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     

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≤     

撤抗精神病药后的静坐不能及其相关因素分析

Ｇａｒｄｏｓ等[1] 提出运动不安是一种撤药现象 ,是撤药运动障碍的一部分。并有证据表明当抗精神病药减量或撤药时可出现静坐不能 ,但其发生率及其相关的危险因子报道甚少 ,本文就此者进行了研究 ,现报道于后。1　对象与方法1.1　对象　 71例住院病人 (男 5 4例 ,女 17例 ) ,均符合ＣＣＭＤ - 2 -Ｒ中精神分裂症诊断标准 ,无严重躯体疾病史。1.2　方法　 71例病人递减抗精神病药物剂量 ,并于 3～ 7天内停用 ,同时于第 2周亦停用抗胆碱能药。停药前及停药后第 2周末应用Ｓｉｍｐｓｏｎ锥体外系症状量表(ＳＥＰＳ)、迟发性运动障碍 (ＴＤ)量…     

丁螺环酮治疗迟发性运动障碍

丁螺环酮治疗迟发性运动障碍【英】／ＭｏｓｓＬＥ…／／Ｊ　ＣｌｉｎＰｓｙｃｈｏｐｈａｒｍａｃｏｌ－１９９３，１３（３）：－２０４～２０９有人报告抗精神病药治疗的病人有近２０％存在迟发性运动障碍（ＴＤ）。以往曾用胆碱能药、胺类合成阻滞剂、胺类耗竭剂、γ－...     

迟发性运动障碍出现率及其危险因素的调查分析

目的本文调查了住院５年至１０年之间病人的迟发性运动障碍（ＴＤ）的出现率及其危险因素。方法采用“Ｓｉｍｐｓｏｎ迟发性运动障碍评分表”为工具，共调查了１０７例住院病人。确定有ＴＤ的标准是面部、唇部、颌部、舌部、颈部和躯干、上肢和下肢中至少有两个部位具轻度或轻度以上的异常运动。结果ＴＤ总的出现率为３７４％。ＴＤ组首次发病年龄显著高于无ＴＤ组（ｔ＝２．０９，Ｐ＝０．０３９）；服用抗精神病药物的剂量也显著低于无ＴＤ组（ｔ＝－２．００，Ｐ＜０．０４８）。服用抗精神病药的同时联用安坦者，ＴＤ出现率显著低于未联用者（χ２＝７．１，Ｐ＜０．０１）。结论在我国长期住院病人ＴＤ的出现率并不低于西方的报道。发病年龄晚者在服用抗精神病药以后更容易出现ＴＤ；抗精神病药与安坦联用者，ＴＤ出现率显著低于未联用者     

维生素E治疗迟发性运动障碍双盲对照观察

维生素Ｅ治疗迟发性运动障碍双盲对照观察冯春霞杨洪志黄世勋陈九义黄晓龙作者以维生素Ｅ治疗迟发性运动障碍（ＴＤ）２２例，其中男１５例、女７例。年龄１８～６５岁，平均３８．２±１３．２岁。病程２～２０年，平均６．５±３．７年。诊断精神分裂症１６例，分裂情感...     

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     

迟发性运动障碍12年随访报告

目的：探讨迟发性运动障碍（ＴＤ）预后及其相关因素。方法：采用异常不自主运动量表（ＡＩＭＳ）评分，对２３例住院的迟发性运动障碍患者进行１２年随访结果：进步１１例，无变化５例，加重７例，原ＴＤ恢复的６例病人全部复发，结论：ＴＤ缓解与性别、药物及ＴＤ部位无关，随年龄增加ＴＤ症状会复发，缓解率下降。ＴＤ的长期预后的不良。     

氯氮平治疗过程中迟发性运动障碍的随访研究

本文对长期使用氯氮平治疗的精神分裂症病人所致的迟发性运动障碍进行了三年随访，发现ＴＤ发生与年龄，病程，疾病严重度，抗精神病药使用时间有关；部分ＴＤ病人加大氯氮平剂量后ＴＤ症状缓解，临床以口面部和上肢的运动障碍多见。     

情感性精神障碍患者的药源性锥体外系症状

对情感性精神障碍患者出现药源性锥体外系症状（ＥＰＳ）研究较少，ＥＰＳ与锂盐的关系尚不清楚。有研究发现，接受抗精神病药治疗的情感性精神障碍患者比精神分裂症患者对ＥＰＳ（包括迟发性运动障碍，ＴＤ）有较高的易感性［１］。有关锂盐与ＥＰＳ间的关系，动物实验［...     

