Richardson M A, Haugland G, Craig T J
Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962.
Am J Psychiatry. 1991 Oct;148(10):1322-8. doi: 10.1176/ajp.148.10.1322.
The authors' goal was to determine the prevalence of and risk factors for neuroleptic-induced movement disorders in a group of psychiatrically hospitalized children and adolescents.
They evaluated the presence or absence of parkinsonism, tardive dyskinesia, and akathisia in 104 children and adolescents who were in residence in or admitted over a 6-month period to a state-operated child psychiatric center. They applied a standardized, structured assessment procedure used in research on adult and geriatric psychiatric patients and the mentally retarded.
The prevalence of parkinsonism among the 61 subjects at risk was 34% and was significantly associated with longer neuroleptic treatment periods immediately before evaluation. The prevalence of treatment-emergent tardive dyskinesia among the 41 subjects at risk was 12% and showed no association with quantitative neuroleptic treatment variables. However, patients with tardive dyskinesia were significantly more likely to have a family history of mental illness and significantly less likely to have a history of assaultive behavior. A pattern of complex pharmacological responses for parkinsonism and tardive dyskinesia, some of which are not typical of those most commonly reported in adults, was seen in this group of young patients.
The study data highlight the acute sensitivity of the neuroleptic-treated child and adolescent to the development of parkinsonism, the possible role of certain patient characteristics in the vulnerability to develop tardive dyskinesia, and the possibility that neuroleptic-induced side effects experienced by children and adolescents differ in some ways from those experienced by adults. The data further strongly support the need for systematic monitoring of neuroleptic-treated child and adolescent patients for a full range of side effects.
作者的目标是确定一组住院接受治疗的儿童和青少年中抗精神病药物所致运动障碍的患病率及危险因素。
他们评估了104名在州立儿童精神病中心住院或在6个月内入院的儿童和青少年是否存在帕金森症、迟发性运动障碍和静坐不能。他们采用了一种标准化的、结构化的评估程序，该程序用于对成年和老年精神病患者以及智力迟钝者的研究。
61名有风险的受试者中帕金森症的患病率为34%，且与评估前较长的抗精神病药物治疗期显著相关。41名有风险的受试者中治疗中出现的迟发性运动障碍的患病率为12%，且与抗精神病药物治疗的定量变量无关。然而，患有迟发性运动障碍的患者有精神疾病家族史的可能性显著更高，有攻击性行为史的可能性显著更低。在这组年轻患者中观察到了帕金森症和迟发性运动障碍的复杂药理反应模式，其中一些反应并非成年人中最常见的典型反应。
研究数据突出了接受抗精神病药物治疗的儿童和青少年对帕金森症发生的急性敏感性、某些患者特征在迟发性运动障碍易感性中的可能作用，以及儿童和青少年抗精神病药物所致副作用在某些方面可能与成年人不同的可能性。数据进一步有力支持了对接受抗精神病药物治疗的儿童和青少年患者进行全面副作用系统监测的必要性。
