矛盾性失眠-Case report PPT课件.ppt

A Case of Extreme Paradoxical Insomnia Responding Selectively To Electroconvulsive Therapy
Journal of Clinical Sleep Medicine,
Vol. 4, No. 1, 2008 62
一例极重度矛盾性失眠患者对电休克疗法的选择性应答
病例报告——睡眠医学临床杂志
经活动记录仪证实,被诊断抑郁症的48岁妇女的主诉随后被诊断为重度矛盾性失眠。尽管先前认为是安眠药及抗抑郁药物难治的,但经5次电休克治疗后,两种障碍均缓解。
关键词:活动记录仪,失眠,睡眠知觉障碍,矛盾性失眠,抑郁症,电休克疗法
Severe paradoxical insomnia, documented by actigraphy, was the predominant plaint of a 48-year-old woman subsequently diagnosed with major depression. Both disorders remitted following a course of 5 electroconvulsive therapy treatments in spite of being previously refractory to hypnotic and antidepressant pharmacotherapy.
Keywords: Actigraphy, insomnia, sleep state misperception, paradoxical insomnia, major depression, electroconvulsive therapy, ECT
失眠是抑郁症的一项前驱和伴随症状。为达到抑郁症的完全缓解,消除失眠是治疗中的一个重要组成部分。电休克疗法是治疗抑郁症及非典型性抑郁症的一种安全、有效、普遍耐受良好的治疗方法。下面是一例抑郁症伴随严重失眠,经电休克疗法治疗有效的病例。
Elimination of insomnia, a precursor and often concurrent symptom of clinical depression, is an ponent of treatment undertaken to plete remission of depression. Electroconvulsive therapy (ECT) is a safe, effective, generally well-tolerated treatment for major depression, including depression with atypical features. The following is a case of major depression presenting as severe insomnia that was selectively responsive to ECT.
病例报告
患者为职业女性,48岁,已婚,既往无精神疾病病史。患者因计划自杀入院,她说“因为没有人能指出我的问题在哪”。患者自诉总计“在之前的一个月睡眠35小时”,睡前服用氯硝安定1毫克,羟基安定 30毫克,唑吡坦 20毫克,或者喹硫平25毫克均无效。
REPORT OF CASE
A 48-year-old married, employed female with no prior psychiatric history was admitted to hospital with a suicidal plan “because no one can figure out what is wrong with me.” plained of a total of “35 hours sleep during the previous month,” unresponsive to clonazepam 1mg, temazepam 30 mg, zolpidem 20 mg, or quetiapine 25 mg at bedtime.
她将此归因于之前因浅静脉炎所行急诊手术静脉造影染色剂过敏性反应使用了三天40毫克泼尼松,以及后续非甾体类抗炎使用引发的胃炎。
She attributed this to a 3-day course of prednisone 40 mg for an allergic reaction to radiopaque venogram dye prior to emergency surgery