1St. John's University, College of Pharmacy and Health Sciences, Queens, New York.
2Montefiore Nyack Hospital, Nyack, New York.
Sr Care Pharm. 2021 Oct 1;36(10):493-500. doi: 10.4140/TCP.n.2021.493.
Drug-induced dystonias are rare but can occur with second-generation antipsychotics. They are usually dose-related and occur soon after dose initiation. This case describes the development of dystonia after two years of olanzapine 5 mg daily in an older person with Alzheimer's dementia. The dystonia resolved after diphenhydramine treatment on day two of hospitalization, but then the patient became delirious, which was treated with lorazepam on day three. Six days after admission, she developed tremors and rigidity that self-resolved. Her dystonia resolved after 11 days. The recurrence of symptoms during the hospitalization may have been a result of the progression of her dementia. This is the first known case of a patient developing dystonia after chronic use of low-dose olanzapine. This was not characterized as tardive dystonia because the dystonia was resolved with anticholinergic medication. This case illustrates the difficulty of using anticholinergics to treat dystonias in older people, which can precipitate delirium. Choosing an alternative antipsychotic with less extrapyramidal symptom risk is challenging as she had previous trials with quetiapine and risperidone. Clozapine was deemed an unfavorable alternative, as laboratory monitoring would be burdensome. Olanzapine-induced dystonias can develop anytime during therapy. Families must balance the desire for mood stabilization with antipsychotics side effects.
药物引起的运动障碍很少见，但可能发生在第二代抗精神病药物中。它们通常与剂量有关，并且在开始剂量后不久发生。本例描述了一名老年阿尔茨海默病痴呆患者每天服用奥氮平 5 毫克两年后出现运动障碍。在住院第二天用苯海拉明治疗后，运动障碍得到缓解，但随后患者出现谵妄，用劳拉西泮治疗第三天。入院后六天，她出现震颤和僵硬，自行缓解。她的运动障碍在 11 天后得到缓解。住院期间症状的复发可能是她痴呆症进展的结果。这是首例已知的慢性低剂量奥氮平使用后出现运动障碍的病例。由于使用抗胆碱能药物可缓解运动障碍，因此不能将其归类为迟发性运动障碍。该病例说明了在老年人中使用抗胆碱能药物治疗运动障碍的困难，因为这可能会引发谵妄。由于她之前曾尝试使用喹硫平和利培酮，因此选择一种具有较少锥体外系症状风险的替代抗精神病药物具有挑战性。氯氮平被认为是一种不利的替代药物，因为实验室监测会带来负担。奥氮平引起的运动障碍可能在治疗期间的任何时候发生。患者家属必须在希望用抗精神病药物稳定情绪与药物副作用之间取得平衡。
