Chan Chia-Hsiang, Chan Hung-Yu, Chen Yen-Ching
Department of Psychiatry, Taoyuan Psychiatric Center.
Department of Psychology, Chung Yuan Christian University, Taoyuan.
Int Clin Psychopharmacol. 2018 May;33(3):155-162. doi: 10.1097/YIC.0000000000000208.
Aripiprazole is a second-generation antipsychotics, acting as a partial dopamine D2 receptor agonist. Previous studies on aripiprazole for tardive dyskinesia (TD) treatment were limited and inconclusive. This study was aimed to examine the effectiveness of aripiprazole in psychotic patients with a pre-existing TD. This was an open-label 24-week prospective cohort study conducted in a public mental hospital in Northern Taiwan from January 2009 to February 2010. Psychotic patients were cross-titrated of prior antipsychotics with aripiprazole, and the severity of TD was assessed at baseline and at weeks 2, 4, 8, 12, 16, 20, and 24. The primary study outcome was the change of TD severity, assessed by Abnormal Involuntary Movement Scale (AIMS) total score. Responder was defined as the reduction of AIMS total scores of no less than 50% from baseline to the study endpoint (24 weeks). Thirty psychotic patients with neuroleptic-induced TD were recruited. The AIMS total scores significantly decreased from baseline to the study endpoint (-7.17±5.55). The significant decrease of AIMS total scores started at week 2 (P<0.0001), and the change remained significant throughout the entire study period (P<0.0001). A greater severity of TD (adjusted odds ratio: 1.35, 95% confidence interval: 1.04-1.76, P=0.03) or a lower severity of parkinsonism (adjusted odds ratio: 0.78, 95% confidence interval: 0.61-0.99, P=0.04) at baseline was significantly associated with treatment responders. Our findings implicated that aripiprazole can be a promising treatment for clinicians considering drug switch in psychotic patients with TD. Further large randomized, controlled trials are warranted to confirm our findings.
阿立哌唑是一种第二代抗精神病药物，作为一种部分多巴胺D2受体激动剂发挥作用。先前关于阿立哌唑治疗迟发性运动障碍（TD）的研究有限且结论不明确。本研究旨在检验阿立哌唑对已有TD的精神病患者的有效性。这是一项于2009年1月至2010年2月在台湾北部一家公立精神病院进行的开放标签、为期24周的前瞻性队列研究。将精神病患者先前使用的抗精神病药物与阿立哌唑进行交叉滴定，并在基线以及第2、4、8、12、16、20和24周评估TD的严重程度。主要研究结局是TD严重程度的变化，通过异常不自主运动量表（AIMS）总分进行评估。反应者定义为从基线到研究终点（24周）AIMS总分降低不少于50%。招募了30例患有抗精神病药物所致TD的精神病患者。从基线到研究终点，AIMS总分显著降低（-7.17±5.55）。AIMS总分从第2周开始显著降低（P<0.0001），并且在整个研究期间变化均保持显著（P<0.0001）。基线时TD严重程度较高（调整比值比：1.35，95%置信区间：1.04 - 1.76，P = 0.03）或帕金森症严重程度较低（调整比值比：0.78，95%置信区间：0.61 - 0.99，P = 0.04）与治疗反应者显著相关。我们的研究结果表明，对于考虑在患有TD的精神病患者中换药的临床医生而言，阿立哌唑可能是一种有前景的治疗方法。需要进一步进行大规模随机对照试验来证实我们的研究结果。
