Soares K V, McGrath J J, Deeks J J
Dov Hoz Street, 27/16, Kfar Saba, Israel, 44356.
Cochrane Database Syst Rev. 2000(2):CD000203. doi: 10.1002/14651858.CD000203.
Chronic antipsychotic drug treatment may cause tardive dyskinesia (TD), a long-term movement disorder. The gamma-aminobutyric acid (GABA) agonist drugs have been trialed as a treatment for TD, but these drugs have intense sedative properties and can possibly exacerbate psychotic symptoms.
To determine the effects of GABA agonist drugs (baclofen, gamma-vinyl-GABA, gamma-acetylenic-GABA, progabide, muscimol, sodium valproate and tetrahydroisoxazolopyridine (THIP)) in people with neuroleptic-induced tardive dyskinesia (TD) and schizophrenia or other chronic mental illnesses.
Electronic searches of Biological Abstracts (1982-1998), The Cochrane Library CENTRAL (1998), Cochrane Schizophrenia Group's Register of Trials (1998), EMBASE (1980-1998), LILACS (1982-1996), MEDLINE (1966-1998), PsycLIT (1974-1998), and SCISEARCH were undertaken. References of all identified studies were searched for further trial citations. First authors of each included trial were contacted.
The inclusion criteria for all relevant randomised studies were that they should focus on people with schizophrenia or other chronic mental illnesses, with neuroleptic-induced TD and compare the use of GABA agonist drugs to placebo or no intervention.
The reviewers extracted the data independently and the odds ratio (OR) and its 95% confidence interval (CI) or the weighted mean difference with 95% CI were estimated. The reviewers assumed that people who dropped out had no improvement.
Eight studies were able to be included. Results were equivocal, showing only a tendency for clinical improvement for those using GABA agonist drugs but, when analysis of any improvement (rather than clinical improvement) was performed, a significant reduction was noted in the GABA group (OR 0.36 CI 0.15-0.85). This suggests that for every 10 people treated with GABA drugs one person would benefit with a reduction in TD symptoms. People using the interventions had more confusion (OR 7.4 CI 1.3-40.9) and sedation (OR 3.0 CI 1.2-7.6). The numbers of people needed to treat to cause one extra person to experience these side effects were three and six, respectively. Tendency for more deterioration of the TD symptoms (OR 1.72 CI 0. 54-5.5), deterioration of the mental state (OR 3.07 CI 0.78-12.05), and to drop out before the end of the trial (OR 2.05 CI 0.8-5.21) were also observed in those using GABA agonists.
REVIEWER'S CONCLUSIONS: No clear statement about the efficacy of GABA agonist drugs could be provided. From the combined data, GABA agonist drugs tend to be associated with some degree of improvement in TD symptoms, but also with side effects such as confusion and sedation and a deterioration of the person's mental state.
长期使用抗精神病药物可能会导致迟发性运动障碍（TD），这是一种长期的运动障碍。γ-氨基丁酸（GABA）激动剂药物已被尝试用于治疗TD，但这些药物具有强烈的镇静作用，可能会加重精神病症状。
确定GABA激动剂药物（巴氯芬、γ-乙烯基-GABA、γ-乙炔基-GABA、普罗加比、蝇蕈醇、丙戊酸钠和四氢异恶唑并吡啶（THIP））对患有抗精神病药物所致迟发性运动障碍（TD）以及精神分裂症或其他慢性精神疾病的患者的影响。
对《生物学文摘》（1982 - 1998年）、《考克兰图书馆》CENTRAL（1998年）、考克兰精神分裂症研究小组试验注册库（1998年）、《荷兰医学文摘数据库》（1980 - 1998年）、《拉丁美洲和加勒比地区卫生科学数据库》（1982 - 1996年）、《医学索引》（1966 - 1998年）、《心理学文摘》（1974 - 1998年）以及《科学引文索引》进行了电子检索。对所有已识别研究的参考文献进行检索以获取更多试验引用。与每项纳入试验的第一作者进行了联系。
所有相关随机研究的纳入标准是，研究应聚焦于患有精神分裂症或其他慢性精神疾病且伴有抗精神病药物所致TD的患者，并将GABA激动剂药物的使用与安慰剂或不干预进行比较。
评审人员独立提取数据，并估计比值比（OR）及其95%置信区间（CI）或带有95%CI的加权平均差。评审人员假定退出研究的患者病情没有改善。
共纳入八项研究。结果并不明确，仅显示使用GABA激动剂药物的患者有临床改善的趋势，但在分析任何改善情况（而非临床改善）时，GABA组有显著降低（OR 0.36，CI 0.15 - 0.85）。这表明每10名接受GABA药物治疗的患者中有1人会因TD症状减轻而受益。使用这些干预措施的患者出现更多的意识模糊（OR 7.4，CI 1.3 - 40.9）和镇静作用（OR 3.0，CI 1.2 - 7.6）。导致另外一人出现这些副作用所需治疗的患者人数分别为3人和6人。在使用GABA激动剂的患者中还观察到TD症状有进一步恶化的趋势（OR 1.72，CI 0.54 - 5.5）、精神状态恶化（OR 3.07，CI 0.78 - 12.05）以及在试验结束前退出的趋势（OR 2.05，CI 0.8 - 5.21）。
无法对GABA激动剂药物的疗效给出明确说明。综合数据表明，GABA激动剂药物往往与TD症状有一定程度的改善相关，但也伴有如意识模糊和镇静等副作用以及患者精神状态的恶化。
