见，估计范围为 18% 至 38%（Prasher 和 Day 1995；Capone 等人 2006）。尽管关于 DS 人群中强迫症 (OCD) 的研究还很少，但估计有 0.8% 至 4.5% 的患者会出现这种情况（Prasher 和 Day 1995；Capone 等人 2006）。强迫症的特点是侵入性的想法、图像或冲动（强迫观念）以及有目的的精神或身体行为（强迫行为），旨在减少由强迫观念引起的焦虑。据推测，DS 患者的强迫症更常出现排序和整洁的强迫行为，例如重新整理个人物品或打开/关闭门、橱柜、百叶窗和电灯开关（Prasher 和 Day 1995；Capone 等人 2006），这是由“恰到好处”的强迫观念驱动的（Charlot 等人 2002）。非发育障碍人群中强迫症的一线药物治疗是血清素再摄取抑制剂 (SSRI)，对 40-60% 的病例有效（儿科强迫症治疗研究 [POTS] 团队 2004 年；Abudy 等人，2011 年）。治疗难治性强迫症的各种策略包括改用另一种 SSRI、增强抗精神病药物或使用血清素去甲肾上腺素药物（Abudy 等，2011）。最近，有新的证据表明，美金刚等谷氨酸能药物对成人和儿童强迫症患者的难治性强迫症均有效（Pasquni 和 Bodni 2006；Aboujaoude、Barry、Gamel，2009；Hezel 等人，2009；Stewart 等人，2010）。鉴于美金刚已被证明对非发育障碍患者的难治性强迫症有效，因此它可能对患有强迫症的 DS 人群有所帮助。在这里，我们报告一个在患有 DS 和强迫症的青少年中使用美金刚的病例。病例报告 N 是一名 16 岁白人男性，有 DS 和轻度 MR 病史，他与亲生父母一起到大学儿童/青少年精神病诊所就诊，以评估强迫行为。 N 以前没有任何精神病史，直到 14 岁时他养成了“恰到好处”的习惯。他的症状是强迫性地关灯；坚持所有门都需要关闭；以及对齐书籍、图片、盒子和太阳镜，使它们“恰到好处”。他还表现出囤积行为，例如保留水瓶、太阳镜和盒子。如果家庭成员关上门、打开灯或乱放物品，他就会变得非常不安和激动。他每天从事这些行为长达 8 小时，给家里带来了极大的痛苦。社区精神科医生对 N 进行了评估，诊断他患有强迫症并开始服用舍曲林。他很快就变得烦躁、焦虑，强迫行为增多。停药并改用利培酮。服用利培酮（剂量未知）后，他的症状没有变化，但体重增加并流口水。随后，利培酮改为阿立哌唑，他服用了几个月，然后在大学儿童/青少年诊所接受评估。在大学诊所评估中，他的父母报告说，阿立哌唑“在一定程度上”减轻了他的症状，但尽管如此，这些症状仍继续造成严重的痛苦。鉴于他的反应微乎其微且体重增加了 9.1 公斤，因此逐渐减少。同意进行另一项 SSRI 试验，氟西汀最初滴定至 20 毫克。 ……
[Author Affiliation]Scott R. Pekrul. Department of Child and Adolescent Psychiatry, University of Michigan Ann Arbor, Michigan.Kate D. Fitzgerald. Department of Child and Adolescent Psychiatry, University of Michigan Ann Arbor, Michigan.Address correspondence to: Scott R. Pekrul, MD, Department of Psychiatry, University of Michigan, 4250 Plymouth Rd. SPC 5766, Ann Arbor, MI 48109, E-mail: scottpek@med.umich.eduTo The Editor:Down's syndrome (DS) is a chromosomal disorder that is the most frequent cause of intellectual disability (mental retardation [MR]). Psychiatric comorbidity is relatively common in the Down's population, and is estimated to range from 18% to 38% (Prasher and Day 1995; Capone et al. 2006). Although little research has been completed with obsessive-compulsive disorder (OCD) in DS populations, it is estimated to occur in from 0.8% to 4.5% of patients (Prasher and Day 1995; Capone et al. 2006). OCD is characterized by intrusive thoughts, images, or urges (obsessions) with purposeful mental or physical actions (compulsions) aimed at reducing anxiety caused by the obsession. OCD in DS patients is postulated to present more often with compulsive behaviors of ordering and tidiness, such as rearranging personal belongs or opening/closing doors, cabinets, blinds, and light switches (Prasher and Day 1995; Capone et al. 2006), driven by "just right" obsessions (Charlot et al. 2002).First-line pharmacological treatment for OCD in nondevelopmentally disordered populations is a serotonin reuptake inhibitor (SSRI), which is effective in 40-60% of cases (Pediatric OCD Treatment Study [POTS] Team 2004; Abudy et al. 2011). Various strategies for treatment-resistant OCD include switching to another SSRI, augmentation with antipsychotics, or the use of a serotonin norepinephrine agent (Abudy et al. 2011). More recently, there is emerging evidence that glutamatergic agents such as memantine are effective in treatment-resistant OCD in both adult and pediatric OCD patients (Pasquni and Bodni 2006; Aboujaoude, Barry, Gamel, 2009; Hezel et al. 2009; Stewart et al. 2010). Given that memantine has demonstrated effectiveness in treatment-resistant OCD in nondevelopmentally disabled patients, it may be helpful in DS populations with OCD. Here, we report on a case using memantine in an adolescent with DS and OCD.Case ReportN was a 16-year-old Caucasian male with a history of DS and mild MR who presented to a university-based child/adolescent psychiatry clinic with his biological parents for evaluation of obsessive behaviors. N had had no prior psychiatric history until age 14 when he developed "just right" rituals. His symptoms were characterized by compulsively turning off lights; insisting that all doors needed to be shut; as well as aligning books, pictures, boxes, and sunglasses so they were "just so." He also displayed hoarding behaviors such as keeping water bottles, sunglasses, and boxes. If a family member closed a door, turned on a light, or misarranged his items, he became very upset and agitated. He would engage in these behaviors up to 8 hours per day, causing significant distress in the home.N was evaluated by a community psychiatrist who diagnosed him with OCD and initiated sertraline. He quickly developed agitation, anxiety, and increased compulsive behaviors. The medication was discontinued and changed to risperidone. On risperidone (dose unknown), he showed no change in symptoms and developed weight gain and drooling. Risperidone was then changed to aripiprazole, which he was on for several months before being evaluated at the university-based child/adolescent clinic.At the university clinic evaluation, his parents reported that aripiprazole decreased his symptoms "somewhat" but that nonetheless the symptoms continued to cause significant distress. Given his minimal response and a 9.1 kg weight gain, it was tapered off. Another trial of an SSRI was agreed upon, and fluoxetine was initially titrated to 20 mg. …
DOI：
10.1002/neu.480230915
发表时间：
1992-11-01
期刊：
JOURNAL OF NEUROBIOLOGY
影响因子：
--
作者：
CHOI, DW
通讯作者：
CHOI, DW
影响因子：
13.5
作者：
Pittenger, Christopher;Bloch, Michael H.;Williams, Kyle
通讯作者：
Williams, Kyle