Abstract Introduction Patients with cystic fibrosis (CF) have a high prevalence of comorbid anxiety and depressive symptoms, ranging from 8-29% in children and adolescents and 13-33% among adults. There is also a correlation between their physical symptoms and quality of life. A fixed-dose triple combination tablet of the cystic fibrosis transmembrane conductance regulator (CFTR) correctors elexacaftor and tezacaftor, along with the CFTR potentiator ivacaftor (hereafter referred to as TrikaftaTM) has been developed to treat patients with at least one F5508del mutation. No psychiatric or sleep-related adverse events have been reported with this combination until now. Case Report Here we present a case of a female patient who experienced worsening depression, anxiety, and worsening sleep paralysis with hypnopompic hallucinations following initiation of Trikafta therapy for CF, and consequent improvement of psychiatric symptoms following discontinuation and decreased dosing. Discussion In a previous case series, worsening of anxiety and depressive symptoms has been reported with lumacaftor/ivacaftor. Extrapolating from animal studies investigating ivacaftor’s effects on serotonin receptors, we would expect potential improvement of anxiety and depressive symptoms with Trikafta. However, this was not the case and ivacaftor’s effects on 5-HT2A receptors and/or her worsening depression could have played a role in exacerbating our patient’s sleep paralysis. As our patient’s psychiatric symptoms improved with discontinuation of Trikafta and worsened again with re-initiation of Trikafta, we advocate appropriate screening for psychopathology in patients with CF before initiating Trikafta.

中文翻译：

---

Trikafta 和囊性纤维化的精神病理学：病例报告

摘要 介绍 囊性纤维化 (CF) 患者合并焦虑和抑郁症状的患病率很高，在儿童和青少年中为 8-29%，在成人中为 13-33%。他们的身体症状与生活质量之间也存在相关性。囊性纤维化跨膜电导调节剂 (CFTR) 校正剂 elexacaftor 和 tezacaftor 以及 CFTR 增效剂 ivacaftor（以下称为 TrikaftaTM）的固定剂量三联组合片剂已开发用于治疗至少具有一个 F5508del 突变的患者。到目前为止，尚未报告这种组合的精神或睡眠相关不良事件。病例报告 在此我们介绍一例女性患者，她的抑郁、焦虑、在开始对 CF 进行 Trikafta 治疗后，睡眠麻痹恶化并伴有催眠幻觉，并因此在停药和减少剂量后改善精神症状。讨论 在之前的病例系列中，据报道使用 lumacaftor/ivacaftor 会导致焦虑和抑郁症状恶化。从调查依伐卡托对血清素受体影响的动物研究推断，我们预计 Trikafta 可能会改善焦虑和抑郁症状。然而，情况并非如此，ivacaftor 对 5-HT2A 受体的影响和/或她恶化的抑郁症可能在加剧我们患者的睡眠麻痹方面发挥了作用。由于我们患者的精神症状在停用 Trikafta 后有所改善，并在重新开始使用 Trikafta 后再次恶化，