肝豆状核变性合并双相情感障碍抑郁发作1例

Hepatolenticular degeneration with depressive episodes of bipolar disorder:a case report

本病例报告了一例17岁女性患者,因“情绪欠佳、易烦躁5月+”来院治疗。患者5岁时诊断肝豆状核变性。此次入院后,根据《国际疾病分类(第10版)》(ICD-10),诊断为:①肝豆状核变性;②双相情感障碍抑郁发作。给予心境稳定剂和抗抑郁药联合治疗后病情好转。目前,鲜有关于肝豆状核变性合并双相情感障碍抑郁发作的报道,诊断考虑躯体疾病所致的精神障碍还是两者共病,存在争议。另外,在对患者精神疾病的治疗中,往往忽视躯体情况。本案例综合考虑患者的精神症状和躯体情况,对诊断和药物治疗方案进行分析,提示精神科医生在临床工作中既要关注精神症状,也要密切重视患者既往躯体疾病病史,进行合理诊断与治疗。

This case reported a 17-year-old female patient who presented to the hospital with"poor mood and irritability for more than 5 months".The patient was diagnosed with hepatolenticular degeneration at the age of five.According to the International Classification of Diseases,tenth edition(ICD-10),she was diagnosed with hepatolenticular and depressive episodes of bipolar disorder.The condition improved after administration of a combination of a mood stabilizer and an antidepressant.There are few reports of hepatolenticular degeneration combined with depressive episodes of bipolar disorder,and it is controversial whether the diagnosis should be considered a psychiatric disorder due to a physical illness or a co-morbidity.In addition,somatic conditions are often overlooked in the treatment of patients with psychiatric disorders.This case analyzed the diagnosis and medication by integrating the patient's psychiatric symptoms and somatic conditions,suggesting that psychiatrists should pay attention to both psychiatric symptoms and the patient's previous history of somatic diseases in their clinical work for rational diagnosis and treatment.