Corporal Michael J. Crescenz Veterans Affairs Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104.
Corporal Michael J. Crescenz Veterans Affairs Medical Center and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
J Clin Psychiatry. 2020 Jan 28;81(2):19cs12983. doi: 10.4088/JCP.19cs12983.
A nominal group process followed by a modified Delphi method was used to survey expert opinions on best practices for tardive dyskinesia (TD) screening, diagnosis, and treatment and to identify areas lacking in clinical evidence.
A steering committee of 11 TD experts met in nominal group format to prioritize questions to be addressed and identify core bibliographic materials and criteria for survey panelists. Of 60 invited experts, 29 (23 psychiatrists and 6 neurologists) agreed to participate.
A targeted literature search of PubMed (search term: tardive dyskinesia) and recommendations of the steering committee were used to generate core bibliographic material. Inclusion criteria were as follows: (1) review articles, meta-analyses, guidelines, or clinical trials; (2) publication in English between 2007 and 2017; (3) > 3 pages in length; and (4) publication in key clinical journals with impact factors ≥ 2.0. Of 29 references that met these criteria, 18 achieved a score ≥ 5 (calculated as the number of steering committee votes multiplied by journal impact factor and number of citations divided by years since publication) and were included.
Two survey rounds were conducted anonymously through electronic media from November 2017 to January 2018; responses were collected, collated, and analyzed. Respondent agreement was defined a priori as unanimous (100%), consensus (75%-99%), or majority (50%-74%). For questions using a 5-point Likert scale, agreement was based on percentage of respondents choosing ≥ 4 ("agree completely" or "agree"). Round 1 survey included questions on TD screening, diagnosis, and treatment. Round 2 questions were refined per panelist feedback and excluded Round 1 questions with < 25% agreement and > 75% agreement (unless feedback suggested further investigation).
Consensus was reached that (1) a brief, clinical assessment for TD should be performed at every clinical encounter in patients taking antipsychotics; (2) even mild movements in 1 body area may represent possible TD; (3) management requires an overall evaluation of treatment, including reassessment of antipsychotics and anticholinergics as well as consideration of vesicular monoamine transporter 2 (VMAT2) inhibitors; and (4) informed discussions with patients/caregivers are essential.
采用名义群体法和改良 Delphi 法调查专家对迟发性运动障碍（TD）筛查、诊断和治疗最佳实践的意见，并确定临床证据不足的领域。
一个由 11 名 TD 专家组成的指导委员会以名义群体的形式开会，确定需要解决的问题的优先级，并确定调查小组成员的核心文献资料和标准。在 60 名受邀专家中，有 29 名（23 名精神科医生和 6 名神经科医生）同意参与。
对 PubMed 的针对性文献检索（搜索词：迟发性运动障碍）和指导委员会的建议用于生成核心文献资料。纳入标准如下：（1）综述文章、荟萃分析、指南或临床试验；（2）2007 年至 2017 年期间以英文发表；（3）长度超过 3 页；（4）在影响因子≥2.0 的主要临床期刊上发表。符合这些标准的 29 篇参考文献中，有 18 篇得分≥5（计算方法为指导委员会投票数乘以期刊影响因子和引用数除以发表年限），被纳入研究。
2017 年 11 月至 2018 年 1 月，通过电子媒体匿名进行了两轮调查；收集、整理和分析了答复。事先定义了应答者的一致性为一致（100%）、共识（75%-99%）或多数（50%-74%）。对于使用 5 分李克特量表的问题，一致性基于选择≥4（“完全同意”或“同意”）的应答者的百分比。第一轮调查包括关于 TD 筛查、诊断和治疗的问题。根据小组成员的反馈，第二轮问题进行了细化，并排除了第一轮中<25%的一致性和>75%的一致性的问题（除非反馈表明需要进一步调查）。
专家组达成一致意见，即（1）在服用抗精神病药物的患者每次临床就诊时，都应进行简短的 TD 临床评估；（2）即使只有一个身体部位的轻微运动也可能代表可能的 TD；（3）管理需要对治疗进行全面评估，包括重新评估抗精神病药物和抗胆碱能药物，以及考虑使用囊泡单胺转运体 2（VMAT2）抑制剂；（4）与患者/照顾者进行知情讨论至关重要。
