本文提醒同行碳酸锂中毒的精神症状类似躁狂症,似乎是病情复发,但只要认真加以区别可以降低误诊率,同时在长期服用碳酸锂的患者中,病情反复者应首先排除锂中毒,有条件者应做锂浓度监测。作者: monkoct 时间: 2011-3-3 20:13
考虑锂中毒,建议查血锂浓度。尤其在服用碳酸锂的病人,要适当在饭菜里加使用盐,或者多喝盐水。作者: 下一秒天晴 时间: 2011-3-3 22:27
谢谢楼上两位,他她的血锂浓度查了,0.56,并不高啊,怎么回事?作者: panjiesgod 时间: 2011-3-4 12:55
一般血锂浓度>1.5mmol/L,才会出现不同程度的中毒症状。
有些未出现躯体症状的中毒可以小于1时出现,但0.56绝对不会,反而未到完全维持量,与临床“描述最近精力充沛,情绪不错,语量较正常时稍多,”相一致。
精神科毒草书籍《为药疯狂》上说,观察到长期锂盐会引起记忆问题,但我始终认为不会。
双向混合发作也没有这种表现,长期用药也没有心理动机说自己记忆不好。
如果并非突然记忆下降,CT无明显异常表现,那就用些石杉碱甲片即可。作者: bingling 时间: 2011-3-6 13:05
关于锂盐对记忆影响的研究结果并不一致。国内有动物研究证实锂盐可以改善记忆力。但是,实验持续时间比较短,和临床这样大量长期服用锂盐比起来,参考价值就少了很多。这里有一篇综述,是外文的,我无法拿到全文,我将摘要部分**下来:
RATIONALE: Adverse cognitive effects associated with lithium are often implicated as contributing to vocational and social impairment, as well as medication noncompliance. As impaired cognitive functioning caused by lithium has clear clinical implications, it is important to determine whether evidence for or against impaired cognitive functioning exists in the literature. OBJECTIVES: An attempt is made to synthesize findings from previous studies, which assess a variety of cognitive domains, to determine whether conclusions can be drawn regarding lithium-associated cognitive impairment. The "reversibility" of neuropsychological impairment following lithium discontinuation and whether lithium administration has negative cumulative effects on cognition were also reviewed. METHODS: Key word searches on "Medline" and "Psych Info" were completed for clinical articles that investigated the neuropsychological effects of lithium in clinical and normal populations between 1968 and 2000. RESULTS: Despite methodological flaws, poor replicability and the subtle cognitive effects of lithium, five consistent findings emerged from the review; impairment on tasks of psychomotor speed, impaired functioning in the majority of studies examining verbal memory, no impairment on tasks of visuo-spatial constructional ability or attention/ concentration, and no negative cumulative effect. CONCLUSIONS: Many patients administered lithium carbonate complained of mental slowness. Lithium carbonate also appeared to have definite, yet subtle, negative effects on psychomotor speed. Studies reviewed also showed a trend toward impaired verbal memory. Recommendations with respect to future research, methodological and statistical problems, and additional clinical implications are presented.
你可以看一下,摘要中说明碳酸锂确实可以导致语言记忆力损害。具体内容建议看全文,呵呵,看有没有朋友能拿到全文,我把题目附在下面:The effects of lithium on cognition: an updated review.