慢性精神分裂症住院病人迟发性运动障碍研究

目的　了解慢性精神分裂症住院患者迟发性运动障碍 (TD)的发生率并进行危险因素分析。方法　对4 4 3例慢性住院精神分裂症患者用自制患者情况调查表、阳性和阴性症状量表 (PANSS)、不自主运动量表 (AIMS)进行调查 ,并行二分量Logistic回归分析。结果　住院精神分裂症患者TD发生率为 2 1.7% ,其中男性为 2 0 .3% ,女性为2 7.3%。回归分析显示 ,年龄、性别、PANSS量表总分、目前抗精神病药物日剂量与TD的发生密切相关。结论　慢性精神分裂症住院患者的TD发生率很高 ,老年女性伴严重精神症状、每日药量较低时比男性更易患TD。     

迟发性运动障碍与急性锥外系反应

目的：探讨抗精神病药所致的迟发性运动障碍（ＴＤ）的相关因素。方法：用不自主运动量表（ＡＩＭＳ），锥体外系副反应量表（ＲＳＥＳＥ）评定确认ＴＤ、急性锥体外系副反应（ＥＰＳ）存在，建立对照组。对所得临床资料进行统计学分析。结果：ＴＤ组年轻男性多，总服药时间长，服药剂量高，高效价药使用多，既往ＥＰＳ次数多，情感性精神障碍患者服药剂量比精神分裂症患者明显低。ＴＤ严重程度与各临床变量无显著相关性，ＡＩＭＳ≤     

慢性精神分裂症迟发性运动障碍患者6年随访

目的:了解长期服用抗精神病药的慢性精神分裂症住院患者迟发性运动障碍(TD)的预后。方法:对以往诊断为TD的54例住院患者TD症状进行6年随访。结果:42.6%患者TD症状改善,35.2%患者症状不变,22.2%患者症状恶化。服用新型非典型抗精神病药者TD症状改善较明显。患者的年龄、性别、目前药物剂量、药物剂量的改变、首次用药年龄、累计服药时间及总病程对TD症状的改善无影响。结论:长期用药患者TD症状仍可有所改善,新型非典型抗精神病药物可能改善TD症状。     

氯氮平与迟发性运动障碍的相关对照研究

目的　探讨氯氮平长期治疗与迟发性运动障碍 (TD)的关系。方法　以迟发性运动障碍评定量表 (TDRS)和异常不自主运动量表 (AIMS) ,分别对持续单用治疗剂量氯氮平和使用典型抗精神病药达 1年以上的住院精神分裂症患者进行为期 1 2个月的随访。结果　单用氯氮平组与服用典型抗精神病药组的TD发生率分别为 3 51 % (n=57)和 9 8% (n=51 )。TD发生的临床特点以口面部运动障碍为主 ,合并安坦可能会增加TD发生的机会。在年龄、性别、剂量及以往是否有急性锥体外系副反应 ,两组间无显著性差异。结论　氯氮平在长期治疗过程中 ,有可能与典型抗精神病药一样导致TD的发生 ,但其发生率明显较低。     

Ⅰ型、Ⅱ型精神分裂症迟发性运动障碍调查分析

对130例住院男性精神分裂症患者(Ⅰ型54例、Ⅱ型76例)的迟发性运动障碍(下称TD)作了调查,采用阴性症状量表(SANS)、阳性症状量表(SAPS)、及异常不自主运动量表(AIMS)进行评定,结果表明,TD的总发生率为16.92％(22/130),Ⅰ型及Ⅱ型患者TD的发生率分别为5.56％(3/54)和25％(19/76),TD组阴性症状综合评价总分明显高于非TD组,TD的患病率随年龄的增大,服药时间的延长而增高,讨论了减少TD发生的措施。     

长期住院男性精神分裂症患者血清催乳素水平调查

目的:调查长期住院服用典型抗精神病药的男性精神分裂症患者血清催乳素(PRL)水平。方法:114例长期住院的男性精神分裂症患者(患者组)使用电化学发光免疫分析技术检测血清PRL水平,并与性别、年龄相匹配的57名正常男性(对照组)相比较。结果:患者组的血清PRL水平平均(24.1±18.8)ng/ml显著高于对照组(10.6±5.5)ng/ml(t=7.06,P<0.01)。患者组中吸烟精神分裂症患者血清PRL水平平均(21.2±15.4)ng/ml显著低于非吸烟精神分裂症患者(30.7±23.9)ng/ml(t=-2.17,P<0.05)。精神分裂症患者血清PRL水平与患者年龄(r=0.003)、服药剂量(折算为氯丙嗪,r=-0.12)、服药时间(r=-0.18)以及体质量指数(r=-0.07)之间无明显相关性(P均>0.05)。结论:长期服用典型抗精神病药可显著增高男性精神分裂症患者血清PRL水平,吸烟对血清PRL水平有一定的影响。     

