Friedman Joseph H
Continuum (Minneap Minn). 2019 Aug;25(4):1081-1098. doi: 10.1212/CON.0000000000000754.
This article reviews the history, nosology, clinical features, epidemiology, and treatment of tardive syndromes.
The major advance in the field of tardive syndromes has been the development and US Food and Drug Administration (FDA) approval of two vesicular monoamine transporter type 2 inhibitors, valbenazine and deutetrabenazine, for treating tardive syndromes. These medications are derivatives of tetrabenazine and reduce dyskinetic movements by reducing dopamine stimulation. Treatment is not curative, and the medications reduce, or "mask," symptoms but presumably without adding to the long-term risk of increased involuntary movements believed to accrue from suppressive treatment with dopamine receptor-blocking drugs. A confounding advance has been the accumulation of data finding that second-generation antipsychotics, also known as atypical antipsychotics, may not be safer than first-generation antipsychotics in causing tardive syndromes. The public health risk of tardive syndromes may actually have increased as some second-generation antipsychotics, widely promoted to both doctors and patients, are increasingly used as antidepressants.
Tardive syndromes remain a public health risk. Second-generation antipsychotics have not been proven to have less risk than first-generation drugs in causing tardive syndromes and are nevertheless being used more widely to treat depression, bipolar disease, and insomnia. Symptomatic treatment for tardive syndromes is available, although expensive.
本文回顾迟发性综合征的历史、疾病分类学、临床特征、流行病学及治疗方法。
迟发性综合征领域的主要进展是两种囊泡单胺转运体2抑制剂——缬苯那嗪和氘代丁苯那嗪的研发及美国食品药品监督管理局（FDA）批准其用于治疗迟发性综合征。这些药物是丁苯那嗪的衍生物，通过减少多巴胺刺激来减轻运动障碍。治疗并非治愈性的，这些药物可减轻或“掩盖”症状，但据推测不会增加因多巴胺受体阻断药物抑制治疗而产生的长期不自主运动风险。一个令人困惑的进展是，有数据表明第二代抗精神病药物（也称为非典型抗精神病药物）在导致迟发性综合征方面可能并不比第一代抗精神病药物更安全。由于一些被广泛向医生和患者推广的第二代抗精神病药物越来越多地被用作抗抑郁药，迟发性综合征的公共卫生风险实际上可能已经增加。
迟发性综合征仍然是一种公共卫生风险。第二代抗精神病药物在导致迟发性综合征方面尚未被证明比第一代药物风险更低，但仍被更广泛地用于治疗抑郁症、双相情感障碍和失眠。尽管价格昂贵，但迟发性综合征有对症治疗方法。