Tardive dyskinesia: relation to computer-tomographic, endocrine, and psychopathological variables

Severity of tardive dyskinesia (TD) and psychopathology of 36 chronic schizophrenic patients under long-term treatment with neuroleptics (NL) was rated during NL therapy and again 12 days after NL withdrawal. Both times serum levels of prolactin, norepinephrine, beta-endorphin, and cortisol were determined. In 27 of these patients ventricular-brain ratio, width of third ventricle, maximal width of anterior horns, distance between choroid plexus, and width of four largest sulci were also measured. Fifteen patients had no signs of TD; 14 had moderate, and 7 severe TD. TD was not related to age, age at onset of illness, duration of illness, dosage and type of neuroleptics, number of ECTs, or any endocrine variable. Psychopathology was barely related to TD, but after NL withdrawal, patients with TD tended to show more deterioration, particularly with regard to thought disorder and activation. With regard to computer-tomographic (CT) variables, patients without TD showed significantly less sulcal enlargement than those with TD. These results indicate that individual predisposition, which may have led to the development of TD, also seems to involve a higher risk of relapse after NL withdrawal.     

A survey of tardive dyskinesia in psychiatric inpatients in Japan.

To investigate the prevalence of tardive dyskinesia (TD) in a group of psychiatric patients receiving low doses of antipsychotic drugs, we examined 647 Japanese inpatients (361 men and 286 women) with a mean age of 49.8 years, receiving a mean dose of antipsychotic drugs of 276.8 mg of chlorpromazine equivalent. TD was diagnosed according to the criteria of Schooler and Kane with the Abnormal Involuntary Movement Scale. The overall prevalence of TD was 22.3%. Mild TD was found in 67.4% of TD patients, moderate TD in 29.2%, and severe TD in 3.5%. The TD patients were older (59.0 years) than those without this condition (47.2 years). The prevalence of TD increased with advancing age until the 7th decade, when it reached a plateau. The dose of daily antipsychotic drugs was lower in the TD patients (207.6 mg) than in the patients without TD (296.6 mg). The duration of primary illness was longer in the TD patients (28.9 years) than in the patients without TD (20.4 years). Patients receiving antiparkinsonism drugs showed TD less frequently (20.7%) than those not receiving such drugs (31.0%). No significant associations were found between the presence of TD and sex or primary illness.     

Tardive dyskinesia, mild drug-induced dyskinesia, and drug-induced parkinsonism: risk factors and topographic distribution.

This study attempted to contribute to the subtyping of tardive dyskinesia (TD) by studying the effects of age, sex, psychiatric diagnosis and duration of illness on the severity and topographic distribution of dyskinesia, and to describe the topographic distribution of drug-induced dyskinesia (DID) and drug-induced parkinsonism (DIP) in detail by examining 170 consecutive inpatients on antipsychotic treatment. Age, sex, psychiatric diagnosis or total duration of exposure to antipsychotics had no significant effect on either the severity or the distribution of DID. Drug-induced dyskinesia and DIP did not show a conspicuous pattern of lateralisation. Progression of mild DID to TD may not be a rule and factors other than age, sex, psychiatric diagnosis or duration of antipsychotic exposure might be operating in the development of clinically significant TD. Gait abnormalities and falls might be frequent manifestations of DIP as well as other side effects in these patients.     

