Walther Sebastian, Stegmayer Katharina
1 Universitätsklinik für Psychiatrie und Psychotherapie, Bern.
Ther Umsch. 2018 Jun;75(1):31-36. doi: 10.1024/0040-5930/a000963.
Diagnosis and treatment of motor phenomena in schizophrenia spectrum disorders Abstract. Motor abnormalities are intrinsic features of schizophrenia spectrum disorders. They may be spontaneous or antipsychotic drug-induced. The four most important symptom groups are abnormal involuntary movements or dyskinesia, Parkinsonism, catatonia and neurological soft signs. In addition, there are further motor abnormalities, which are less frequent and less operationalized. The suspected etiology of motor abnormalities is strongly associated with altered neurodevelopment. Delayed maturation in conjunction with environmental insults may give further rise to motor symptoms. For the four most relevant motor abnormalities clinical examination procedures and rating scales are available, aiding clinicians in both screening and evaluation of symptom severity. Besides these currently instrumental measures are being tested for wide spread and easy application. Treatment of motor abnormalities is necessary according to subjective well-being. Treatment options are few and remain symptomatic. The most important strategy is critical evaluation of antispychotic pharmacotherapy. Benefitial effects on motor phenomena have been noted with clozapine. Currently, specific substances against tardive dyskinesia and non-invasive brain stimulation techniques are being evaluated. However, the effeciacy of these approaches will only be available in the near future.
精神分裂症谱系障碍中运动现象的诊断与治疗 摘要。运动异常是精神分裂症谱系障碍的内在特征。它们可能是自发的,也可能是抗精神病药物引起的。四个最重要的症状组是异常不自主运动或运动障碍、帕金森症、紧张症和神经学软体征。此外,还有其他运动异常,其出现频率较低且较少被操作化。运动异常的疑似病因与神经发育改变密切相关。发育延迟加上环境损伤可能进一步引发运动症状。对于四种最相关的运动异常,有临床检查程序和评定量表可供使用,有助于临床医生进行症状严重程度的筛查和评估。除了这些,目前正在测试一些易于广泛应用的工具性措施。根据主观幸福感,对运动异常进行治疗是必要的。治疗选择有限,且仍为对症治疗。最重要的策略是对抗精神病药物治疗进行批判性评估。氯氮平对运动现象有有益作用。目前,正在评估针对迟发性运动障碍的特定物质和非侵入性脑刺激技术。然而,这些方法的疗效在不久的将来才会显现。