氯氮平日剂量与精神分裂症患者稳态血药浓度相关性分析

目的探讨精神分裂症患者服用氯氮平日剂量与稳态血药浓度之间的关系,为指导临床合理用药提供参考。方法回顾分析服用氯氮平的精神分裂症患者病历,选取2013年6月-2014年6月在天津市安定医院住院的精神病患者,男性218例,女性157例。均采用高效液相色谱法检测住院患者血清氯氮平稳态血药浓度,并按日剂量分组,将其中位数进行等级相关性分析。结果氯氮平日剂量与稳态血药浓度呈正相关(男性组r=0.951,P0.01;女性组r=0.983,P0.01)。结论氯氮平稳态血药浓度与精神分裂症患者服药日剂量呈正相关。     

氯氮平所致迟发性运动障碍的调查

对长期应用氯氮平治疗的患者进行迟发性运动障碍(TD)调查 ,并以使用典型抗精神病药患者作对照。1　对象和方法系本院住院患者 ,诊断均符合 CCMD- 2 - R标准。研究组至少 1年持续单用氯氮平治疗 ,除外以往使用其它抗精神病药者。对照组以至少 1年以上持续服用典型抗精神病药 ,除外合并使用氯氮平或舒必利者。研究组 5 2例 ,男性 ,平均年龄 (4 3.6± 8.2 )岁 ,总病程 (13.3± 7.34 )年 ,持续服药时间 (4 .2± 2 .3)年 ,药物剂量折合氯丙嗪效价 (35 2± 12 5 ) mg/d。对照组 46例 ,男性 ,平均年龄 (4 5 .3± 7.8)岁 ,总病程(15 .2± 8.4)年 …     

住院精神分裂症患者主观舒适度的影响因素分析

目的 了解影响精神分裂症患者主观舒适度的相关因素。方法 对200例住院精神分裂症患者测评“抗精神病药物治疗中主观舒适度（SWN）简表”及自制的“相关因素调查表”。结果 住院精神分裂症患者SWN评分异常率为31％，SWN评分异常组与正常组相比，在总病程、住院次数、服药次数、药物剂量、家庭经济水平、服药依从性、社会支持、医患关系、诊断亚型、合并使用抗副作用药、藏药行为等方面差异显著。2项Logistic回归分析显示，精神分裂症患者主观舒适度影响因素依次为：药物剂量、合并使用抗副作用药、服药依从性、藏药行为、家庭经济水平、医患关系。结论 在治疗精神分裂症患者时应注意多因素对主观舒适度的影响，尤其注意发挥人为干预因素作用。     

10省市抗精神病药使用现况的调查

目的调查中国10省市精神药物治疗精神分裂症的使用现状.方法按人均国内生产总值将各省分为五个经济发展等级,以一定的抽样比例,选择10个省市的46家精神疾病专科医院或综合医院精神科的4 779例住院和门诊精神分裂症患者,于2002年5月20～24日用自制调查问卷进行精神分裂症药物治疗的现况调查.结果 (1)在4 779例患者中,门诊为1 969例(41.20%),住院为2 810例(58.80%).与门诊患者比较,住院患者中的男性患者比例高、年龄大、病程长、公费医疗比例高(均P<0.01).(2)使用频率在前六位的药物依次是氯氮平、利培酮、舒必利、氯丙嗪、奋乃静和氟哌啶醇.换算为氯丙嗪等效剂量后,治疗剂量为12.5～4 125 mg/d,平均(365±253)mg/d.其中住院患者的使用剂量[(409±274)mg/d]高于门诊患者[(300±201)mg/d;F=223,P<0.01].(3)2 617例次(54.99%)使用典型抗精神病药,2 940例次(61.78%)使用非典型抗精神病药(包括氯氮平在内).312例接受长效抗精神病药.3 523例(74.03%)接受单一抗精神病药治疗,1 236例(25.97%)联合使用2种及其以上抗精神病药.(4)常见的合并治疗药物有抗胆碱能药、β-受体阻断剂、苯二氮NFDA3类药、抗抑郁药和心境稳定剂.结论国内精神分裂症药物处方方式逐渐以非典型抗精神病药占主流,经济负担和患者的症状表现对精神药物的处方方式影响较大.     

