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題名 | Pegylated Interferon α-2a相關性的憂鬱及意圖自殺案例=Pegylated Interferon α-2a Associated Depression and Suicide Attempt |
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作者 | 陳緯毓; 鄭繼鳳; 林惜燕; | 書刊名 | 藥學雜誌 |
卷期 | 27:1=106 2011.03[民100.03] |
頁次 | 頁96-102 |
分類號 | 418.285 |
關鍵詞 | 慢性B型肝炎; 憂鬱; 意圖自殺; 藥物不良反應; Pegylated Interferon α-2a; |
語文 | 中文(Chinese) |
中文摘要 | 這是一件疑似 Pegylated interferon α-2a (Peg-IFNα-2a)所致憂鬱、進而引發意圖自殺的藥物不良反應案例。一名無精神疾病史的 32歲女性病人,在每週注射長效型 interferon達10劑後,發生蓄意服用過量藥物之不良事件。在排除疾病的因素及其他併用藥品的可能性後,懷疑與 Peg-IFNα-2a的相關性較高。除了追溯不良反應發生前後之用藥史外,亦探討其後續處理及預防再發生之辦法。慢性活動性 B型肝炎的治療,可單獨使用 Peg-IFNα-2a治療年輕 (小於 40歲)和無 C型肝炎病史的病人。與口服 B肝抗病毒藥物相比, Peg-IFNα-2a可以縮短疾病的療程,但卻可能造成病人情緒不穩定,生活中或因刺激 (trigger)而導致病人企圖自殺。 IFNα-2a會減少血清中 monoamine類物質,尤其降低 5-HT levels,可能是 IFNα-2a導致憂鬱的主因。 IFNα-2a療程開始前宜先評估病人的情緒狀況,若為中度精神疾病患者,可預防性使用抗憂鬱劑治療;而對於先前無精神病史者,療程中仍要定期評估病人的情緒起伏,以預防此類不良反應之發生,幫助病人完成整個療程。 |
英文摘要 | We reported an episode of depression and suicide suspected to be associated to pegylated interferon α-2a. A 32-year-old female without previous psychiatric history received pegylated IFN-α injection weekly for hepatitis B exacerbation, and she attended suicide by taking large amount of fludiazepam when she finished 10 doses of IFN-α injection. After evaluating the possible causes of diseases and other medications taken regularly by the patients, pegylated IFN-α was highly suspected. For chronic hepatitis B infection, pegylated IFN-α monotherapy was recommended for patients less than 40 year-old and without HCV infection history. It offers a shorter treatment course when compared with oral anti-viral agents. However, it may induce various neuropsychiatric adverse effects, which may lead to suicide attempts and pose an immediate threat to patient's life. The possible cause of IFN-α induced depression may be due to reduce tryptophan availability and decrease serotonin synthesis. Psychiatric evaluation should be an important screening process before giving IFNα treatment. It was suggested that for patients of moderate depression and anxiety, they should be pretreated with antidepressants such as SSRIs; and for those without previous psychiatric disturbance, giving symptomatic treatment when they developed symptoms of depression. Thus, all patients who endorse depressive symptoms during treatment should be carefully evaluated and screened for suicidal ideation and given antidepressants to help them complete the course of IFNα-2a treatment. |
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