Liječenje bipolarnog afektivnog poremećaja tijekom trudnoće

Autor: Rafaela Jurman, Gordana Rubeša
Rok vydání: 2021
Předmět:
Zdroj: Medicina Fluminensis : Medicina Fluminensis
Volume 57
Issue 1
Medicina Fluminensis
ISSN: 1848-820X
1847-6864
DOI: 10.21860/medflum2021_365349
Popis: Cilj: Prikazati slučaj trudnice oboljele od bipolarnog afektivnog poremećaja (BAP) te terapijske izazove u njezinu liječenju. Prikaz slučaja: Trudnica u dobi od 35 godina hospitalizirana je na Klinici za psihijatriju zbog psihotične dekompenzacije od ranije dijagnosticiranog BAP-a. Pacijentica se u više navrata bolnički liječila zbog BAP-a. Prvi put je bila hospitalizirana u 25. godini života. Od tada je, unatoč redovitim kontrolama i medikaciji, došlo do nekoliko pogoršanja psihičkog stanja i to u vidu maničnih epizoda. U 35. godini života kod pacijentice je ustanovljena trudnoća te se ambulantno korigirala prethodno preporučena terapija. Ukinuo se litij i uveo se natrijev valproat. Nakon četiri tjedna pacijentica je hospitalizirana radi manične epizode s psihotičnim elementima. Hospitalno se terapija korigirala u skladu sa svjetskim iskustvima u liječenju BAP-a tijekom trudnoće. Tako se tijekom hospitalizacije kod ove pacijentice doza natrijeva valproata reducirala, a u terapiju se uveo antipsihotik kvetiapin, čija se doza titrirala do ukidanja simptoma bolesti. Pacijentica je na termin, carskim rezom, rodila zdravu djevojčicu. Do danas više nije bila hospitalno liječena, a podaci pedijatra ukazuju na uredan psihofizički razvoj djevojčice. Zaključak: Duševna bolest i njeno liječenje prije i/ili tijekom trudnoće predstavljaju rizične faktore za majku i za novorođenče. Stoga pojačani nadzor ovog tipa rizične trudnoće te propisivanje adekvatne psihofarmakoterapije s najmanjim mogućim posljedicama za majku i dijete predstavlja poseban izazov, ali i dužnost liječnika.
Aim: To report a case of a pregnant woman with bipolar affective disorder (BAD) and therapeutic challenges in her treatment. Case report: A 35-year-old pregnant woman was hospitalized at the psychiatric clinic due to psychotic decompensation from a previously diagnosed BAD. The patient was hospitalized several times due to BAD. She was first hospitalized at the age of 25. Since than, despite regular check-ups and medication, there have been several deteriorations in mental health, mostly manic episodes. At the age of 35 the patient got pregnant and the previously recommended therapy was corrected. Lithium was abolished and sodium valproate was introduced. After four weeks, the patient was hospitalized due to manic episode with psychotic elements. The therapy was adjusted in accordance with world experience in the treatment of BAD during pregnancy. During hospitalization the dose of sodium valproate was reduced and the antipsychotic quetiapine was introduced into the therapy. The dose of quetiapine was titrated until the symptoms of the disease disappeared. The patient gave birth to a healthy baby girl by C-section. So far she has not been hospitalized. The pediatrician`s data indicate normal psychophysical development of the girl. Conclusion: Mental illness before and during pregnancy is a risk factor both for the mother and her newborn. Therefore, careful monitoring of pregnancy, as well as prescribing adequate psychopharmacotherapy with the least possible consequences for the mother and her child is a special challenge, but also a doctor`s duty.
Databáze: OpenAIRE
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