每日一题_2023.03.28

A 15-year-old girl is brought to the emergency department by her mother after experiencing a first-time seizure. The thin-appearing girl has a heart rate of 55/min, signs suggestive of dehydration, and fine, velvety hair covering her arms and legs. The physician calculates her body mass index to be 16.4 kg/m2. When the patient’s mother leaves the room for a moment, the patient admits to the physician that she has been feeling depressed recently and that for the past week she has been selfmedicating with normal daily doses of one of her friend’s antidepressant medications. What antidepressant is the patient most likely taking?

一个15岁的女孩在经历了第一次癫痫发作后被她的母亲带到急诊室。这名瘦女孩的心率为55次/分，有脱水迹象，手臂和腿部覆盖着细而柔软的毛发。医生计算出她的体重指数为16.4 kg/m2。当患者的母亲离开房间一会儿时，患者向医生承认，她最近感到抑郁，在过去的一周里，她一直在自我治疗，每天服用她朋友的一种抗抑郁药。患者最可能服用的抗抑郁药是什么?

(A) Amitriptyline 阿米替林

(B) Bupropion 安非他酮

(C) Fluoxetine 氟西汀

(D) Mirtazapine 米氮平

(E) Selegiline 司来吉兰

答案解析：

该患者的体征符合神经性厌食症，最显著的是低体重指数、心动过缓、低血压证据、细小体毛(称为胎毛)和伴随的抑郁。神经性厌食症是一种严重的疾病，需要加强精神卫生保健，以及密切监测体重、电解质水平和水合状态。治疗的主要方法是认知行为疗法和SSRIs的联合治疗。神经性厌食症患者禁用抗抑郁药安非他酮，因为它会增加该人群癫痫发作的风险。

正确答案：B