Barnes T R
Department of Psychiatry, Charing Cross and Westminster Medical School, Epsom, Surrey.
Psychiatr Dev. 1987 Winter;5(4):301-19.
Motor disturbance is a major disadvantage of the antipsychotic drugs currently available for the treatment of schizophrenia. Acute akathisia is a dose-related side-effect comprising a subjective awareness of inner tension and characteristic patterns of restless movement. The natural history of akathisia is unclear, and several variants of the condition are seen in older patients on maintenance antipsychotic medication. These include acute akathisia that has persisted, and tardive akathisia which tends to be associated with signs of tardive dyskinesia. Tardive akathisia and tardive dyskinesia share some pharmacological characteristics which raises the possibility that common elements of pathophysiology underlie the 2 conditions. Tardive dyskinesia, comprising oro-facial dyskinesia and choreiform trunk and limb movements, has come to symbolize the complications of long-term antipsychotic drug treatment, although the condition is often little more than a mild social handicap and is manifest in only a minority of patients receiving such treatment. This paper discusses the treatment and patient variables that may be considered as risk factors for tardive dyskinesia. Some of the inconsistencies in the relevant literature may be explained by a speculative sub-classification of tardive dyskinesia into early and late forms. The interaction of advancing age, drug treatment and the schizophrenic disease process in the development of late dyskinesia is discussed.
运动障碍是目前可用于治疗精神分裂症的抗精神病药物的一个主要缺点。急性静坐不能是一种与剂量相关的副作用，包括内心紧张的主观意识和不安运动的特征模式。静坐不能的自然病程尚不清楚，在接受维持性抗精神病药物治疗的老年患者中可见到该病症的几种变体。这些包括持续存在的急性静坐不能，以及往往与迟发性运动障碍体征相关的迟发性静坐不能。迟发性静坐不能和迟发性运动障碍具有一些药理学特征，这增加了两种病症存在共同病理生理学因素的可能性。迟发性运动障碍包括口面部运动障碍以及躯干和肢体的舞蹈样动作，已成为长期抗精神病药物治疗并发症的象征，尽管该病症通常只不过是一种轻微的社会障碍，且仅在少数接受此类治疗的患者中表现出来。本文讨论了可能被视为迟发性运动障碍危险因素的治疗和患者变量。相关文献中的一些不一致之处可能可以通过将迟发性运动障碍推测性地分为早期和晚期形式来解释。本文还讨论了年龄增长、药物治疗和精神分裂症病程在迟发性运动障碍发生发展中的相互作用。
