Dixon L, Thaker G, Conley R, Ross D, Cascella N, Tamminga C
University of Maryland, Department of Psychiatry, Baltimore 21201.
Schizophr Res. 1993 Oct;10(3):267-71. doi: 10.1016/0920-9964(93)90061-m.
The goal of this study was to assess the time course of change in psychopathology and dyskinesia after neuroleptic withdrawal. Fifteen DSM-III schizophrenic patients were abruptly withdrawn in a double-blind fashion from stable haloperidol treatment. Weekly ratings of dyskinesia and psychopathology were performed for 4 weeks post-withdrawal. There was an overall increase in dyskinesia ratings over the 4-week period (p < 0.05) beginning in week 2, with dyskinetic movements of the fingers showing the most significant increase (p < 0.001). There were no overall changes in psychopathology, though the group appeared to be bimodal with 6 of the 15 patients showing a significant relapse in psychotic symptoms. Neither baseline TD nor psychotic relapse significantly interacted with change in TD over time. These schizophrenic patients showed an increase in global dyskinesia rating early within four weeks of neuroleptic withdrawal. This time course did not appear to be associated with reemergence of psychopathology which occurred later. A significant minority of patients relapsed within this time period. This suggests the relative safety of brief periods of neuroleptic withdrawal for carefully selected patients in a controlled setting with specific goals (e.g., for evaluation or in preparation for clozapine) and the need to further understand who is at risk for rapid relapse.
本研究的目的是评估停用抗精神病药物后精神病理学和运动障碍变化的时间进程。15名符合《精神疾病诊断与统计手册》第三版（DSM-III）标准的精神分裂症患者以双盲方式从稳定的氟哌啶醇治疗中突然停药。停药后4周每周对运动障碍和精神病理学进行评分。在停药后第2周开始的4周内，运动障碍评分总体增加（p < 0.05），手指的运动障碍最为显著（p < 0.001）。精神病理学方面没有总体变化，尽管该组似乎呈双峰分布，15名患者中有6名出现明显的精神病症状复发。基线迟发性运动障碍（TD）和精神病复发均未随时间与TD变化产生显著交互作用。这些精神分裂症患者在停用抗精神病药物后的4周内早期出现了整体运动障碍评分增加。这一时间进程似乎与后来出现的精神病理学无关。在此期间有少数患者复发。这表明在有特定目标（如评估或为氯氮平做准备）的受控环境中，对精心挑选的患者进行短期停用抗精神病药物相对安全，且有必要进一步了解哪些人有快速复发的风险。
