从未接受治疗的慢性和首发精神病患者中自发性运动障碍（运动障碍、帕金森病、静坐不能和肌张力障碍）的患病率：系统评价和荟萃分析。
Prevalence of spontaneous movement disorders (dyskinesia, parkinsonism, akathisia and dystonia) in never-treated patients with chronic and first-episode psychosis: a systematic review and meta-analysis.
机构信息
Research and Development, West London NHS Trust, London, UK.
Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
出版信息
BMJ Ment Health. 2024 Sep 22;27(1):e301184. doi: 10.1136/bmjment-2024-301184.
BACKGROUND
The aim of this systematic review and meta-analysis is to evaluate and compare the prevalence rates of spontaneous movement disorders (SMDs), including dyskinesia, parkinsonism, akathisia and dystonia, in antipsychotic-naïve individuals with chronic psychosis and first-episode psychosis (FEP) and gain a more nuanced understanding of factors influencing their presence.
METHODS
Several literature databases were systematically searched and screened based on predetermined eligibility criteria. Included articles underwent risk of bias assessment. The prevalence rates of SMDs were calculated using a random-effects model.
RESULTS
Out of 711 articles screened, 27 were included in this meta-analysis. The pooled prevalence of spontaneous dyskinesia was 7% (3% FEP and 17% chronic schizophrenia) across 24 studies (95% CI 3 to 11; I=94%, p<0.01) and 15% for spontaneous parkinsonism (14% FEP and 19% chronic schizophrenia) in 21 studies (95% CI 12 to 20; I=81%, p<0.01). A meta-regression analysis found a significant positive correlation between age (p<0.05) and duration of untreated psychosis (DUP) (p<0.05) with dyskinesia but not parkinsonism prevalence. Akathisia and dystonia appear to be both less studied and less frequent in occurrence with a pooled prevalence of 4% (95% CI: 3 to 6; I=0%, p=0.65) for akathisia in eight studies and a mean prevalence of 6% (range 0%-16%) for dystonia in five studies.
CONCLUSION
The presence of varying degrees of neurodysfunction in antipsychotic-naïve patients with schizophrenia underscores the need for individualised treatment approaches that consider each patient's unique predisposition and neuromotor profile. Further research is warranted into the role of specific SMDs and risk factors including sex, race and diagnostic variations.
PROSPERO REGISTRATION NUMBER
CRD42024501951.
背景
本系统评价和荟萃分析的目的是评估和比较抗精神病药物初治的慢性精神病和首发精神病患者中自发性运动障碍（SMD）的患病率，包括运动障碍、帕金森病、静坐不能和肌张力障碍，并更细致地了解影响其发生的因素。
方法
根据预定的纳入标准，系统地检索和筛选了多个文献数据库。纳入的文章进行了偏倚风险评估。使用随机效应模型计算 SMD 的患病率。
结果
在筛选出的 711 篇文章中，有 27 篇被纳入本荟萃分析。24 项研究中自发性运动障碍的总患病率为 7%（首发精神病为 3%，慢性精神分裂症为 17%）（95%CI 3-11；I=94%，p<0.01），21 项研究中自发性帕金森病的患病率为 15%（首发精神病为 14%，慢性精神分裂症为 19%）（95%CI 12-20；I=81%，p<0.01）。一项荟萃回归分析发现，年龄（p<0.05）和未治疗精神病持续时间（DUP）（p<0.05）与运动障碍的患病率呈显著正相关，但与帕金森病的患病率无关。静坐不能和肌张力障碍似乎研究较少，且发生率较低，8 项研究中静坐不能的总患病率为 4%（95%CI：3-6；I=0%，p=0.65），5 项研究中肌张力障碍的平均患病率为 6%（范围 0%-16%）。
结论
抗精神病药物初治的精神分裂症患者存在不同程度的神经功能障碍，这凸显了需要采用个体化的治疗方法，考虑每个患者独特的易感性和神经运动特征。需要进一步研究特定的 SMD 和风险因素的作用，包括性别、种族和诊断差异。
PROSPERO 注册号：CRD42024501951。
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