第一型雙極性情感疾患病人使用Varenicline引發躁症發作

Varenicline-induced Manic Episode in a Bipolar I Disorder Patient

目的：varenicline被准許用來戒菸，但是在臨床使用上有一些個案報告產生了一些精神上的不良反應，尤其是憂鬱但不是躁症。病例報告：一位52歲的台灣男性，第一型雙向情感障礙症疾患，他在我們醫院精神科護理之家及門診規則服藥1年半，病情穩定，他在使用varenicline八天後產生明顯的躁症症狀而住精神病房，住院後停用varenicline，在停用15天後情緒趨於穩定，23天後病人出院並持續穩定的在門診規則服藥半年。結論：基於這個個案，當我們使用varenicline於第一型雙極性情感疾患個案戒菸時，必須要有一些預防性的評估及密切的追蹤以減少藥物不良反應。

Objective: Since varenicline was approved for smoking cessation in 2006, but case reports associated with psychiatric adverse effects have been published, especially with regard to depression, but not manic episodes. Case report: We describe a 52-year-old ethnic Taiwanese male with a history of bipolar I disorder. He had received regular treatment in the clinic and psychiatric nursing home for one and half years. He developed mixed mood and psychotic disturbances after an eight-day varenicline treatment. After withdrawal of varenicline treatment 15 days, his mood stabilized. He was discharged 23 days later and received regular clinical follow-up. Conclusion: This case, history suggests that preventive measures with closed observation are needed if a bipolar patient quits smoking with varenicline. Further study should be identifi ed that varenicline-induced manic episode is due to imbalance between cholinergic, adrenergic or dopaminergic tone.