Apud Jose A, Egan Michael F, Wyatt Richard J
Neuropsychiatry Branch, National Institute of Mental Health, NIH, Bethesda, MD 20892-1379, USA.
Schizophr Res. 2003 Sep 1;63(1-2):151-60. doi: 10.1016/s0920-9964(02)00338-9.
The objective of this retrospective study was to determine whether tardive dyskinesia (TD) represents a risk factor for supersensitive psychosis (SS) by assessing the effect of medication withdrawal on ratings of psychopathology for 30 days following discontinuation of antipsychotic medication in patients with and without TD. The subjects were 101 treatment-resistant patients with schizophrenia who had been admitted to the inpatient service of Neuroscience Research Hospital (NRH), National Institute of Mental Health, between 1982 and 1994 to undergo studies involving discontinuation of antipsychotic medication. Patients were rated independently on a daily basis on the 22-item Psychiatric Symptom Assessment Scale (PSAS), an extended version of the Brief Psychiatric Rating Scale (BPRS). The overall frequency of TD was 35.6%. Tardive dyskinesia patients were older (p < 0.0006) and had suffered from schizophrenia for a longer time (p < 0.003) than No-TD patients. Repeated measure ANOVA revealed a "time" effect for all subgroups studied. The interaction TD x time, however, was not statistically significant for any of the clusters. Within-group analysis revealed significant differences against baseline for measures of positive symptoms, negative symptoms and abnormal involuntary movements in the No-TD group 3 and 4 weeks after antipsychotic withdrawal. In the TD group, however, the changes were observed only at 4 weeks following antipsychotic discontinuation in just two of the positive symptoms cluster. Between-group analyses revealed that, at baseline, the Mannerisms cluster (abnormal involuntary movements) was significantly higher in the TD group (p < 0.05). No significant differences were observed between any of the remaining clusters at baseline or at different times following drug withdrawal. In conclusion, the relationship between SS and TD could not be confirmed in a cohort of patients with treatment-resistant schizophrenia. In the present study, patients with no TD seemed to deteriorate faster than patients with TD in terms of psychopathology and abnormal involuntary movements. It is possible that both group of patients may undergo supersensitive receptor changes, and that these changes may be more pronounced but potentially reversible in the group without TD.
这项回顾性研究的目的是，通过评估停用抗精神病药物后30天内停药对伴有或不伴有迟发性运动障碍（TD）患者精神病理学评分的影响，来确定迟发性运动障碍是否是超敏性精神病（SS）的一个风险因素。研究对象为101例难治性精神分裂症患者，他们于1982年至1994年间被收治入国立精神卫生研究所神经科学研究医院（NRH）的住院部，接受涉及停用抗精神病药物的研究。患者每天独立接受22项精神症状评估量表（PSAS）评分，该量表是简明精神病评定量表（BPRS）的扩展版本。TD的总体发生率为35.6%。与无TD患者相比，迟发性运动障碍患者年龄更大（p < 0.0006），患精神分裂症的时间更长（p < 0.003）。重复测量方差分析显示，所研究的所有亚组均有“时间”效应。然而，TD×时间的交互作用在任何一个聚类中均无统计学意义。组内分析显示，无TD组在停用抗精神病药物3周和4周后，阳性症状、阴性症状及异常不自主运动的测量值与基线相比有显著差异。然而，在TD组中，仅在停用抗精神病药物4周时，阳性症状聚类中的两项出现了变化。组间分析显示，在基线时，TD组的怪癖聚类（异常不自主运动）显著更高（p < 0.05）。在基线或停药后的不同时间，其余任何聚类之间均未观察到显著差异。总之，在一组难治性精神分裂症患者中，无法证实SS与TD之间的关系。在本研究中，就精神病理学和异常不自主运动而言，无TD患者似乎比有TD患者恶化得更快。两组患者都可能发生超敏受体变化，并且这些变化在无TD组中可能更明显，但可能是可逆的。
