抗精神病药物诱发的双相情感障碍和精神分裂症锥体外系副作用：一项系统评价
Antipsychotic-induced extrapyramidal side effects in bipolar disorder and schizophrenia: a systematic review.
作者信息
Gao Keming, Kemp David E, Ganocy Stephen J, Gajwani Prashant, Xia Guohua, Calabrese Joseph R
机构信息
Department of Psychiatry, Bipolar Disorder Research Center at the Mood Disorders Program, University Hospitals Case Medical Center/Case Western Reserve University, School of Medicine, Cleveland, OH, USA.
出版信息
J Clin Psychopharmacol. 2008 Apr;28(2):203-9. doi: 10.1097/JCP.0b013e318166c4d5.
OBJECTIVES
Newer atypical antipsychotics have been reported to cause a lower incidence of extrapyramidal side effects (EPS) than conventional agents. This review is to compare antipsychotic-induced EPS relative to placebo in bipolar disorder (BPD) and schizophrenia.
METHODS
English-language literature cited in Medline was searched with terms antipsychotics, placebo-controlled trial, and bipolar disorder or schizophrenia and then with antipsychotic (generic/brand name), safety, akathisia, EPS, or anticholinergic use, bipolar mania/depression, BPD, or schizophrenia, and randomized clinical trial. Randomized, double-blind, placebo-controlled, monotherapy studies with comparable doses in both BPD and schizophrenia were included. Absolute risk increase and number needed to treat to harm (NNTH) for akathisia, overall EPS, and anticholinergic use relative to placebo were estimated.
RESULTS
Eleven trials in mania, 4 in bipolar depression, and 8 in schizophrenia were included. Haloperidol significantly increased the risk for akathisia, overall EPS, and anticholinergic use in both mania and schizophrenia, with a larger magnitude in mania, an NNTH for akathisia of 4 versus 7, EPS of 3 versus 5, and anticholinergic use of 2 versus 4, respectively Among atypical antipsychotics, only ziprasidone significantly increased the risk for overall EPS and anticholinergic use in both mania and schizophrenia, again with larger differences in mania, an NNTH for overall EPS of 11 versus 19, and anticholinergic use of 5 versus 9. In addition, risks were significantly increased for overall EPS (NNTH = 5) and anticholinergic use (NNTH = 5) in risperidone-treated mania, akathisia in aripiprazole-treated mania (NNTH = 9) and bipolar depression (NNTH = 5), and overall EPS (NNTH = 19) in quetiapine-treated bipolar depression.
CONCLUSIONS
Bipolar patients, especially in depression, were more vulnerable to having acute antipsychotic-induced movement disorders than those with schizophrenia.
目的
据报道，新型非典型抗精神病药物引起锥体外系副作用（EPS）的发生率低于传统药物。本综述旨在比较双相情感障碍（BPD）和精神分裂症中抗精神病药物诱发的EPS与安慰剂的情况。
方法
在Medline中检索英文文献，检索词为抗精神病药物、安慰剂对照试验、双相情感障碍或精神分裂症，然后再用抗精神病药物（通用名/商品名）、安全性、静坐不能、EPS或抗胆碱能药物使用、双相躁狂/抑郁、BPD或精神分裂症以及随机临床试验。纳入在BPD和精神分裂症中剂量相当的随机、双盲、安慰剂对照的单药治疗研究。估计相对于安慰剂，静坐不能、总体EPS和抗胆碱能药物使用的绝对风险增加和伤害所需治疗人数（NNTH）。
结果
纳入了11项躁狂试验、4项双相抑郁试验和8项精神分裂症试验。氟哌啶醇显著增加了躁狂和精神分裂症中静坐不能、总体EPS和抗胆碱能药物使用的风险，在躁狂中幅度更大，静坐不能的NNTH分别为4比7，EPS为3比5，抗胆碱能药物使用为2比4。在非典型抗精神病药物中，只有齐拉西酮显著增加了躁狂和精神分裂症中总体EPS和抗胆碱能药物使用的风险，同样在躁狂中差异更大，总体EPS的NNTH为11比19，抗胆碱能药物使用为5比9。此外，利培酮治疗的躁狂中总体EPS（NNTH = 5）和抗胆碱能药物使用（NNTH = 5）的风险显著增加，阿立哌唑治疗的躁狂（NNTH = 9）和双相抑郁（NNTH = 5）中静坐不能的风险增加，喹硫平治疗的双相抑郁中总体EPS（NNTH = 19）的风险增加。
结论
双相情感障碍患者，尤其是抑郁患者，比精神分裂症患者更容易出现急性抗精神病药物诱发的运动障碍。
Zotero 插件