双相情感性精神障碍患者迟发性运动障碍初探

调查３３例双相情感性精神障碍患者迟发性运动障碍（ＴＤ）有关的因素，并评估其认知功能。用迟发性运动障碍量表（Ｓｉｍｐｓｏｎ量表）、认知功能问卷调查，并收集临床资料。结果发现，有ＴＤ的比无ＴＤ的患者住院总次数多，因躁狂发作住院的次数多，抗精神病药治疗时间长，平均日剂量高，合并抗胆碱能药时间长。表明长期、高剂量抗精神病药治疗可能是双相情感性精神障碍病人ＴＤ产生的高危因素，且长期并用抗胆碱能药增加ＴＤ产生的危险。有无ＴＤ的病人认知功能并无差异。     

Tardive dyskinesia in non-western countries: A review

Tardive dyskinesia (TD) is a well-described adverse effect of treatment with neuroleptics. Studies from non-western countries are sparse and those that exist are not well publicized. We analyzed prevalence data on TD, published in English or French, and carried out in countries in Africa and Asia through December 1993. The estimated prevalence of TD among African subjects was 24% and among Asian subjects 17.20%. Both rates are in the middle range when compared with the western prevalence rates of 10–50%. Long-term hospitalization and older age were risk factors associated with TD. Female gender did not emerge as a risk factor. Also, several Asian studies showed that subjects with TD were taking lower doses of neuroleptics than subjects without TD. Prospective and controlled cross-cultural studies of TD are recommended for better understanding of associated risk factors and primary prevention.     

Drug-induced movement disorders in institutionalised adults with mental retardation: clinical characteristics and risk factors.

Fifty-three institutionalised adults with mental retardation, the majority (73.5%) moderate to severe, were examined for drug-induced movement disorders. Using a global AIMS score of 2 or more, 16 (34%) of the 47 subjects who had been exposed to neuroleptics had tardive dyskinesia (TD). Three of these had developed the dyskinesia upon withdrawal of neuroleptics. The dyskinetic movements were mainly seen in the lingual, perioral and other facial muscles. Two (33%) out of 6 subjects with no history of exposure to neuroleptics also had similar dyskinetic movements. The total neuroleptic dose significantly, and age marginally, but not sex, brain damage or level of mental retardation, emerged as risk factors for TD. Two (3.7%) subjects had definite akathisia and 16 (30.8%) significant extrapyramidal side effects. This study supports the findings of previous studies of considerable neurological adverse effects of neuroleptics in this patient group and cautions against their injudicious use. It provides further evidence for some putative risk factors for TD and is noteworthy for its lack of support for the contentious issue of brain damage as a risk factor.     

Tardive dyskinesia in schizophrenics under 60 years of age

Ninety-one schizophrenics (mean age 34 years) were examined for tardive dyskinesia (TD) during chronic neuroleptic treatment. Dyskinesia was found in 23 (25.3%). The only variable that showed an association with TD was the current doses of neuroleptics: in none of the TD patients did the dose of fluphenazine decanoate (or equivalent) exceed 45 mg/week, whereas it was higher in 23 of the 68 without TD (p less than 0.01). When these 23 "high-dose" patients were disregarded, the TD group differed significantly from the 45 dose-matched non-TD subjects in that it had more common anticholinergic drugs, more common parkinsonian symptoms, and less instances of good remission (p less than 0.05 in each case). There was no association between TD and other considered variables (drug history, age, sex, clinical characteristics, size of the lateral brain ventricles, neurological "soft" signs, cognitive impairment). The results illustrate a relationship between TD prevalence and current doses of neuroleptics and indicate that differences in doses between the groups with and without TD may obscure associations between dyskinesia and other factors.     

Early extrapyramidal side-effects as risk factors for later tardive dyskinesia: a prospective study

OBJECTIVE: To determine whether acute neuroleptic-induced parkinsonism and akathisia were risk factors for the later development of tardive dyskinesia (TD) in patients on typical neuroleptics. METHOD: Of 100 subjects examined for parkinsonism and akathisia after the initiation of typical neuroleptic medication, 78 were followed up for TD after a mean 41.2 months. RESULTS: Nine (11.5%) subjects were diagnosed with TD, predominantly manifesting as oro-facial dyskinesia. They had greater severity of parkinsonism and akathisia at baseline, and a larger neuroleptic load, than those who did not develop TD. On regression analyses, parkinsonism at baseline was a significant predictor of later TD. Examined independently of parkinsonism, akathisia severity at 2 weeks was also a significant predictor of later TD. CONCLUSIONS: Acute drug-induced parkinsonism and akathisia are both predictors of TD, with parkinsonism having greater predictive value. Acute and tardive extrapyramidal syndromes may share vulnerability factors.     

