Pappa S, Dazzan P
Institute of Psychiatry, Division of Psychological Medicine, King's College London, UK.
Psychol Med. 2009 Jul;39(7):1065-76. doi: 10.1017/S0033291708004716. Epub 2008 Nov 12.
Spontaneous movement disorders (SMDs), such as spontaneous dyskinesia and parkinsonism, have been described in patients with schizophrenia who have never been treated with antipsychotic medication. Their presence has been documented extensively in chronic schizophrenia but not at the time of illness onset.
We performed a systematic review of studies investigating spontaneous abnormal movements elicited on clinical examination in antipsychotic-naive patients with first-episode psychosis.
We identified a total of 13 studies. Findings suggest a spontaneous dyskinesia median rate of 9% and a spontaneous parkinsonism median rate of 17%. Information on akathisia and dystonia was limited. The presence of SMDs may be associated with negative symptoms and cognitive dysfunction.
These findings support the notion that spontaneous abnormal movements are part of a neurodysfunction intrinsic to the pathogenesis of schizophrenia. Future studies should further investigate the role of basal ganglia and extrapyramidal pathways in the pathophysiology of psychosis, with particular attention to treatment implications.
未接受过抗精神病药物治疗的精神分裂症患者中曾出现过自发运动障碍（SMD），如自发异动症和帕金森症。这些症状在慢性精神分裂症患者中已有广泛记录，但在疾病发作时未见相关记录。
我们对有关首次发作精神病且未服用过抗精神病药物患者临床检查中引发的自发异常运动的研究进行了系统综述。
我们共确定了13项研究。研究结果显示，自发异动症的中位发生率为9%，自发帕金森症的中位发生率为17%。关于静坐不能和肌张力障碍的信息有限。SMD的存在可能与阴性症状和认知功能障碍有关。
这些发现支持了自发异常运动是精神分裂症发病机制中固有神经功能障碍一部分的观点。未来的研究应进一步探讨基底神经节和锥体外系通路在精神病病理生理学中的作用，尤其要关注对治疗的影响。
