儿童和青少年使用第二代抗精神病药物相关锥体外系副作用的治疗建议。
Treatment recommendations for extrapyramidal side effects associated with second-generation antipsychotic use in children and youth.
作者信息
Pringsheim Tamara, Doja Asif, Belanger Stacey, Patten Scott
机构信息
Department of Clinical Neurosciences and Pediatrics, University of Calgary, Calgary, Alberta;
出版信息
Paediatr Child Health. 2011 Nov;16(9):590-8.
BACKGROUND/OBJECTIVE: Antipsychotic use in children is increasing. The purpose of the present article was to provide guidance to clinicians on the clinical management of extrapyramidal side effects of second-generation antipsychotics.
METHODS
Published literature, key informant interviews, and discussions with panel members and stakeholder partners were used to identify key clinical areas of guidance and preferences on format for the present recommendations. Draft recommendations were presented to a guideline panel. Members of the guideline panel evaluated the information gathered from the systematic review of the literature and used a nominal group process to reach a consensus on treatment recommendations. A description of the neurological abnormalities commonly seen with antipsychotic medications is provided, as well as recommendations on how to examine and quantify these abnormalities. A stepwise approach to the management of neurological abnormalities is provided.
RESULTS
Several different types of extrapyramidal symptoms can be seen secondary to antipsychotic use in children including neuroleptic-induced acute dystonia, neuroleptic-induced akathisia, neuroleptic-induced parkinsonism, neuroleptic-induced tardive dyskinesia, tardive dystonia and tardive akathisia, and withdrawal dyskinesias. The overwhelming majority of evidence on the treatment of antipsychotic-induced movement disorders comes from adult patients with schizophrenia. Given the scarcity of paediatric data, recommendations were made with reference to both the adult and paediatric literature. Given the limitations in the generalizability of data from adult subjects to children, these recommendations should be considered on the basis of expert opinion, rather than evidence based.
CONCLUSION
Clinicians must be aware of the potential of second-generation antipsychotics to induce neurological side effects, and should exercise a high degree of vigilance when prescribing these medications.
背景/目的：儿童抗精神病药物的使用正在增加。本文旨在为临床医生提供有关第二代抗精神病药物锥体外系副作用临床管理的指导。
方法
通过已发表的文献、关键信息提供者访谈以及与专家小组和利益相关者伙伴的讨论，确定指导的关键临床领域和本建议的格式偏好。将建议草案提交给一个指南小组。指南小组成员评估了从文献系统评价中收集的信息，并采用名义群体法就治疗建议达成共识。提供了抗精神病药物常见神经异常的描述，以及检查和量化这些异常的建议。提供了神经异常管理的逐步方法。
结果
儿童使用抗精神病药物后可出现几种不同类型的锥体外系症状，包括抗精神病药所致急性肌张力障碍、抗精神病药所致静坐不能、抗精神病药所致帕金森综合征、抗精神病药所致迟发性运动障碍、迟发性肌张力障碍和迟发性静坐不能，以及撤药后运动障碍。关于抗精神病药物所致运动障碍治疗的绝大多数证据来自成年精神分裂症患者。鉴于儿科数据匮乏，参考成人和儿科文献提出了建议。鉴于成人受试者数据对儿童的可推广性存在局限性，这些建议应基于专家意见而非循证依据来考虑。
结论
临床医生必须意识到第二代抗精神病药物诱发神经副作用的可能性，在开具这些药物处方时应保持高度警惕。
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