Department of Psychiatry, Veterans Affairs Medical Center and University of Pennsylvania School of Medicine, Philadelphia, USA.
J Clin Psychiatry. 2011 Mar;72(3):295-303. doi: 10.4088/JCP.09m05793yel. Epub 2010 Aug 10.
We compared the response to antipsychotic treatment between patients with and without tardive dyskinesia (TD) and examined the course of TD.
This analysis compared 200 patients with DSM-IV-defined schizophrenia and TD and 997 patients without TD, all of whom were randomly assigned to receive one of 4 second-generation antipsychotics. The primary clinical outcome measure was time to all-cause treatment discontinuation, and the primary measure for evaluating the course of TD was change from baseline in Abnormal Involuntary Movement Scale (AIMS) score. Kaplan-Meier survival analysis and Cox proportional hazards regression models were used to compare treatment discontinuation between groups. Changes in Positive and Negative Syndrome Scale (PANSS) and neurocognitive scores were compared using mixed models and analysis of variance. Treatment differences between drugs in AIMS scores and all-cause discontinuation were examined for those with TD at baseline. Percentages of patients meeting criteria for TD postbaseline or showing changes in AIMS scores were evaluated with χ(2) tests. Data were collected from January 2001 to December 2004.
Time to treatment discontinuation for any cause was not significantly different between the TD and non-TD groups (χ(2)(1) = 0.11, P = .743). Changes in PANSS scores were not significantly different (F(1,974) = 0.82, P = .366), but patients with TD showed less improvement in neurocognitive scores (F(1,359) = 6.53, P = .011). Among patients with TD, there were no significant differences between drugs in the decline in AIMS scores (F(3,151) = 0.32, P = .811); 55% met criteria for TD at 2 consecutive visits postbaseline, 76% met criteria for TD at some or all postbaseline visits, 24% did not meet criteria for TD at any subsequent visit, 32% showed a ≥ 50% decrease in AIMS score, and 7% showed a ≥ 50% increase in AIMS score.
Schizophrenia patients with and without TD were similar in time to discontinuation of treatment for any cause and improvement in psychopathology, but differed in neurocognitive response. There were no significant differences between treatments in the course of TD, with most patients showing either persistence of or fluctuation in observable symptoms.
clinicaltrials.gov Identifier: NCT00014001.
我们比较了伴有和不伴有迟发性运动障碍（TD）的精神分裂症患者对抗精神病治疗的反应，并检查了 TD 的病程。
本分析比较了 200 例符合 DSM-IV 定义的精神分裂症和 TD 患者和 997 例无 TD 患者，所有患者均被随机分配接受 4 种第二代抗精神病药物之一。主要临床结局测量是全因治疗停药时间，评估 TD 病程的主要测量是异常不自主运动量表（AIMS）评分从基线的变化。采用 Kaplan-Meier 生存分析和 Cox 比例风险回归模型比较组间治疗停药情况。采用混合模型和方差分析比较阳性和阴性综合征量表（PANSS）和神经认知评分的变化。对基线时患有 TD 的患者，检查 AIMS 评分和全因停药的药物治疗差异。使用卡方检验评估基线后符合 TD 标准的患者比例或 AIMS 评分变化。数据收集于 2001 年 1 月至 2004 年 12 月。
任何原因的治疗停药时间在 TD 和非 TD 组之间无显著差异（χ²(1) = 0.11，P =.743）。PANSS 评分的变化无显著差异（F(1,974) = 0.82，P =.366），但 TD 患者的神经认知评分改善较小（F(1,359) = 6.53，P =.011）。在患有 TD 的患者中，药物在 AIMS 评分下降方面没有显著差异（F(3,151) = 0.32，P =.811）；55%在基线后连续 2 次就诊时符合 TD 标准，76%在某些或所有基线后就诊时符合 TD 标准，24%在任何后续就诊时均不符合 TD 标准，32%的患者 AIMS 评分下降≥50%，7%的患者 AIMS 评分增加≥50%。
伴有和不伴有 TD 的精神分裂症患者在任何原因的治疗停药时间和精神病学改善方面相似，但在神经认知反应方面存在差异。TD 病程中，各治疗组之间无显著差异，大多数患者表现为症状持续或波动。
clinicaltrials.gov 标识符：NCT00014001。
