Schimmelmann B Graf, Schacht M, Perro C, Lambert M
Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg.
Nervenarzt. 2004 Jan;75(1):36-43. doi: 10.1007/s00115-003-1544-z.
Initial dysphoric response (IDR) is characterized by a negative affective reaction within 48 h after a neuroleptic test dose. Currently, there are three scales for measuring the IDR (Neuroleptic Dysphoria Scale, Dysphoric Response Index, Drug Attitude Inventory). The debate continues about the definition, measurement, and underlying aetiology of IDR. Nevertheless, with a prevalence of 30%, the response is a clinically relevant phenomenon. Empirical data give some evidence of an association between IDR and short-term outcome. No correlation of IDR with pretreatment variables has been found yet (e.g. age, gender, and psychopathology at baseline, especially depression and hostility). With respect to aetiology, a negative subjective reaction to concurrent extrapyramidal side effects and direct dysaffective effects of some neuroleptics have been discussed. Other studies found that IDR might not be a specifically antipsychotic effect. Our first results give some evidence that patients treated with atypical antipsychotics experience IDR less often and less severely than those treated with conventional antipsychotics described in the literature. Further research should include placebo-controlled studies and the evaluation of specific pretreatment variables. To assess the aetiology of IDR, further basic research is needed.
初始烦躁反应（IDR）的特征是在给予抗精神病药物试验剂量后的48小时内出现负面情感反应。目前，有三种量表可用于测量IDR（抗精神病药物烦躁量表、烦躁反应指数、药物态度量表）。关于IDR的定义、测量方法及潜在病因的争论仍在继续。然而，该反应的发生率为30%，是一种具有临床相关性的现象。实证数据为IDR与短期预后之间的关联提供了一些证据。目前尚未发现IDR与治疗前变量（如年龄、性别以及基线时的精神病理学，尤其是抑郁和敌意）之间存在相关性。关于病因，有人讨论了对同时出现的锥体外系副作用的负面主观反应以及某些抗精神病药物的直接情感障碍效应。其他研究发现，IDR可能并非一种特定的抗精神病药物效应。我们的初步结果表明，与文献中描述的使用传统抗精神病药物治疗的患者相比，使用非典型抗精神病药物治疗的患者出现IDR的频率更低、程度更轻。进一步的研究应包括安慰剂对照研究以及对特定治疗前变量的评估。为了评估IDR的病因，还需要进一步的基础研究。
