Gourzis Philippos, Skokou Maria, Soubasi Evanthia, Katrivanou Aggeliki, Polychronopoulos Panagiotis
*Department of Psychiatry, †Department of Psychiatry, and ‡Department of Neurology, General University Hospital of Patras, School of Medicine, University of Patras, Rio, Greece.
Clin Neuropharmacol. 2015 Jul-Aug;38(4):121-6. doi: 10.1097/WNF.0000000000000086.
Tardive dystonia is a serious extrapyramidal side effect emerging after long-term treatment with antipsychotics, frequently with a deteriorating course, and unsatisfactory treatment. Presently, clozapine is used for the cotreatment of tardive dystonia and psychosis, at the cost of serious side effects. Apart from clozapine, there have been case reports describing positive effects of quetiapine on dystonic symptoms. Aim of the present study was to demonstrate the ameliorating effects of quetiapine on dystonic symptoms, in a sample of patients suffering from antipsychotic-induced tardive dystonia.
Quetiapine was administered to 16 consecutively enrolled stabilized patients with psychotic or mood disorders and tardive dystonia, replacing the "offending drugs," over a 3-month cross-tapering period. Target dose of quetiapine was set according to the defined daily dose of the received antipsychotic(s) at baseline, as reviewed by the World Health Organization Center of Drug Statistics Methodology, aiming at both maintenance of psychosis control and reduction of dystonic symptoms.
Patients were found to have significant positive results in amelioration of dystonia (P < 0.001) over a 1-year period, without loss of antipsychotic efficacy. Reduction of dystonic symptoms with the use of quetiapine could be considered comparable with the positive effects of clozapine, with the additional advantage of relatively lacking serious side effects.
Quetiapine may represent a valuable therapeutic choice for the treatment of tardive dystonia.
迟发性肌张力障碍是长期使用抗精神病药物后出现的一种严重锥体外系副作用，病程常呈恶化趋势，治疗效果不理想。目前，氯氮平用于迟发性肌张力障碍和精神病的联合治疗，但存在严重副作用。除氯氮平外，有病例报告描述了喹硫平对肌张力障碍症状有积极作用。本研究的目的是在一组抗精神病药物所致迟发性肌张力障碍患者中，证明喹硫平对肌张力障碍症状的改善作用。
对16例连续入组的患有精神病性或心境障碍及迟发性肌张力障碍的稳定患者给予喹硫平，在3个月的交叉减量期内替代“致病药物”。根据世界卫生组织药物统计方法中心审查的基线时所接受抗精神病药物的规定日剂量设定喹硫平的目标剂量，旨在维持精神病症状的控制并减轻肌张力障碍症状。
在1年期间，患者的肌张力障碍改善有显著阳性结果（P<0.001），且抗精神病疗效未丧失。使用喹硫平减轻肌张力障碍症状的效果可认为与氯氮平的积极作用相当，且具有相对缺乏严重副作用的额外优势。
喹硫平可能是治疗迟发性肌张力障碍的一种有价值的治疗选择。
