Pieters Lydia E, Bakker P Roberto, van Harten Peter N
Faculty of Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Psychiatric Center GGz Centraal, Amersfoort, Netherlands.
Front Psychiatry. 2018 Feb 5;9:18. doi: 10.3389/fpsyt.2018.00018. eCollection 2018.
Drug-induced parkinsonism (DIP) is the most common movement disorder induced by antipsychotics. Although DIP is mostly symmetric, asymmetric DIP is reported in a substantial part of the patients. We investigated the frequency of motor asymmetry in DIP and its relationship to the severity of psychopathology in long-stay psychiatric patients.
We obtained data from a cohort study of 207 long-stay psychiatric patients on the frequency and risk factors of tardive dyskinesia, akathisia, tardive dystonia, and DIP. From July 2003 to May 2007 (mean follow-up, 1.1 year) drug-induced movement disorders were assessed at least two times in each patient, with a frequency of persistent DIP of 56.2%. All patients who had at least one time parkinsonism in the upper/lower limb(s) were included for analyses (190 patients, 79 women; mean age, 48.0 ± 12.9 years). The Unified Parkinson Disease Rating Scale motor scale was used to calculate the frequency of asymmetric parkinsonism. Multilevel mixed models were built to explore the relationship between asymmetry in parkinsonism and the severity of psychopathology, measured on the Clinical Global Impression-Schizophrenia scale severity index (CGI-SCH SI).
The frequency of asymmetric parkinsonism was 20.8%. Asymmetry in parkinsonism was associated with symptom severity on all CGI-SCH SI scales (β range, 0.37-3.74) and significantly associated with the positive symptom scale (β, 3.74; 95% CI, 0.35-7.31).
DIP is asymmetric in a substantial part of patients. Asymmetric presentation of DIP is of clinical relevance as it is related to the severity of psychopathology and may alert the clinician of more severe psychopathology. Future research is recommended to provide insight into the neuropsychopathology and clinical value of asymmetric parkinsonism for psychiatric patients.
药物性帕金森综合征（DIP）是抗精神病药物引起的最常见的运动障碍。尽管DIP大多为对称性，但相当一部分患者存在非对称性DIP。我们调查了长期住院精神科患者中DIP运动不对称的频率及其与精神病理学严重程度的关系。
我们从一项对207名长期住院精神科患者进行的队列研究中获取了有关迟发性运动障碍、静坐不能、迟发性肌张力障碍和DIP的频率及危险因素的数据。从2003年7月至2007年5月（平均随访1.1年），对每位患者至少进行了两次药物性运动障碍评估，持续性DIP的发生率为56.2%。纳入所有至少有一次上肢/下肢帕金森综合征的患者进行分析（190例患者，79名女性；平均年龄48.0±12.9岁）。使用统一帕金森病评定量表运动量表来计算非对称性帕金森综合征的频率。构建多水平混合模型以探讨帕金森综合征不对称性与精神病理学严重程度之间的关系，精神病理学严重程度通过临床总体印象-精神分裂症量表严重程度指数（CGI-SCH SI）进行测量。
非对称性帕金森综合征的频率为20.8%。帕金森综合征的不对称性与所有CGI-SCH SI量表上的症状严重程度相关（β范围为0.37 - 3.74），且与阳性症状量表显著相关（β为3.74；95%置信区间为0.35 - 7.31）。
相当一部分患者的DIP为非对称性。DIP的非对称性表现具有临床相关性，因为它与精神病理学严重程度相关，可能提醒临床医生注意更严重的精神病理学情况。建议未来的研究深入探讨非对称性帕金森综合征对精神科患者的神经精神病理学及临床价值。
