新型冠状病毒肺炎患者急性应激障碍精神科药物干预2例报告

Psychotropic drug intervention in patients with acute stress disorder caused by coronavirus disease 2019:a report of 2 cases

目的总结新型冠状病毒肺炎患者伴发急性应激障碍(acute stress disorder,ASD)的病例特征及精神科干预策略,以提高对新型冠状病毒肺炎患者ASD的识别和诊疗认识。方法报告2例在隔离状态下确诊新型冠状病毒肺炎患者出现ASD的病例,结合文献分析其临床特征及精神科干预过程。结果2例患者在隔离状态下确诊为新型冠状病毒肺炎后,出现ASD,2例患者均无自知力,不配合治疗,同时有情绪激动、冲动或纠缠行为,严重影响隔离病房诊疗秩序,并增加工作人员感染风险。其中1例因有明显焦虑、悲观、绝望表现,短期使用小剂量奥氮平合并氟哌噻吨美利曲辛片治疗后,焦虑、抑郁情绪很快缓解;另1例老年患者除情绪症状外,有被害妄想症状,在持续小剂量奥氮平治疗约5 d后,情绪症状改善,妄想症状消失。结论新型冠状病毒肺炎患者ASD不仅有焦虑、抑郁、睡眠障碍症状,还会出现冲动、消极行为,临床上应高度警惕,需要精神科干预时,应灵活应用指南,在保证安全的基础上,选择快速、有效的治疗方案。

Objective To delineate the characteristics of patients with acute stress disorder(ASD)induced by coronavirus disease 2019(COVID-19)and explore the intervention strategies in order to improve the recognition and treatment of ASD in patients with COVID-19.Methods We reported 2 cases with COVID-19 who developed ASD during quarantine.The clinical characteristics,intervention process and related literatures were discussed.Results Two patients developed ASD after diagnosis of COVID-19 during quarantine.They lost their insight,and did not cooperate with treatment.They also had emotional,impulsive or entangled behaviors,which seriously affected the routine work of quarantine ward and increased the risk of staff infection.The two patients were treated with atypical antipsychotic drugs,olanzapine,which had a small dose of sedative effect.After treatment,emotional symptoms were quickly relieved.One case showed obvious anxiety,pessimism and despair.After a short period of treatment with the flupentixol and melitracen tablets,the anxiety and depression were relieved quickly.The other case was an elderly patient who had both the delusional and emotional symptoms.After the treatment with low dose of olanzapine for about 5 days,the delusional symptoms were completely eliminated.Conclusion The COVID-19 patients with ASD not only have insomnia and anxious symptoms,but also have impulsive and passive behaviors.In clinical practice,we should be highly vigilant for ASD in quarantined people.When psychiatric intervention is needed,we should apply the guidelines flexibly in their medication selection and choose a fast and effective treatment plan on the basis of safety.