抗精神病药物所致静坐不能的评估与治疗
The Assessment and Treatment of Antipsychotic-Induced Akathisia.
作者信息
Pringsheim Tamara, Gardner David, Addington Donald, Martino Davide, Morgante Francesca, Ricciardi Lucia, Poole Norman, Remington Gary, Edwards Mark, Carson Alan, Barnes Thomas R E
机构信息
Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Department of Psychiatry and Pharmacy, Dalhousie University, Halifax, NS, Canada.
出版信息
Can J Psychiatry. 2018 Nov;63(11):719-729. doi: 10.1177/0706743718760288. Epub 2018 Apr 23.
BACKGROUND
Akathisia is a common and distressing neuropsychiatric syndrome associated with antipsychotic medication, characterised by subjective and objective psychomotor restlessness. The goal of this guideline is to provide clinicians with recommendations on the assessment and treatment of akathisia.
METHODS
We performed a systematic review of therapeutic studies assessing the treatment of antipsychotic-induced extrapyramidal symptoms. Forty studies on akathisia and 4 systematic reviews evaluating the adverse effects of antipsychotics were used in the formulation of recommendations. Studies were rated for methodological quality using the American Academy of Neurology Risk of Bias Classification system. The overall level of evidence classifications and grades of recommendation were made using the Scottish Intercollegiate Guidelines Network framework.
RESULTS
As a good practice point, clinicians should systematically assess akathisia with a validated scale before starting antipsychotics and during antipsychotic dosage titration. For the management of akathisia, there was adequate evidence to allow recommendations regarding antipsychotic dose reduction, antipsychotic polypharmacy, switching antipsychotic medication, and the use of adjuvant medications including beta-blockers, anticholinergics, 5HT antagonists, benzodiazepines, and vitamin B6.
CONCLUSION
The treatment of antipsychotic-induced akathisia should be personalised, with consideration of antipsychotic dose reduction, cessation of antipsychotic polypharmacy, and switching to an antipsychotic with a perceived lower liability for akathisia, before the use of adjuvant medications. The choice of adjuvant medications should favour the more established treatments, with careful consideration of contraindications and side effects. Limitations in the evidence should be acknowledged and prompt cautious prescribing, particularly with respect to the duration of use of adjuvant medications, is warranted.
背景
静坐不能是一种常见且令人痛苦的神经精神综合征，与抗精神病药物有关，其特征为主观和客观的精神运动性不安。本指南的目的是为临床医生提供关于静坐不能评估和治疗的建议。
方法
我们对评估抗精神病药物所致锥体外系症状治疗的研究进行了系统评价。在制定建议时使用了40项关于静坐不能的研究和4项评估抗精神病药物不良反应的系统评价。使用美国神经病学学会偏倚风险分类系统对研究的方法学质量进行评分。证据分类的总体水平和推荐等级采用苏格兰校际指南网络框架确定。
结果
作为一个良好实践要点，临床医生应在开始使用抗精神病药物前以及抗精神病药物剂量滴定期间，使用经过验证的量表系统评估静坐不能。对于静坐不能的管理，有充分证据支持就降低抗精神病药物剂量、联合使用抗精神病药物、更换抗精神病药物以及使用辅助药物（包括β受体阻滞剂、抗胆碱能药物、5-羟色胺拮抗剂、苯二氮䓬类药物和维生素B6）提出建议。
结论
抗精神病药物所致静坐不能的治疗应个体化，在使用辅助药物之前，应考虑降低抗精神病药物剂量、停止联合使用抗精神病药物以及换用被认为导致静坐不能可能性较低的抗精神病药物。辅助药物的选择应优先考虑更成熟的治疗方法，并仔细考虑禁忌证和副作用。应认识到证据中的局限性，并谨慎开药，特别是对于辅助药物的使用时长，这是有必要的。
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