Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Clinical Medical Sciences Department, College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia.
Drug Chem Toxicol. 2024 Jul;47(4):386-403. doi: 10.1080/01480545.2024.2313561. Epub 2024 Feb 13.
Worldwide, acute antipsychotic poisoning results in high morbidities and mortalities. Though extrapyramidal syndromes are commonly associated, the extent of extrapyramidal syndromes in relation to the severity of antipsychotic poisoning has not been addressed yet. Thus, this study aimed to assess the Global Dystonia Rating Scale (GDRS) as an unfavorable outcomes predictive tool in acute antipsychotic poisoning. A cross-sectional study included 506 antipsychotic-poisoned patients admitted to Tanta University Poison Control Center, Egypt, over three years was conducted. The mean GDRS was 9.1 ± 16.7 in typical antipsychotic poisoning, which was significantly higher than that of atypical antipsychotics (4.2 ± 11.5) ( 0.003). Patients with GDRS> 20 showed significantly higher liability for all adverse outcomes ( 0.05). However, poisoning with typical antipsychotics was associated with significantly more cardiotoxicity ( 0.042), particularly prolonged QRS ( 0.005), and intensive care unit (ICU) admission ( 0.000). In contrary to the PSS, which failed to predict the studied adverse outcomes, GDRS significantly predicted all adverse outcomes ( 0.000) for all antipsychotic generations. In atypical antipsychotics, GDRS above three accurately predicted cardiotoxicities, prolonged QTc interval, and respiratory failure with Area under curves (AUC) of 0.937, 0.963, and 0.941, respectively. In typical antipsychotic poisoning, at higher cutoffs (7.5, 27.5, 18, and 7.5), cardiotoxicities, prolonged QTc interval, and respiratory failure were accurately predicted (AUC were 0.974, 0.961, and 0.960, respectively). GDRS is an objective, substantially useful tool that quantifies dystonia and can be used as an early reliable predictor of potential toxicity in acute antipsychotic poisoning.
全球范围内，急性抗精神病药物中毒会导致高发病率和死亡率。虽然锥体外系综合征通常与之相关，但锥体外系综合征与抗精神病药物中毒严重程度的关系尚未得到解决。因此，本研究旨在评估全球肌张力障碍评定量表（GDRS）作为急性抗精神病药物中毒不良预后的预测工具。
进行了一项横断面研究，纳入了三年内在埃及坦塔大学中毒控制中心就诊的 506 例抗精神病药物中毒患者。典型抗精神病药物中毒患者的平均 GDRS 为 9.1±16.7，明显高于非典型抗精神病药物（4.2±11.5）（0.003）。GDRS>20 的患者发生所有不良结局的可能性显著更高（0.05）。然而，典型抗精神病药物中毒与更高的心脏毒性（0.042）相关，尤其是 QRS 延长（0.005）和重症监护病房（ICU）入住率（0.000）。与未能预测所研究不良结局的 PSS 不同，GDRS 显著预测了所有抗精神病药物的所有不良结局（0.000）。在非典型抗精神病药物中，GDRS 高于 3 可准确预测心脏毒性、QTc 间期延长和呼吸衰竭，曲线下面积（AUC）分别为 0.937、0.963 和 0.941。在典型抗精神病药物中毒中，在更高的截断值（7.5、27.5、18 和 7.5）时，心脏毒性、QTc 间期延长和呼吸衰竭可被准确预测（AUC 分别为 0.974、0.961 和 0.960）。GDRS 是一种客观、非常有用的工具，可定量评估肌张力障碍，可作为急性抗精神病药物中毒潜在毒性的早期可靠预测指标。