Prevalence and risk factors for tardive dyskinesia: a study in an Italian population of chronic schizophrenics

Summary The aim of this study was to evaluate tardive dyskinesia (TD) (prevalence and possible risk factors, pharmacological and clinical), in a population of schizophrenic patients after prolonged institutionalization. A total of 148 patients (80 male, 68 female) aged between 28 and 87 years (mean 55, SD 11) diagnosed according to DSM III were included in the study and assessed for the presence and severity of TD using the Abbreviated Rockland Simpson Scale for TD. Of the examined population, 32% were found to be affected by TD. Patients over 55 years had a relative risk of TD that was 2.3 times higher than in subjects under 55 (P<0.05). The most frequent movements were orofacial (60%) and in the extremities (56.4%). No significant relationship between duration of neuroleptic treatments, illness or hospitalization, anticholinergic drugs and TD prevalence was found. Severity was related to age, since there was a positive linear relationship between age and Simpson Scale scores (r=0.45,P<0.01).     

CYP2D6 polymorphism and tardive dyskinesia in schizophrenic patients

Antipsychotic drug-induced tardive dyskinesia (TD) is a serious problem during psychopharmacologic treatment of schizophrenic patients. In search of genetic factors contributing to TD, there is a lack of consensus regarding the role of the polymorphic isozyme cytochrome P450 CYP2D6, which is involved in the oxidative metabolism of antipsychotic drugs. In the present case-control study, we tested the putative influence of the CYP2D6 genotype on the development of TD. Out of 157 patients, 109 were retrospectively selected meeting DSM IV criteria for schizophrenia or schizoaffective disorder, and 50 of them persistently presenting with TD. Genotyping detected the functional allele CYP2D6 *1, the known major defective alleles CYP2D6 *3, *4, *5, *6, and gene duplication. According to their number of functional CYP2D6 alleles, subjects were divided into carriers of none, one, or at least two functional CYP2D6 alleles. The proportions of these categories did not differ between patients and an ethnically homogenous control population (n = 195, p = 0.99) or between patients with and without TD (p = 0.818). Schizophrenic patients were carriers of gene duplication more often than healthy probands, without revealing statistical significance (p = 0.10). Out of seven patients with gene duplication, three developed persistent TD. Furthermore, patients with and without TD were comparable according to age, age of onset, gender, and duration of illness, but subjects with TD had taken more lifetime chlorpromazine equivalents (CPZ) than had patients without TD (chi 2-test, Student's t-test). Forward as well as backward logistic regression analyses confirmed that the presence of TD was influenced by lifetime CPZ but not by age, age of onset, gender, duration of illness, or CYP2D6 genotype. In contrast to the relevance of lifetime CPZ, the lifetime dose of antipsychotic drugs known to be metabolized by CYP2D6 did not significantly influence the presence of TD. In conclusion, our results provide no evidence for the contribution of CYP2D6 genotype to the development of TD in schizophrenic patients receiving long-term antipsychotic medication.     

Changes in negative symptoms and the risk of tardive dyskinesia: a longitudinal study. UK700 Group

OBJECTIVE: To examine whether the development of tardive dyskinesia (TD) is accompanied by a parallel process of worsening negative symptoms in a longitudinal study. METHOD: A sample of 708 psychotic patients were followed over a period of 2 years, using the Abnormal Involuntary Movement Scale and the Scale for the Assessment of Negative Symptoms (SANS). RESULTS: Of 361 individuals with no prior evidence of dyskinesia, 46 (13%) developed TD by year 2. Independent of the effects of male sex (odds ratio (OR)=2.18, 95% confidence interval: 1.00-4.74), age (OR per quartile group = 1.39, 95% CI: 1.01-1.90), duration of exposure to antipsychotic medication (OR = 2.35 per 8 months, 95% CI: 1.17-4.72) and average SANS score (OR per quartile group = 1.38, 95% CI: 0.99-1.93), worsening of negative symptoms over the 2 previous years was associated with TD onset (OR per quartile group = 1.46, 95% CI: 1.07-2.00). CONCLUSION: The development of TD is linked, independent of the effect of antipsychotics and older age, to an illness-related pathological process, characterized by worsening negative symptoms.     

