Oosthuizen Piet P, Emsley Robin A, Maritz J Stephanus, Turner Jadri A, Keyter N
Department of Psychiatry, University of Stellenbosch Faculty of Health Sciences, P.O. Box 19063, Tygerberg 7505, South Africa.
J Clin Psychiatry. 2003 Sep;64(9):1075-80. doi: 10.4088/jcp.v64n0913.
Previous studies suggest that the risk of tardive dyskinesia is increased with higher doses of conventional antipsychotics. This study evaluates the 12-month incidence of tardive dyskinesia in subjects with first-episode psychosis who were treated with very low doses of haloperidol.
Fifty-seven subjects with first-episode psychosis and a DSM-IV diagnosis of schizophreniform disorder, schizophrenia, or schizoaffective disorder were treated according to a fixed protocol with a mean dose of haloperidol of 1.68 mg/day and prospectively studied for 12 months. Subjects were assessed for extrapyramidal symptoms and psychiatric symptoms at 3-month intervals. Data were gathered from 1999 to 2001.
Twelve-month incidence of probable or persistent tardive dyskinesia according to Schooler and Kane criteria was 12.3% (N = 7). Subjects with tardive dyskinesia did not differ from the rest of the sample regarding gender, race, duration of untreated psychosis, or baseline clinical characteristics. Subjects with tardive dyskinesia were older compared with subjects without tardive dyskinesia (37.14 +/- 9.23 vs. 27.30 +/- 8.09 years, respectively; t = -2.77, df = 30, p = .01) and received higher mean doses of haloperidol at 12 months (2.80 +/- 1.64 vs. 1.39 +/- 0.69 mg/day, respectively; t = -3.13, df = 25, p = .004). Cox regression analysis revealed that age at inclusion (p = .031), percentage change in negative symptoms (p = .028), and dose of haloperidol at 12 months (p = .016) were significant predictors of risk for tardive dyskinesia.
Incidence of tardive dyskinesia was at least as high as in other samples treated with standard doses of conventional antipsychotics. Subjects at risk for tardive dyskinesia could not be identified on the basis of initial clinical features or acute treatment response. Risk of tardive dyskinesia was related to age, antipsychotic dose, and worsening of negative, depressive, and parkinsonian symptoms.
先前的研究表明，使用高剂量传统抗精神病药物会增加迟发性运动障碍的风险。本研究评估了接受极低剂量氟哌啶醇治疗的首发精神病患者中迟发性运动障碍的12个月发病率。
57例首发精神病且诊断为精神分裂症样障碍、精神分裂症或分裂情感性障碍的患者，按照固定方案接受平均剂量为1.68毫克/天的氟哌啶醇治疗，并进行为期12个月的前瞻性研究。每3个月对患者进行锥体外系症状和精神症状评估。数据收集时间为1999年至2001年。
根据斯库勒和凯恩标准，可能或持续性迟发性运动障碍的12个月发病率为12.3%（n = 7）。患有迟发性运动障碍的患者在性别、种族、未治疗精神病的持续时间或基线临床特征方面与样本中的其他患者没有差异。与未患迟发性运动障碍的患者相比，患有迟发性运动障碍的患者年龄更大（分别为37.14±9.23岁和27.30±8.09岁；t = -2.77，自由度 = 30，p = 0.01），且在12个月时接受的氟哌啶醇平均剂量更高（分别为2.80±1.64毫克/天和1.39±0.69毫克/天；t = -3.13，自由度 = 25，p = 0.004）。Cox回归分析显示，纳入时的年龄（p = 0.031）、阴性症状的百分比变化（p = 0.028）以及12个月时氟哌啶醇的剂量（p = 0.016）是迟发性运动障碍风险的显著预测因素。
迟发性运动障碍的发病率至少与使用标准剂量传统抗精神病药物治疗的其他样本一样高。无法根据初始临床特征或急性治疗反应识别出有迟发性运动障碍风险的患者。迟发性运动障碍风险与年龄、抗精神病药物剂量以及阴性、抑郁和帕金森症状的恶化有关。
