Bristow M F, Hirsch S R
Academic Department of Psychiatry, Charing Cross and Westminster Medical School, London, England.
Drug Saf. 1993 Feb;8(2):136-48. doi: 10.2165/00002018-199308020-00004.
Although acute and immediate extrapyramidal syndromes are common and, in the case of neuroleptic malignant syndrome, may have serious sequelae, the most important problem with psychotropic medication in schizophrenia remains the tardive movement disorders. These are increasingly recognised as being aetiologically as well as symptomatically heterogeneous. Although risk factors are being identified with greater clarity, there is little in the way of effective treatment. This suggests that clinicians must embark on long term neuroleptic treatment with vigilance. Clozapine alone has few extrapyramidal effects, and has been described in isolated instances as improving established movement disorders. However, haematological idiosyncrasies will preclude its use in all where compliance is uncertain. Its superior efficacy will hopefully give impetus to research into safer analogues.
尽管急性和即刻锥体外系综合征很常见，而且就抗精神病药物恶性综合征而言，可能会有严重的后遗症，但精神分裂症患者使用精神药物最重要的问题仍然是迟发性运动障碍。人们越来越认识到，迟发性运动障碍在病因和症状方面都具有异质性。尽管风险因素正被更清晰地识别出来，但几乎没有有效的治疗方法。这表明临床医生在进行长期抗精神病药物治疗时必须保持警惕。单独使用氯氮平几乎没有锥体外系效应，在个别情况下，它还被描述为可改善已有的运动障碍。然而，血液学方面的特异反应会妨碍在所有依从性不确定的患者中使用它。其卓越的疗效有望推动对更安全类似物的研究。