Tardive dyskinesia in psychiatric outpatients: a study of prevalence and association with demographic, clinical, and drug history variables

We examined 153 psychiatric outpatients, on a maintenance regimen of neuroleptics, for tardive dyskinesia (TD) and parkinsonism. Demographic, clinical, and drug history data were collected to assess whether any of these factors were significantly associated with TD. After initial univariate screening, significant variables were analyzed by multivariate statistical methods. Tardive dyskinesia was significantly associated with the use of high-potency or high-dosage neuroleptics and depot fluphenazine, whereas low-potency neuroleptics were negatively correlated with moderate TD. Age, but not sex, correlated significantly with TD, as did histories of incoherence, grandiose delusions, and teeth or denture problems. Parkinsonism and TD were strongly associated. Although the prevalence of TD was quite high, there were no severe involvements of any of the Abnormal Involuntary Movement Scale body areas.     

Prevalence of and risk factors for tardive dyskinesia in a Xhosa population in the Eastern Cape of South Africa

OBJECTIVE: Despite prolonged use of antipsychotic drug treatment, the prevalence of tardive dyskinesia (TD) in a Xhosa population has not been evaluated. This study was undertaken to assess the prevalence and identify possible factors, including antioxidant intake and smoking history, which may increase or reduce the risk of TD. METHOD: One hundred two subjects who had been exposed to typical antipsychotic drugs for at least 6 months and were currently on an antipsychotic were screened for abnormal movements using the Abnormal Involuntary Movement Scale (AIMS) rating scale. Data about current and past antipsychotic therapy, diagnoses, smoking history, and dietary factors were gathered from the patient and from chart view. RESULT: Twenty-eight and four-tenths percent of subjects met criteria for tardive dyskinesia. Years of treatment and total cumulative antipsychotic dose were significant predictors of TD. Subjects with higher total consumption of foods containing antioxidants had lower rates of TD, but only consumption of onions was significantly associated with reduced prevalence. TD was less prevalent in smokers, but this difference did not reach statistical significance. Age, sex, and psychiatric diagnosis did not predict presence of TD. CONCLUSION: The result of this study indicate that TD in this population is more prevalent than previously believed within this local clinical context. Prolonged treatment and total antipsychotic drug exposure are important risk factors for TD in this population. Further study of the role of concurrent medications and dietary factors is indicated.     

Nicotine exposure and tardive dyskinesia

The prevalence of tardive dyskinesia (TD) in chronic psychiatric outpatients was significantly higher in smokers (46/85) than in nonsmokers (18/69) (p less than 0.001). This increased prevalence was associated with a significantly greater prescribed dose of neuroleptics in women, but not in men. Nicotine increases the synthesis and release of dopamine in the nigrostriatal pathway of animals. Such a mechanism may contribute to the higher prevalence of TD in smokers. The present findings suggest that smoking is a risk factor for the development of TD. A statistically significant association between smoking and TD, however, does not necessarily imply a cause-effect relationship. Treatment of TD with mecamylamine or other central nicotine antagonists merits investigation.     

长期服抗精神病药病人的隐性运动障碍

目的：评估抗精神病药对迟发性运动障碍（ＴＤ）的掩盖,即隐性运动障碍（ｃｏｖｅｒｔ ｄｙｓｋｉｎｅ－ｓｉａ）状况。方法应用Ｓｉｍｐｓｏｎ运动障碍评分表评定ＴＤ。入组的６９例病人有２３例病人完成了减药之前、停药三周后和再服药四个月后的ＴＤ评定,６９例次检查都给于隶像,并且两个评定者按照录像独立评定ＴＤ是否存在,评定ＴＤ的一致性良好（ＩＣＣ＝０．７５）。结果完成整个调查的２３例病人中,减药前ＴＤ出现率为     

情感障碍病人锥体外系症状横断面分析

探索住院情感障碍病人锥体外系症状的发生率，并研究这些症状与药物和其它因素的关系。方法 用Ｓｉｍｐｓｏｎ锥体外系症状量表评定帕金森氏征，静坐不能，肌张力障碍和ＴＤ。结果 震颤，运动减少，静坐不能，肌张力障碍，ＴＤ发生率分别为３０．７％，１３．６％，１０．３％，１．７％和１３．６％。运动减少与年龄有关；静坐不能与抗抑郁药有关；ＴＤ与抗精神病药，锂盐及年龄显著相关。