University of Padua, Neuroscience Department, Psychiatry Unit, Padua, Italy; University Hospital of Padua, Azienda Ospedaliera di Padova, Psychiatry Unit, Padua, Italy.
University Hospital of Padua, Azienda Ospedaliera di Padova, Psychiatry Unit, Padua, Italy.
J Neurol Sci. 2018 Jun 15;389:21-27. doi: 10.1016/j.jns.2018.02.012. Epub 2018 Feb 5.
Tardive dyskinesia (TD) is a severe condition that can affect almost 1 out of 4 patients on current or previous antipsychotic treatment, including both first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs). While two novel vesicular monoamine transporter inhibitors, deutetrabenazine and valbenazine, have shown acute efficacy for TD, the majority of patients do not remit, and TD appears to recur once treatment is withdrawn. Hence, prevention of TD remains a crucial goal.
We provide a clinically oriented overview of risk factors for TD, dividing them into patient-, illness- and treatment-related variables, as well as nonmodifiable and modifiable factors.
Unmodifiable patient-related and illness-related risk factors for TD include older age, female sex, white and African descent, longer illness duration, intellectual disability and brain damage, negative symptoms in schizophrenia, mood disorders, cognitive symptoms in mood disorders, and gene polymorphisms involving antipsychotic metabolism and dopamine functioning. Modifiable comorbidity-related and treatment-related factors include diabetes, smoking, and alcohol and substance abuse, FGA vs SGA treatment, higher cumulative and current antipsychotic dose or antipsychotic plasma levels, early parkinsonian side effects, anticholinergic co-treatment, akathisia, and emergent dyskinesia.
Clinicians using dopamine antagonists need to consider risk factors for TD to minimize TD and its consequences.
迟发性运动障碍（TD）是一种严重的病症，在当前或之前接受抗精神病药物治疗的患者中，近 1/4 可能受到影响，包括第一代抗精神病药物（FGAs）和第二代抗精神病药物（SGAs）。虽然两种新型囊泡单胺转运体抑制剂——哌甲酯和丙戊酸钠对 TD 具有急性疗效，但大多数患者并未缓解，且一旦停止治疗，TD 似乎会再次出现。因此，预防 TD 仍然是一个关键目标。
我们提供了一个与临床相关的 TD 风险因素概述，将其分为患者、疾病和治疗相关的变量，以及不可变和可改变的因素。
TD 的不可变患者相关和疾病相关风险因素包括年龄较大、女性、白人和非裔、更长的疾病持续时间、智力障碍和脑损伤、精神分裂症的阴性症状、心境障碍、心境障碍的认知症状，以及涉及抗精神病药物代谢和多巴胺功能的基因多态性。可改变的合并症相关和治疗相关因素包括糖尿病、吸烟、酒精和物质滥用、FGA 与 SGA 治疗、更高的累积和当前抗精神病药物剂量或抗精神病药物血浆水平、早期帕金森副作用、抗胆碱能药物联合治疗、静坐不能和急性运动障碍。
使用多巴胺拮抗剂的临床医生需要考虑 TD 的风险因素，以尽量减少 TD 及其后果。
