Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
J Dual Diagn. 2020 Apr-Jun;16(2):208-217. doi: 10.1080/15504263.2020.1714099. Epub 2020 Jan 26.
Extrapyramidal side-effects (EPSE) are frequent in patients treated with antipsychotics and comorbid substance use disorders (SUDs). Methamphetamine has been shown to act as a dopaminergic neurotoxin. We aimed to determine whether EPSE occur more often in patients with psychotic disorders and co-occurring methamphetamine (MA) use disorders, and we examined the relationship between MA use, antipsychotic type, dose and EPSE. This study was a secondary analysis of data from three separate primary studies. Across all studies, psychiatric and SUD diagnoses were determined using the SCID-I for DSM-IV. EPSE were determined using the Simpson-Angus Scale (SAS) for Parkinsonism, the Barnes Akathisia Rating scale (BARS), and the Abnormal Involuntary Movement Scale (AIMS) for tardive dyskinesia. Participants were classified as having any EPSE if they scored above the cutoff on any of the EPSE scales (SAS, BARS, AIMS). We analyzed data using multivariable logistic regression analysis. The sample included 102 patients with non-affective or affective psychotic disorders. Of the total sample, 65.7% were male, 54.9% had schizophrenia spectrum disorders, 20.5% bipolar type I disorder with psychotic features, 11.7% schizoaffective disorder and 12.7% had substance-induced psychosis. A diagnosis of a methamphetamine use disorder (abuse or dependence) was present in 25.5% of participants. EPSE occurred in 38.2% of patients and were significantly associated with MA use in the unadjusted and adjusted analysis, = 4.01, 95% CI [1.07, 14.98], = .039. Patients with MA dependence and MA use >3 years were significantly more likely to have EPSE. We found a significant interaction effect between MA use disorders and standardized antipsychotic dose on the occurrence of EPSE, = 1.01, 95% CI [1.00, 1.01], = .042, with MA users having a disproportionally higher likelihood of having EPSE compared to MA non-users as antipsychotic dosage increased. There were no significant associations of EPSE with comorbid alcohol, cannabis, or methaqualone use disorders. Patients with a MA use disorder were significantly more likely to have EPSE with evidence for a dose-response effect. Clinicians should carefully titrate antipsychotic dosage from lower to higher doses to avoid EPSE in patients with MA use disorders.
锥体外系副作用（EPS）在接受抗精神病药物治疗的患者中很常见，且这些患者常伴有共病物质使用障碍（SUD）。已证实安非他命会对多巴胺能神经产生毒性作用。我们旨在确定患有精神病障碍和共病安非他命（MA）使用障碍的患者是否更常出现 EPS，我们还检查了 MA 使用、抗精神病药物类型、剂量与 EPS 之间的关系。本研究是对三项独立的初步研究数据的二次分析。在所有研究中，使用DSM-IV 的 SCID-I 确定精神和 SUD 诊断。使用 Simpson-Angus 量表（SAS）评估帕金森病，Barnes 静坐不能评定量表（BARS）和迟发性运动障碍的异常不自主运动量表（AIMS）评估 EPS。如果任何 EPS 量表（SAS、BARS、AIMS）的评分超过临界值，则将参与者归类为有任何 EPS。我们使用多变量逻辑回归分析来分析数据。该样本包括 102 名非情感或情感性精神病患者。在总样本中，65.7%为男性，54.9%患有精神分裂症谱系障碍，20.5%患有伴有精神病特征的 I 型双相情感障碍，11.7%患有分裂情感障碍，12.7%患有物质诱发的精神病。25.5%的参与者有 MA 使用障碍（滥用或依赖）的诊断。38.2%的患者出现 EPS，且在未调整和调整后的分析中，与 MA 使用显著相关， = 4.01，95%CI [1.07, 14.98]， = .039。MA 依赖和 MA 使用>3 年的患者出现 EPS 的可能性显著更高。我们发现 MA 使用障碍和标准化抗精神病药物剂量之间存在显著的交互效应， = 1.01，95%CI [1.00, 1.01]， = .042，MA 使用者与 MA 非使用者相比，随着抗精神病药物剂量的增加，出现 EPS 的可能性不成比例地更高。EPS 与共病酒精、大麻或甲喹酮使用障碍之间无显著关联。有 MA 使用障碍的患者更有可能出现 EPS，且存在剂量反应关系。临床医生应仔细从低剂量滴定抗精神病药物剂量，以避免 MA 使用障碍患者出现 EPS。
