Sangroula Dinesh, Virk Inderpreet, Mohammad Wali, Kahn David A
SANGROULA: Psychiatry Department, Jamaica Hospital Medical Center, Jamaica, NY VIRK: Interfaith Medical Center, Brooklyn, NY MOHAMMAD: Montefiore Medical Center, Bronx, NY KAHN: Columbia University College of Physicians and Surgeons, New York, NY.
J Psychiatr Pract. 2017 Jan;23(1):53-59. doi: 10.1097/PRA.0000000000000203.
Tardive dyskinesias (TD) are serious, often irreversible side effects of dopamine blocking agents, most commonly first-generation antipsychotics. No definitive treatment exists, with different interventions showing inconsistent results. We report a case of TD presenting after 12 years of olanzapine therapy in a 66-year-old Hispanic male with paranoid schizophrenia. The TD symptoms were successfully treated within a few weeks by switching to clozapine. Two cases of olanzapine-induced TD treated with clozapine have previously been reported, but in those cases, the symptom onset was quicker, ranging from a few months to a few years after initiation of olanzapine therapy, and the treatment response was relatively slower. Clinicians should carefully monitor for symptoms of TD after prolonged treatment with olanzapine and other antipsychotics. If otherwise indicated for psychiatric treatment, clozapine can be considered a good choice for patients with TD in preventing or reversing the debilitating consequences of this condition.
迟发性运动障碍（TD）是多巴胺阻滞剂的严重且通常不可逆的副作用，最常见于第一代抗精神病药物。目前尚无确切的治疗方法，不同的干预措施效果不一。我们报告一例66岁患有偏执型精神分裂症的西班牙裔男性，在接受奥氮平治疗12年后出现迟发性运动障碍。通过换用氯氮平，迟发性运动障碍症状在几周内得到成功治疗。此前曾报道过两例用氯氮平治疗奥氮平所致迟发性运动障碍的病例，但在那些病例中，症状出现更快，在奥氮平治疗开始后的几个月至几年内，且治疗反应相对较慢。临床医生在用奥氮平和其他抗精神病药物长期治疗后应仔细监测迟发性运动障碍的症状。如果因其他原因需要进行精神科治疗，氯氮平可被视为预防或逆转迟发性运动障碍这种致残后果的患者的良好选择。
