Zolpidem引起的輕躁狀態及其相關SPECT結果：一例報告

Zolpidem-induced Hypomanic State and Associated SPECT Findings: One Case Report

Zolpidem為一短效、非典型非成癮性安眠劑，廣泛使用於失眠症狀的治療。近年來，有些個案報告中指出，在使用zolpidem後出現譫妄、失憶、精神病症狀及夢遊等副作用，但zolpidem引起的輕躁狀態在精神科文獻中仍尚未發表過。本文將報告一例在使用zolpidem後引起輕躁狀態的個案。個案初期是因憂鬱症相關的失眠症狀，除服用抗憂鬱劑fluvoxamine之外，亦合併使用zolpidem，家人在無意間觀察到個案在家服用zolpidem 5-10 mg後，低落的情緒會短暫於當天好轉。入院治療期間，亦發現個案在投予zolpidem 5 mg半小時後，神情顯得較為愉悅，話量及活動量均增多，其效果莫約可以維持八小時。針對此項觀察，在未用藥前及服藥一小時後各安排一次腦部單光子掃瞄（SPECT）。檢查當日，在服用zolpidem 10 mg半小時後，個案情緒顯得十分愉悅高亢，活動量大增，話量亦明顯增多，注意力顯得渙散，但當下確認定向感仍是完好；整體評估結果，病人臨床表現為輕躁狀態。兩次SPECT均顯示額葉區出現血灌注量下降，且服藥後，下降情形更為明顯。而在fluvoxamine 200mg的持續治療三星期後，個案情緒逐漸好轉，現已恢復至病前狀況。五個月後，個案的鬱症症狀完全改善時，重覆SPECT的檢查結果發現，先前額葉區出現血液灌流量減少的情形已有部分改善。本個案使用zolpidem之後引起的輕躁狀態暗示GABA與情感性精神病治療上的藥理機轉有其相關性；本報告同時也呈現鬱症病人在不同情緒狀態下的SPECT的結果。

Zolpidem is a short-acting, nonbenzodiazepine hypnotic and used for treatment of insomnia. Recently, there are some reports of delirium, amnesia, psychotic symptoms and somnambulism associated with zolpidem; however, to our knowledge, zolpidem-induced hypomanic state has not been reported before. A case report of zolpidem-induced hypomanic state will be presented here. Initially, because of depression-related insomnia, in addition to antidepressant fluvoxamine, the patient took zolpidem. Her family incidentally observed that depressed mood improved transiently after taking zolpidem 5-10 mg. During hospitalization, her mood became more euphoric, and the amount of verbal output and activity level also increased half an hour after zolpidem was taken. Its effectiveness lasted for about eight hours. For further investigation, SPECT study was done twice, respectively, before and one hour after taking zolpidem. On the day of exam, half an hour after taking zolpidem 10 mg, she was noted to have elated and euphoric mood, hyperactivity, hypertalkativity, and distractible attention with clear orientation to time, place and person. In general, her clinical feature was assessed as hypomanic state. Although both results of SPECT study revealed hypoperfusion at bifrontal cerebral region, it was quantitatively more hypoperfusion after a single 10-mg dose of zolpidem. Three weeks after regular treatment with fluvoxamine, her depressed symptoms improved gradually. Now, her mood could keep euthymic as premorbidly. Five months later, her depressive syndrome resolved completely. Repeated SPECT study showed previous hypoperfusion at bifrontal cerebral region had improved partially. Zolpidem-induced hypomanic state in our case implies GABA might be associated with pharmacological mechanism of treatment effect on mood disorder. Our report also demonstrated SPECT findings in different mood status of the depressed patient.