Lithium Cabonate와 Chlorpromazine 병합 투여로 인한 급성 뇌증후군 : 유효 치료혈중 Lithium농도에서 = Acute Brain Syndrome in Treatment with Lithium Carbonate and Chlorpromazine

국문 초록 (Abstract)

조울 정신병 환자와 정동형 정신분열증 환자의 급성 상태에 있는 환자에게 Lithium Carbonate와 동시에 항정신병 약물을 병합 투여하여 치료하는 것이 바람직한 치료법으로 지금까지 널리 알려져 왔다. 그런데 최근에 Lithium Carbonate와 Halopendol을 동시에 투여함으로 인해서 신경 독성 증상이 발생할 수가 있다는 보고가 있는데. 본 저자는 Lithium Carbonate와 Chlorpromazine을 병합 투여함으로 인해서 유효 치료혈중 Lithium농도를 유지하였음에도 불구하고 급성 신경 독성 증상을 보인 경우를 치험하였고 부작용이 발생하였을 때 Lithium Carbonate의 투여를 중단함으로써 독성 신경 증상이 즉시 소실한 경우를 치험하였기에 이에 보고하고자 한다.

다국어 초록 (Multilingual Abstract)

Although lithium carbonate therapy is the treatment of choice for manic patients and useful treatment for schizoaffective patients, the 5 to 10 days delay befor lithium becomes clinically effective usually requires the addition of a neuroleptic to help control acutely and severely disturbed psychotic pstients. Extensive use of this combination has generally proved quite safe and effective. However, several reports have drawn attention to possible neurotoxic side reactions following the combined use of lithium and neuroleptics.
The author experienced to treat a case of schizophrenia, affective type, who had develoed abrupt confusion and selective memory loss during combined use of lithium carbonate 1,200 mg and chlorpromazine 600 mg mg. When this patient developed confusion, her seam lithium concentration was 0.9 mEq/L which was therapeutic range of serum lithium concentration. The author immediatly discontinued the lithium carbonate, but continued chlorpromazine. Her confusion was started to resolve three days later and was resolved completly ten days later except selective memory loss around that time which was irreversible. The author is following this patient as an outpatient and is making her to take lithium carbonate 900 mg a day without any side reactions; Her serum lithium concentration remains in the 0.6 mEq/L and she is doing well.
The author can not explain exactly the reason for neurotoxic side reaction of this patient. But I think the cause of side reaction in this patient is idiosyncratic drug interaction of lithium and chlorpromazine or abnormally elevation of the intracellular concentration of lithium by chlorpromazine. However combined use of lithium and neuroleptics in the treatment of acute manic or schizoaffective patients is generally safe and effective, the author think we have to carefully use combined therapy of lithium and chlorpromazine, especially in schizophrenic patients.
Although it remains unclear whether such toxic reaction is secondary to lithium and neuroleptic interactions or secondary to be elevated the intracellular concentration of lithium by chlorpromazine, discontinuing lithium carbonate and reducing the dose of chlorpromazine should be an effective therapy when neurotoxic symptoms are developed by combined therapy with lithium carbonate and chlorpromazine.

목차 (Table of Contents)

• 서론
• 증례
• 고찰
• 요약