运动障碍与慢性精神病：五件新事。
Movement disorders and chronic psychosis: Five new things.
作者信息
Martino Davide, Morgante Francesca
机构信息
Movement Disorders Program (DM), Department of Clinical Neurosciences, University of Calgary, Canada; Department of Clinical and Experimental Medicine (FM), University of Messina, Italy; and Institute of Molecular and Clinical Sciences (FM), St George's University of London, UK.
出版信息
Neurol Clin Pract. 2017 Apr;7(2):163-169. doi: 10.1212/CPJ.0000000000000344.
PURPOSE OF REVIEW
To discuss selected peer-reviewed research articles published between 2014 and 2016 and highlight 5 clinically relevant messages related to hyperkinetic and hypokinetic movement disorders in patients with chronic psychosis.
RECENT FINDINGS
A recent population-based study complemented data from clinical trials in showing increased risk of developing extrapyramidal symptoms with antipsychotic use. A community service-based longitudinal study showed that dopamine transporter imaging could help identify subgroups of patients with parkinsonism associated with antipsychotics with a progressive course, potentially manageable with l-dopa. Data from recent noteworthy clinical trials showed that a new VMAT-2 inhibitor and, for pharmacologically refractory tardive dyskinesia, deep brain stimulation of the globus pallidus internus are promising interventions. Finally, a population-based study has confirmed that hyperkinesias (encompassing chorea, dystonia, and stereotypies) may be early predictors of psychosis even in childhood and adolescence.
SUMMARY
Movement disorders associated with new-generation antipsychotics, including widely used agents (e.g., aripiprazole), are not rare occurrences. Better monitoring is needed to assess their true effect on patients' quality of life and functioning and to prevent underascertainment.
综述目的
讨论2014年至2016年间发表的经过同行评审的精选研究文章，并强调与慢性精神病患者运动亢进和运动减退性运动障碍相关的5条临床相关信息。
最新发现
最近一项基于人群的研究补充了临床试验数据，表明使用抗精神病药物会增加锥体外系症状的发生风险。一项基于社区服务的纵向研究表明，多巴胺转运体成像有助于识别与抗精神病药物相关的帕金森症患者亚组，这些患者病程呈进行性，可能可用左旋多巴治疗。近期值得关注的临床试验数据表明，一种新型囊泡单胺转运体2（VMAT-2）抑制剂以及针对药物难治性迟发性运动障碍的内侧苍白球深部脑刺激是有前景的干预措施。最后，一项基于人群的研究证实，运动亢进（包括舞蹈症、肌张力障碍和刻板动作）甚至在儿童和青少年时期也可能是精神病的早期预测指标。
总结
与新一代抗精神病药物（包括广泛使用的药物，如阿立哌唑）相关的运动障碍并不罕见。需要更好地进行监测，以评估它们对患者生活质量和功能的真正影响，并防止漏诊。
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