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임신과 정신약물(II): 임신부 정신질환의 치료

Pregnancy and Psychotropic Drugs (II):Pharmacologic Management of Psychiatric Disorders during Pregnancy

김재민|김성완|양수진|박우영
대한생물치료정신의학회 (Korean Society Of Biological Therapies In Psychiatry)|2007.06|생물치료정신의학 (Journal of the Korean Society of Biological Therapies in Psychiatry)|제13권 제1호|pp. 17-25

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참고문헌

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임신 · 정신약물 · 정신질환Pregnancy · Psychotropic drugs· Psychiatric disorders
주제분류정신과학

초록

임신한 여성의 정신질환은 치료하지 않았을 때에 임신부 및 태아의 위험도와 정신약물에 노출되었을 때의 위험도를 따져본 후 약물 투여 여부를 결정해야 한다.71)-73) 치료자는 환자 및 보호자에게 정신약물을 사용 할 때와 사용하지 않을 때의 위험도, 약물치료 이외의 다른 치료법의 고려가능성, 정신질환을 치료하지 않았을 때 임신부나 태아 모두에게 초래될 위험에 대해 정확하고 객관적인 정보를 서면으로 제공해야 한다.21) 정신약물을 사용하기로 결정하였다면 먼저 과거 약물치료력을 조사해야 한다. 약물 치료력이 없거나 이전에 치료했던 약물이 임신 중 위험도가 높은 약물로 판명되었다면, 위험도가 낮고, 대사물질이 거의 없으며, 부작용이 적고, 연구자료가 일치하는 약물을 선택하는 것이 바람직하다. 정신질환에 따른 약물 선택에 관해 표 1에 요약 제시하였다. 불충분한 약물 치료는 질병과 약물 모두의 위험에 임신부와 태아를 노출시킴으로써 위험만 가중시킬 수 있으므로 원칙적으로 가장 낮은 유효 용량으로 가장 짧은 기간 동안 사용해야 한다.18)74) 또한 중요한 것은 약물의 사용 여부에만 관심을 집중한 나머지 비만, 흡연, 음주, 그리고 다른 물질남용 등의 문제를 간과해서는 안 된다는 것이다. 기본적으로 임신 중 임신부의 정기적인 산전진찰과 건강한 식습관이 뒷받침이 되어야 한다.

Abstract

The prevalence of psychiatric disorders in childbearing aged women may be higher than in non-childbearing aged women. Traditionally, psychiatric medications were withheld during pregnancy because of fear of teratogenic and other effects. It is well known that potential consequences of an untreated psychiatric problem may be severe. Clinicians need to help mothers weigh both fetal and neonatal risks of exposure to drugs against the potential risk they and their infant may incur if the psychiatric illness is not treated. Decisions regarding the use of psychiatric medications should be individualized., and the most important factor is usually the symptom severity and patients level of functioning in the past when she was not taking medications.. This review focuses on the current knowledge of pregnant women specifically in psychopharmacology.

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