Morton Robert O, Morton Lucas C, Fedora Rissa
Rolling Hills Hospital, Ada, OK, USA.
Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, USA.
Case Rep Psychiatry. 2020 Dec 11;2020:8886980. doi: 10.1155/2020/8886980. eCollection 2020.
Individuals with intellectual disability (ID) commonly suffer from comorbid psychiatric and behavioral disorders that are frequently treated by antipsychotic medications. All individuals exposed to first- and second/third- generation antipsychotics are at risk for developing tardive dyskinesia (TD), characterized by abnormal, involuntary movements of the mouth/tongue/jaw, trunk, and extremities. TD can be highly disruptive for affected individuals and their caregivers, causing embarrassment, isolation, behavioral disturbances, and reduced functioning and quality of life. Information on TD incidence in individuals with ID is limited, but 2 small US studies reported TD prevalence rates of 42-45% in inpatients with ID. The safety and efficacy of vesicular monoamine transporter type 2 (VMAT2) inhibitors approved for treatment of TD in adults have been demonstrated in multiple clinical trials, but they excluded individuals with ID. Clinical characteristics and treatment outcomes of 5 adults (aged 28-63 years) with mild-to-severe ID and TD are presented, illustrating TD symptoms before/after treatment. All individuals had multiple comorbid psychiatric, behavioral, and other medical conditions, history of antipsychotic exposure, and abnormal movements affecting the tongue/mouth/jaw ( = 5), upper extremities ( = 5), lower extremities ( = 3), and trunk ( = 2), resulting in diminished ability to speak ( = 2), ambulate ( = 3), and perform activities of daily living ( = 3). Treatment with valbenazine resulted in meaningful improvements in TD symptoms and improved daily functioning, demeanor, and social/caregiver interactions. Given the high likelihood of antipsychotic exposure in the ID population, it is appropriate to screen for TD at every clinical visit through careful monitoring for abnormal movements and questioning the individual/caregiver regarding abnormal movements or TD-related functional impairments (i.e., speaking, swallowing, eating, ambulating, and social functioning). In this study, 5 individuals with ID and TD received once-daily valbenazine and experienced marked improvement in TD symptoms and daily functioning, resulting in increased quality of life for affected individuals and caregivers.
智力残疾（ID）患者通常患有合并的精神和行为障碍，常需使用抗精神病药物进行治疗。所有使用第一代和第二代/第三代抗精神病药物的患者都有发生迟发性运动障碍（TD）的风险，其特征为口/舌/颌、躯干和四肢出现异常的不自主运动。TD对受影响的个体及其照顾者可能造成极大干扰，导致尴尬、孤立、行为紊乱，以及功能和生活质量下降。关于ID患者中TD发病率的信息有限，但美国两项小型研究报告称，ID住院患者的TD患病率为42%-45%。已在多项临床试验中证实了批准用于治疗成人TD的囊泡单胺转运体2（VMAT2）抑制剂的安全性和有效性，但这些试验排除了ID患者。本文介绍了5名年龄在28-63岁之间、患有轻至重度ID和TD的成年人的临床特征及治疗结果，展示了治疗前后的TD症状。所有个体都有多种合并的精神、行为和其他医疗状况，有抗精神病药物暴露史，且存在影响舌/口/颌（n = 5）、上肢（n = 5）、下肢（n = 3）和躯干（n = 2）的异常运动，并导致说话能力（n = 2）、行走能力（n = 3）和日常生活活动能力（n = 3）下降。使用缬苯那嗪治疗使TD症状有显著改善，并改善了日常功能、行为表现以及社交/照顾者互动。鉴于ID人群中抗精神病药物暴露的可能性很高，每次临床就诊时通过仔细监测异常运动并询问个体/照顾者有关异常运动或TD相关功能损害（即说话、吞咽、进食、行走和社交功能）来筛查TD是合适的。在本研究中，5名患有ID和TD的个体每日服用一次缬苯那嗪，TD症状和日常功能有显著改善，从而提高了受影响个体及其照顾者的生活质量。
