Wu Wei-Yi, Chan Hung-Yu, Tan Happy Kuy-Lok
1 Department of Psychiatry, Taoyuan Mental Hospital, Taoyuan, Taiwan.
Acta Neuropsychiatr. 2014 Feb;26(1):61-4. doi: 10.1017/neu.2013.50.
Aripiprazole has a low risk for causing extrapyramidal syndrome and can remit neuroleptic-induced tardive dyskinesia (TD). Here, we presented a case in which TD was suppressed, but not cured, by long-term aripiprazole treatment.
This 74-year-old male patient had bipolar I disorder and had developed TD many times after several antipsychotic treatments. The lowest chlorpromazine dose equivalent among the previous antipsychotic treatments was 25 mg/day of quetiapine. His TD always improved immediately after the dosage was shifted to aripiprazole. However, his insomnia or other psychiatric symptoms worsened the first three times when the treatment was shifted to aripiprazole, making the transition a failure. Before the fourth attempt of aripiprazole transition, the patient was in a euthymic state but again developed TD under olanzapine 10 mg/day treatment. During the fourth attempt of aripiprazole transition, his TD had remained in complete remission for more than 1 year after the dosage shifted to 10 mg/day of aripiprazole. He developed TD again when we tapered the aripiprazole dose to 5 mg/day, but his TD remitted when we restored his aripiprazole dose to 10 mg/day.
Aripiprazole could be an effective drug in elderly bipolar patients with antipsychotic-induced TD while the patients are in a euthymic state. However, aripiprazole may only suppress TD rather than cure it.
阿立哌唑引起锥体外系综合征的风险较低，并且可以缓解抗精神病药物所致的迟发性运动障碍（TD）。在此，我们报告一例长期使用阿立哌唑治疗后TD得到抑制但未治愈的病例。
该74岁男性患者患有双相I型障碍，在多次抗精神病药物治疗后多次发生TD。既往抗精神病药物治疗中氯丙嗪等效剂量最低为25mg/天的喹硫平。每次换用阿立哌唑后其TD均立即改善。然而，前三次换用阿立哌唑治疗时，其失眠或其他精神症状加重，导致换药失败。在第四次尝试换用阿立哌唑之前，患者处于心境正常状态，但在每天10mg奥氮平治疗下再次出现TD。在第四次尝试换用阿立哌唑时，换用至每天10mg阿立哌唑后其TD完全缓解超过1年。当我们将阿立哌唑剂量减至5mg/天时他再次出现TD，但当我们将阿立哌唑剂量恢复至10mg/天时其TD又缓解了。
对于处于心境正常状态的老年双相障碍且有抗精神病药物所致TD的患者，阿立哌唑可能是一种有效的药物。然而，阿立哌唑可能仅能抑制TD而非治愈它。
