Fernandez Hubert H, Friedman Joseph H
Department of Clinical Neurosciences, Brown University School of Medicine, Providence, Rhode Island, USA.
Neurologist. 2003 Jan;9(1):16-27. doi: 10.1097/01.nrl.0000038585.58012.97.
Tardive syndromes are a group of delayed-onset abnormal involuntary movement disorders induced by a dopamine receptor blocking agent. There are several phenomenologically distinct types of TS.
The term tardive dyskinesia has been used to refer to the TS that presents with rapid, repetitive, stereotypic movements mostly involving the oral, buccal, and lingual areas. Tardive dystonia can be focal, segmental, or generalized. It commonly affects the face and neck followed by the arms and trunk. It usually results in retrocollis when it involves the neck and trunk arching backwards when it involves the trunk. Tardive akathisia is characterized by a feeling of inner restlessness and jitteriness with an inability to sit or stand still. Other tardive syndromes include tardive tics, myoclonus, tremor, and withdrawal-emergent syndrome. It remains unclear whether tardive parkinsonism truly exists. The only way to prevent TS is to avoid its etiologic agents. Chronic use of dopamine receptor blocking agents should be limited as much as possible to patients with chronic psychoses. In general, for mild TS, reducing the neuroleptic dose, switching to an atypical agent, or discontinuing antipsychotic treatment altogether in the hope of facilitating remission is recommended. For moderate to severe TS, tetrabenazine or reserpine may be the most effective agent. Neuroleptics should be resumed to treat TD in the absence of active psychosis only as a last resort for persistent, disabling, and treatment-resistant TD.
The severity of the TS and the absolute need for antipsychotic therapy often dictate the treatment approach for this disorder.
迟发性综合征是一组由多巴胺受体阻断剂诱发的迟发性异常不自主运动障碍。迟发性综合征有几种在现象学上不同的类型。
迟发性运动障碍一词已被用于指代主要表现为快速、重复、刻板运动，大多累及口腔、颊部和舌部区域的迟发性综合征。迟发性肌张力障碍可以是局灶性、节段性或全身性的。它通常影响面部和颈部，其次是手臂和躯干。当累及颈部时通常导致颈后倾，当累及躯干时导致躯干向后拱起。迟发性静坐不能的特征是内心不安和紧张感，无法安静地坐着或站着。其他迟发性综合征包括迟发性抽搐、肌阵挛、震颤和撤药后出现的综合征。迟发性帕金森症是否真的存在仍不清楚。预防迟发性综合征的唯一方法是避免其病因。多巴胺受体阻断剂的长期使用应尽可能限于患有慢性精神病的患者。一般来说，对于轻度迟发性综合征，建议减少抗精神病药物剂量、换用非典型药物或完全停用抗精神病药物治疗以期促进缓解。对于中度至重度迟发性综合征，丁苯那嗪或利血平可能是最有效的药物。仅在作为治疗持续、致残且难治的迟发性运动障碍的最后手段时，才应在无活动性精神病的情况下恢复使用抗精神病药物来治疗迟发性运动障碍。
迟发性综合征的严重程度以及对抗精神病治疗的绝对需求通常决定了这种疾病的治疗方法。
