Lind Cpt Christopher K, Carchedi Cpt Lisa R, Staudenmeier Ltc James J, Diebold Ltc P Carroll J
Psychiatry (Edgmont). 2005 Jun;2(6):32-9.
The atypical antipsychotics have been touted by many as having minimal extrapyramidal symptoms. This case series from the Tripler Army Medical Center Psychiatry Graduate Medical Education Program presents the extrapyramidal symptoms observed with four different atypical antipsychotic medications. Also reviewed are the mechanisms of action that atypical antipsychotics and first-generation antipsychotics use to treat the symptoms of schizophrenia. Cases reviewed include a schizophrenic male patient whose dose of risperidone was doubled from 6mg to 12mg overnight and developed an acute dystonic reaction; a young male patient with a substance-induced psychosis who unintentionally doubled his ziprasidone dose in 24 hours, resulting in an acute dystonic reaction; a young female patient on paroxetine who also recently started olanzapine and had complaints consistent with akathisia that resolved with treatment; and an adolescent female patient on escitalopram for obsessive-compulsive disorder who after starting aripiprazole developed Parkinsonism. All four cases illustrate that even though atypical antipsychotics are less likely to cause extrapyramidal symptoms than their first generation cousins, the physician should be aware that these symptoms may still occur and need to be treated.
许多人都称赞非典型抗精神病药物的锥体外系症状极少。来自特里普勒陆军医疗中心精神病学毕业后医学教育项目的这个病例系列展示了使用四种不同非典型抗精神病药物时观察到的锥体外系症状。同时还回顾了非典型抗精神病药物和第一代抗精神病药物用于治疗精神分裂症症状的作用机制。所回顾的病例包括：一名男性精神分裂症患者，其利培酮剂量在一夜之间从6毫克加倍至12毫克，并出现急性肌张力障碍反应；一名年轻男性物质所致精神病患者，在24小时内无意中将齐拉西酮剂量加倍，导致急性肌张力障碍反应；一名年轻女性患者，正在服用帕罗西汀，近期开始服用奥氮平，出现了与静坐不能相符的症状，经治疗后缓解；以及一名患有强迫症且正在服用艾司西酞普兰的青少年女性患者，在开始服用阿立哌唑后出现帕金森症。所有这四个病例都表明，尽管非典型抗精神病药物比第一代抗精神病药物引起锥体外系症状的可能性更小，但医生应意识到这些症状仍可能出现且需要治疗。
