矛盾性失眠Casereport共19页
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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
Elimination of insomnia, a precursor and often concurrent symptom of clinical depression, is an important component of treatment undertaken to achieve complete 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。
Baidu Nhomakorabea
She attributed this to a 3-day course of prednisone 40 mg for an allergic reaction to radiopaque venogram dye prior to emergency surgery for superficial phlebitis, and gastritis from subsequent nonsteroidal antiinflammatory use.
Keywords: Actigraphy, insomnia, sleep state misperception, paradoxical insomnia, major depression, electroconvulsive therapy, ECT
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。
在医院里,睡前给予米氮平30毫克,连续的规定 的羟基安定30毫克,唑吡坦10毫克,扎来普隆10毫克， 曲唑酮150毫克,以及每日两次去甲基羟安定15毫克， 对改善患者睡眠无效。持续每夜给予米氮平30毫克 (作为抗抑郁),经过10天患者诉最低限度地提高了她 的睡眠和心情。
Venlafaxine 37.5 mg daily was added, and chloral hydrate 2 mg was ordered at bedtime. Despite relentless subjective insomnia, she appeared to remain in bed throughout the night and described minimal daytime sequelae. There were no clinical features of other sleep disorders. She had become hopeless with fear of sleeplessness, and a diagnosis of major depression was established.
Severe paradoxical insomnia, documented by actigraphy, was the predominant presenting complaint 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.
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。
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.” She complained 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。
In hospital, mirtazapine 30 mg, and sequentially prescribed temazepam 30 mg, zolpidem 10 mg, zaleplon 10 mg, trazodone 150 mg at bedtime, and oxazepam 15 mg twice daily did not help her sleep. Mirtazapine 30 mg nightly (as antidepressant) was continued, and after 10 days she reported minimally improved sleep and mood.
Elimination of insomnia, a precursor and often concurrent symptom of clinical depression, is an important component of treatment undertaken to achieve complete 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。
Baidu Nhomakorabea
She attributed this to a 3-day course of prednisone 40 mg for an allergic reaction to radiopaque venogram dye prior to emergency surgery for superficial phlebitis, and gastritis from subsequent nonsteroidal antiinflammatory use.
Keywords: Actigraphy, insomnia, sleep state misperception, paradoxical insomnia, major depression, electroconvulsive therapy, ECT
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。
在医院里,睡前给予米氮平30毫克,连续的规定 的羟基安定30毫克,唑吡坦10毫克,扎来普隆10毫克， 曲唑酮150毫克,以及每日两次去甲基羟安定15毫克， 对改善患者睡眠无效。持续每夜给予米氮平30毫克 (作为抗抑郁),经过10天患者诉最低限度地提高了她 的睡眠和心情。
Venlafaxine 37.5 mg daily was added, and chloral hydrate 2 mg was ordered at bedtime. Despite relentless subjective insomnia, she appeared to remain in bed throughout the night and described minimal daytime sequelae. There were no clinical features of other sleep disorders. She had become hopeless with fear of sleeplessness, and a diagnosis of major depression was established.
Severe paradoxical insomnia, documented by actigraphy, was the predominant presenting complaint 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.
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。
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.” She complained 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。
In hospital, mirtazapine 30 mg, and sequentially prescribed temazepam 30 mg, zolpidem 10 mg, zaleplon 10 mg, trazodone 150 mg at bedtime, and oxazepam 15 mg twice daily did not help her sleep. Mirtazapine 30 mg nightly (as antidepressant) was continued, and after 10 days she reported minimally improved sleep and mood.