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从评估到干预:迟发性运动障碍的循证方法

From assessment to intervention: evidence-based approaches in tardive dyskinesia.

作者信息

Matthews Desiree

机构信息

Different MHP, PC, Charlotte, NC, USA.

出版信息

CNS Spectr. 2025 Feb 12;30(1):e25. doi: 10.1017/S1092852925000082.

DOI:10.1017/S1092852925000082
PMID:39935362
Abstract

Tardive dyskinesia (TD) is a potentially irreversible movement disorder induced by dopamine receptor-blocking agents, including antipsychotics. Despite progress in antipsychotic medications, TD remains widely prevalent even in the era of second-generation antipsychotics. Early detection is critical for preventing irreversible damage and minimizing the disorder's impact on patients' daily lives. Risk factors for TD include advanced age, female sex, medical comorbidities, and prolonged use of dopamine receptor-blocking agents (DRBAs). Effective screening for TD should incorporate evidence-based screening techniques such as the Abnormal Involuntary Movement Scale (AIMS) and informal methods to capture a comprehensive view of TD's severity and impact. Combining these approaches allows for a thorough assessment of both healthcare practitioner-perceived severity and patient-reported effects on daily life. Modern treatment options, including vesicular monoamine transporter 2 (VMAT2) inhibitors like valbenazine and deutetrabenazine, have demonstrated significant efficacy and safety in clinical trials. Approved by the FDA in 2017, these medications enable continued psychiatric care while managing TD symptoms. Long-term studies support their sustained efficacy and safety, underscoring the importance of individualized, evidence-based treatment plans to improve patient outcomes.

摘要

迟发性运动障碍(TD)是一种由多巴胺受体阻断剂(包括抗精神病药物)诱发的潜在不可逆性运动障碍。尽管抗精神病药物取得了进展,但即使在第二代抗精神病药物时代,TD仍然广泛存在。早期检测对于预防不可逆损害和将该疾病对患者日常生活的影响降至最低至关重要。TD的风险因素包括高龄、女性、合并症以及多巴胺受体阻断剂(DRBA)的长期使用。有效的TD筛查应纳入基于证据的筛查技术,如异常不自主运动量表(AIMS)以及非正式方法,以全面了解TD的严重程度和影响。结合这些方法能够对医疗从业者感知的严重程度和患者报告的对日常生活的影响进行全面评估。现代治疗选择,包括像缬苯那嗪和氘代丁苯那嗪这样的囊泡单胺转运体2(VMAT2)抑制剂,已在临床试验中显示出显著的疗效和安全性。这些药物于2017年获得美国食品药品监督管理局(FDA)批准,在控制TD症状的同时能够继续进行精神科护理。长期研究支持它们的持续疗效和安全性,强调了个性化的、基于证据的治疗方案对于改善患者预后的重要性。

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