임신과 정신약물(I): 정신약물이 태아에게 미치는 영향
Pregnancy and Psychotropic Drugs (I):The Effects of Psychotropic Drugs on the Fetus
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가임기 여성의 정신질환 치료에서 있어 임신 중 정신과 약물 사용의 문제는 임상에서 흔히 부딪치나 치료적 결정을 내리기가 어려운 문제 중 하나이다. 환자 및 보호자 그리고 임상가들은 임신 중 약물 사용에 대한 막연한 두려움에서 벗어나 현재까지 진행된 연구 등의 근거에 기반한 합리적 결정을 내려야 한다. 현재까지 이루어진 연구를 종합해 보면 다음과 같다. 항정신병 약물은 대체로 정형약물이 안전하다고 알려져 있으나 최근 clozapine, olanzaepine, risperidone 등의 비정형 약물에 대한 안정성에 대한 연구가 꾸준히 진행 중이며 비교적 안전하다는 보고들이 이어지고 있다. 기분 안정제 중에서는 lithium 이 일차 치료제로 인정되며 항우울제 중에서는 fluoxetine 이 일차치료제로 권유된다. 그러나 이는 환자에 따라 약물에 대한 반응 정도가 다르고 상황에 차이가 있으므로 환자에 따라 유연하게 결정을 내려야 할 것이다. 하지만 무엇보다 가장 중요한 것은 이러한 치료적 결정의 과정에서 환자 및 보호자들을 논의의 중심에 포함시켜야 하며 치료자와 환자가 열린 태도로 토의해야 한다는 것이다.
Abstract
Special care should be taken when administering psychotropic drugs to pregnant women. The relative risks and benefits of drug therapy for these women must be considered with each patient. Risks of psychotropic drug use during pregnancy include teratogenic effects, neonatal toxicity, and the potential for long-term neurobehavioral sequelae. Therefore, a comprehensive understanding of the latest developments in pregnancy-related psychopharmacology is mandatory in the treatment of childbearing aged women. This review focuses on the current knowledge of the effects of psychotropic drugs on the fetus.
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