1 Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, UK.
2 Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Can J Psychiatry. 2019 Jun;64(6):388-399. doi: 10.1177/0706743719828968. Epub 2019 Feb 21.
Tardive dyskinesia is a movement disorder characterised by irregular, stereotyped, and choreiform movements associated with the use of antipsychotic medication. We aim to provide recommendations on the treatment of tardive dyskinesia.
We performed a systematic review of studies of the treatment of tardive dyskinesia. Studies were rated for methodological quality using the American Academy of Neurology Risk of Bias Classification system. Overall level of evidence classifications and grades of recommendation were made using the Scottish Intercollegiate Guidelines Network framework.
Preventing tardive dyskinesia is of primary importance, and clinicians should follow best practice for prescribing antipsychotic medication, including limiting the prescription for specific indications, using the minimum effective dose, and minimising the duration of therapy. The first-line management of tardive dyskinesia is the withdrawal of antipsychotic medication if clinically feasible. Yet, for many patients with serious mental illness, the discontinuation of antipsychotics is not possible due to disease relapse. Switching from a first-generation to a second-generation antipsychotic with a lower D2 affinity, such as clozapine or quetiapine, may be effective in reducing tardive dyskinesia symptoms. The strongest evidence for a suitable co-intervention to treat tardive dyskinesia comes from tests with the new VMAT inhibitors, deutetrabenazine and valbenazine. These medications have not been approved for use in Canada.
Data on tardive dyskinesia treatment are limited, and the best management strategy remains prevention. More long-term safety and efficacy data are needed for deutetrabenazine and valbenazine, and their routine availability to patients outside of the USA remains in question.
迟发性运动障碍是一种运动障碍，其特征是与抗精神病药物使用相关的不规则、刻板和舞蹈样运动。我们旨在提供迟发性运动障碍治疗的建议。
我们对迟发性运动障碍治疗的研究进行了系统回顾。使用美国神经病学学会风险偏倚分类系统对研究进行了方法学质量评估。使用苏格兰校际指南网络框架进行了总体证据水平分类和推荐等级的制定。
预防迟发性运动障碍至关重要，临床医生应遵循抗精神病药物处方的最佳实践，包括限制特定适应症的处方、使用最小有效剂量和尽量缩短治疗时间。如果临床上可行，迟发性运动障碍的一线治疗是停用抗精神病药物。然而，对于许多患有严重精神疾病的患者，由于疾病复发，停用抗精神病药物是不可能的。从第一代抗精神病药切换到第二代抗精神病药，与较低的 D2 亲和力，如氯氮平或喹硫平，可能有效减轻迟发性运动障碍症状。最适合治疗迟发性运动障碍的共干预措施的证据来自于新型 VMAT 抑制剂，即丁苯那嗪和苯丁胺的测试。这些药物尚未在加拿大获得批准使用。
迟发性运动障碍治疗的数据有限，最佳管理策略仍然是预防。丁苯那嗪和苯丁胺需要更多的长期安全性和疗效数据，它们在加拿大以外的患者中常规使用仍存在疑问。
