Optum, Boston, Massachusetts, United States of America.
Teva Pharmaceuticals, Frazer, Pennsylvania, United States of America.
PLoS One. 2019 Jun 4;14(6):e0216044. doi: 10.1371/journal.pone.0216044. eCollection 2019.
Tardive dyskinesia (TD) is a movement disorder resulting from treatment with typical and atypical antipsychotics. An estimated 16-50% of patients treated with antipsychotics have TD, but this number may be underestimated. The objectives of this study were to build an algorithm for use in electronic health records (EHRs) for the detection and characterization of TD patients, and to estimate the prevalence of TD in a population of patients exposed to antipsychotic medications.
This retrospective observational study included patients identified in the Optum EHR Database who received a new or refill prescription for an antipsychotic medication between January 2011 and December 2015 (follow-up through June 2016). TD mentions were identified in the natural language-processed clinical notes, and an algorithm was built to classify the likelihood that the mention represented documentation of a TD diagnosis as probable, possible, unlikely, or negative. The final TD population comprised a subgroup identified using this algorithm, with ≥1 probable TD mention (highly likely TD).
164,417 patients were identified for the antipsychotic population, with1,314 comprising the final TD population. Conservatively, the estimated average annual prevalence of TD in patients receiving antipsychotics was 0.8% of the antipsychotic user population. The average annual prevalence may be as high as 1.9% per antipsychotic user per year, allowing for a more-inclusive algorithm using both probable and possible TD. Most TD patients were prescribed atypical antipsychotics (1049/1314, 79.8%). Schizophrenia (601/1314, 45.7%), and paranoid and schizophrenia-like disorders (277/1314, 21.1%) were more prevalent in the TD population compared with the entire antipsychotic drug cohort (13,308/164,417; 8.1% and 19,359/164,417; 11.8%, respectively).
Despite a lower TD prevalence than previously estimated and the predominant use of atypical antipsychotics, identified TD patients appear to have a substantial comorbidity burden that requires special treatment and management consideration.
迟发性运动障碍（TD）是一种由典型和非典型抗精神病药物治疗引起的运动障碍。估计有 16-50%接受抗精神病药物治疗的患者患有 TD，但这个数字可能被低估了。本研究的目的是建立一种用于电子健康记录（EHR）的算法，用于检测和描述 TD 患者，并估计暴露于抗精神病药物的患者群体中 TD 的患病率。
这项回顾性观察性研究包括在 Optum EHR 数据库中确定的患者，他们在 2011 年 1 月至 2015 年 12 月期间（随访至 2016 年 6 月）接受了新的或续开的抗精神病药物处方。在自然语言处理的临床记录中识别出 TD 提及，并建立了一个算法来分类提及代表 TD 诊断文档的可能性为可能、可能、不太可能或否定。最终的 TD 人群由使用该算法确定的一个亚组组成，至少有 1 个可能的 TD 提及（高度可能的 TD）。
确定了 164417 名抗精神病药物患者作为抗精神病药物人群，其中 1314 名患者构成最终的 TD 人群。保守估计，接受抗精神病药物治疗的患者中 TD 的平均年患病率为抗精神病药物使用者人群的 0.8%。平均年患病率可能高达每年每个抗精神病药物使用者 1.9%，允许使用更具包容性的算法，同时使用可能和可能的 TD。大多数 TD 患者被开了非典型抗精神病药物（1049/1314，79.8%）。与整个抗精神病药物队列相比，TD 人群中精神分裂症（601/1314，45.7%）和偏执和精神分裂样障碍（277/1314，21.1%）更为常见（13，308/164417；8.1%和 19，359/164417；11.8%）。
尽管 TD 的患病率低于之前估计，且主要使用非典型抗精神病药物，但确定的 TD 患者似乎有相当大的合并症负担，需要特殊的治疗和管理考虑。