Treatment of tardive dyskinesia with donepezil: a pilot study

BACKGROUND: Tardive dyskinesia (TD) remains a significant clinical problem for which there is no uniformly effective treatment. Earlier trials with acetylcholine precursors may have been disappointing because of underlying damage to striatal cholinergic neurons in patients with TD. In contrast, new cholinesterase inhibitors, developed for the treatment of dementia, may improve TD by directly increasing cholinergic synaptic transmission. METHOD: We conducted an 8-week open-label trial of donepezil in the treatment of TD. Ten patients with schizophrenia or schizoaffective disorder who received stable doses of antipsychotics and met DSM-IV criteria for TD were treated with donepezil, 5 to 10 mg/day, for 6 weeks after a 2-week baseline period. Changes in total Abnormal Involuntary Movement Scale (AIMS) scores measured every 2 weeks were assessed for significance. Patients were also assessed using the Brief Psychiatric Rating Scale, the Mini-Mental State Examination, the Barnes Akathisia Scale, and the Simpson-Angus Scale. RESULTS: Total AIMS scores decreased significantly (p = .0009), with no changes in other measures. Nine patients showed a positive response. Improvement was greatest in orofacial and upper extremity movements. No significant interactions were noted between the total AIMS scores and age (p > .29), duration of TD (p > .38), or duration of antipsychotic treatment (p > .14). CONCLUSION: Donepezil appeared to be effective in suppressing TD in this pilot study. However, placebo-controlled, double-blind studies are necessary before donepezil can be recommended as a treatment for TD.     

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。     

Books received (selected titles)

OBJECTIVE: Nicotine has a powerful preventive effect on neuroleptic-induced dopamine D2 receptor upregulation in the rat. The aim of this human positron emission tomography (PET) study was to compare upregulation in a smoker and a non-smoker, both of whom had received haloperidol for the same duration of time. METHOD: Two subjects who had been treated for 16 years with a constant dose of haloperidol were scanned after temporary haloperidol withdrawal, using [11C]-raclopride. RESULTS: The non-smoker, who had received a dose of 10 mg/day, showed a D2 upregulation of 98% and developed severe and persistent symptoms of tardive dyskinesia (TD) upon withdrawal. The chronic smoker, who had been treated with 40 mg/day, displayed a D2 upregulation of 71% and did not develop TD. CONCLUSION: These human observations agree with animal data which showed that nicotine can decrease neuroleptic-induced D2 receptor upregulation. This property of nicotine may play a protective role in movement disorders whose pathophysiology involves D2 receptor hypersensitivity.     

Smoking and tardive dyskinesia in male patients with chronic schizophrenia

Interactions between smoking and movement disorders include the contrasting associations of more cigarette smoking with reductions in Parkinson's disease and increases in tardive dyskinesia (TD) symptoms. Here we examine the relationship between smoking and TD in a large sample of inpatients with schizophrenia. We used cross-sectional naturalistic methods to analyze the prevalence and severity of neuroleptic-induced TD in relation to cigarette smoking among 764 male chronic and medicated inpatients meeting DSM-IV criteria for schizophrenia. We administered a detailed questionnaire including general information, medical and psychological conditions, and smoking behaviors. We evaluated TD severity using the abnormal involuntary movement scale (AIMS) and psychopathology using the Positive and Negative Syndrome Scale (PANSS). The main statistical analyses used cross-tabulations for the prevalence of TD by smoking and multivariate regression analyses for continuous measures (AIMS and PANSS). We found that the prevalence of TD did not significantly differ between smokers (41% = 237/578) and non-smokers (37% = 69/186). Secondary outcomes showed a significant association between the AIMS total score and age, duration of illness and hospitalization times. Thus, smoking was not associated with TD in male Chinese schizophrenics, but consistent with previous reports, older patients with a longer duration of illness and more hospitalizations showed greater severity of TD.