Rodnitzky R L, Keyser D L
Department of Neurology, University of Iowa College of Medicine, Iowa City.
Psychiatr Clin North Am. 1992 Jun;15(2):491-510.
Drugs, either self-administered or prescribed by physicians, can result in substantial neurologic disability in psychiatric patients. It is clear that the use of neuroleptic agents to treat psychiatric illness may result in a variety of tardive movement disorders. Most commonly, these take the form of orobuccal dyskinesias, but choreic movements of the trunk and extremities, dystonic postures, myoclonus, tics, parkinsonism, and akathisic syndromes also may occur. The choreic tardive syndromes are thought to occur more commonly in the elderly female population, but tardive variants may affect a different population. The neuroleptic malignant syndrome carries a significant mortality and remains a diagnostic and therapeutic challenge. Early detection and vigorous treatment reduces the morbidity and mortality from this condition. Stroke, seizures, and various movement disorders may complicate the illicit use of cocaine and complicate the rehabilitation of those patients dependent on its use. The unsatisfactory treatment of tardive syndromes, neuroleptic malignant syndrome, and cocaine-induced neurologic disease underscores our incomplete understanding of the neurochemistry of dopamine, the function of newly discovered dopamine receptors, and the role they play in maintaining normal emotional and motoric function. For now, awareness of the varied neurologic syndromes related to neurotransmitter-modulating agents should provide the impetus for careful use of these agents and for the continued development of improved drugs for the treatment of psychiatric disease.
药物，无论是自行服用还是由医生开处方，都可能导致精神病患者出现严重的神经功能残疾。显然，使用抗精神病药物治疗精神疾病可能会导致各种迟发性运动障碍。最常见的形式是口颊运动障碍，但躯干和四肢的舞蹈样动作、张力障碍姿势、肌阵挛、抽搐、帕金森综合征和静坐不能综合征也可能发生。舞蹈样迟发性综合征被认为在老年女性人群中更常见，但迟发性变体可能影响不同人群。抗精神病药物恶性综合征具有较高的死亡率，仍然是诊断和治疗上的挑战。早期发现和积极治疗可降低这种疾病的发病率和死亡率。中风、癫痫发作和各种运动障碍可能使可卡因的非法使用复杂化，并使依赖可卡因的患者的康复变得复杂。迟发性综合征、抗精神病药物恶性综合征和可卡因所致神经疾病的治疗效果不理想，这突出表明我们对多巴胺神经化学、新发现的多巴胺受体的功能以及它们在维持正常情绪和运动功能中所起的作用了解不全面。目前，认识到与神经递质调节药物相关的各种神经综合征，应该促使人们谨慎使用这些药物，并推动继续研发用于治疗精神疾病的改进药物。
