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第二代抗精神病药物与锥体外系不良反应

Second-generation antipsychotics and extrapyramidal adverse effects.

作者信息

Divac Nevena, Prostran Milica, Jakovcevski Igor, Cerovac Natasa

机构信息

Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Dr. Subotica 1, 11000 Belgrade, Serbia.

University Medical Center Hamburg-Eppendorf, Center for Molecular Neurobiology, Falkenried 94, 20251 Hamburg, Germany.

出版信息

Biomed Res Int. 2014;2014:656370. doi: 10.1155/2014/656370. Epub 2014 Jun 3.

Abstract

Antipsychotic-induced extrapyramidal adverse effects are well recognized in the context of first-generation antipsychotic drugs. However, the introduction of second-generation antipsychotics, with atypical mechanism of action, especially lower dopamine receptors affinity, was met with great expectations among clinicians regarding their potentially lower propensity to cause extrapyramidal syndrome. This review gives a brief summary of the recent literature relevant to second-generation antipsychotics and extrapyramidal syndrome. Numerous studies have examined the incidence and severity of extrapyramidal syndrome with first- and second-generation antipsychotics. The majority of these studies clearly indicate that extrapyramidal syndrome does occur with second-generation agents, though in lower rates in comparison with first generation. Risk factors are the choice of a particular second-generation agent (with clozapine carrying the lowest risk and risperidone the highest), high doses, history of previous extrapyramidal symptoms, and comorbidity. Also, in comparative studies, the choice of a first-generation comparator significantly influences the results. Extrapyramidal syndrome remains clinically important even in the era of second-generation antipsychotics. The incidence and severity of extrapyramidal syndrome differ amongst these antipsychotics, but the fact is that these drugs have not lived up to the expectation regarding their tolerability.

摘要

抗精神病药物引起的锥体外系不良反应在第一代抗精神病药物的背景下已得到充分认识。然而,第二代抗精神病药物的出现,其作用机制非典型,尤其是多巴胺受体亲和力较低,临床医生对其导致锥体外系综合征的可能性较低寄予了厚望。本综述简要概述了与第二代抗精神病药物和锥体外系综合征相关的最新文献。许多研究已经考察了第一代和第二代抗精神病药物引起锥体外系综合征的发生率和严重程度。这些研究中的大多数清楚地表明,第二代药物确实会引发锥体外系综合征,尽管与第一代相比发生率较低。危险因素包括特定第二代药物的选择(氯氮平风险最低,利培酮风险最高)、高剂量、既往有锥体外系症状史以及合并症。此外,在比较研究中,第一代对照药物的选择会显著影响结果。即使在第二代抗精神病药物时代,锥体外系综合征在临床上仍然很重要。这些抗精神病药物引起锥体外系综合征的发生率和严重程度各不相同,但事实是这些药物在耐受性方面并未达到预期。

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