迟发性运动障碍与非典型与传统抗精神病药物的发生率：一项前瞻性队列研究。
Incidence of tardive dyskinesia with atypical versus conventional antipsychotic medications: a prospective cohort study.
机构信息
Department of Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, CT 06519, USA.
出版信息
J Clin Psychiatry. 2010 Apr;71(4):463-74. doi: 10.4088/JCP.07m03890yel. Epub 2010 Feb 9.
OBJECTIVE
Most previous studies of the incidence of tardive dyskinesia with atypical antipsychotics compared with conventional antipsychotics have not had tardive dyskinesia as their primary focus. The current study aimed to compare the incidence of tardive dyskinesia with atypical vs conventional antipsychotics using methods similar to those from a previous prospective cohort study at our site in the 1980s.
METHOD
Three hundred fifty-two initially tardive dyskinesia-free psychiatric outpatients (diagnosed at baseline using the Structured Clinical Interview for DSM-IV) were examined for a new diagnosis of tardive dyskinesia (using the Abnormal Involuntary Movement Scale and Glazer-Morgenstern criteria) every 6 months for up to 4 years at a community mental health center. At baseline, subjects were receiving conventional antipsychotics only (23%), atypicals only (64%), or both (14%). Only 26 subjects had never received conventional antipsychotics. Baseline evaluations were conducted from November 2000 through May 2003. Follow-ups were conducted through February 2005.
RESULTS
Compared with subjects treated with conventional antipsychotics alone since the previous visit, the adjusted tardive dyskinesia incidence rate-ratio for subjects treated with atypical antipsychotics alone was 0.68 (95% CI, 0.29-1.64). The incidence and prevalence of tardive dyskinesia was similar to previous findings at this site in the 1980s.
CONCLUSIONS
The incidence of tardive dyskinesia with recent exposure to atypical antipsychotics alone was more similar to that for conventional antipsychotics than in most previous studies. Despite high penetration of atypical antipsychotics into clinical practice, the incidence and prevalence of tardive dyskinesia appeared relatively unchanged since the 1980s. Clinicians should continue to monitor for tardive dyskinesia, and researchers should continue to pursue efforts to treat or prevent it.
目的
大多数先前研究比较了非典型抗精神病药与传统抗精神病药引起迟发性运动障碍的发生率，但这些研究并未将迟发性运动障碍作为主要关注点。本研究旨在使用与我们 20 世纪 80 年代在同一地点进行的前瞻性队列研究类似的方法，比较使用非典型与传统抗精神病药治疗的迟发性运动障碍的发生率。
方法
352 名最初无迟发性运动障碍的精神科门诊患者（根据 DSM-IV 结构化临床访谈在基线时诊断）在社区心理健康中心每 6 个月接受一次新的迟发性运动障碍诊断（使用异常不自主运动量表和 Glazer-Morgenstern 标准），最长可达 4 年。在基线时，患者仅接受传统抗精神病药（23%）、非典型抗精神病药（64%）或两者（14%）治疗。仅有 26 名患者从未接受过传统抗精神病药治疗。基线评估于 2000 年 11 月至 2003 年 5 月进行。随访于 2005 年 2 月进行。
结果
与上一次就诊时仅接受传统抗精神病药治疗的患者相比，单独使用非典型抗精神病药治疗的患者调整后的迟发性运动障碍发生率比值比为 0.68（95%CI，0.29-1.64）。迟发性运动障碍的发生率和患病率与该地点 20 世纪 80 年代的先前发现相似。
结论
与大多数先前研究相比，最近单独使用非典型抗精神病药暴露的迟发性运动障碍发生率更类似于传统抗精神病药。尽管非典型抗精神病药在临床实践中的使用率很高，但自 20 世纪 80 年代以来，迟发性运动障碍的发生率和患病率似乎相对没有变化。临床医生应继续监测迟发性运动障碍，研究人员应继续努力治疗或预防迟发性运动障碍。
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