The effect of antipsychotic medication on neuromotor abnormalities in neuroleptic-naive nonaffective psychotic patients: a naturalistic study with haloperidol, risperidone, or olanzapine.
The effect of antipsychotic medication on neuromotor abnormalities in neuroleptic-naive nonaffective psychotic patients: a naturalistic study with haloperidol, risperidone, or olanzapine.
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DOI：
10.4088/pcc.09m00799gry
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发表时间：
2010-01-01
期刊：
影响因子：
--
通讯作者：
Cuesta, Manuel J
中科院分区：
文献类型：
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作者：
Peralta, Victor;Cuesta, Manuel J
目的：检查抗精神病药物对从未接触过抗精神病药物的精神病患者样本中神经运动异常的影响。方法：使用 DSM-IV 标准对 100 名精神病患者（从 1998 年 1 月至 2002 年 12 月）进行了帕金森病、运动障碍、静坐不能、紧张症和肌张力障碍基线和氟哌啶醇治疗 4 周后的评估（n = 23），利培酮 (n = 52) 或奥氮平 (n = 25)。我们检查了治疗期间各治疗组神经运动评分的变化评分，以及先前存在或不存在神经运动异常的患者的药物反应性和药物突发性神经运动综合征的发生率。结果：总体时间效应显示帕金森症 (P = .002) 和静坐不能 (P = .002) 评分恶化，运动障碍 (P = .001) 和紧张症 (P < .001) 评级。主要治疗效果显示，与服用利培酮 (P = .002) 或奥氮平 (P < .001) 的患者相比，服用氟哌啶醇的患者静坐不能评分平均显着增加。与其他治疗组相比，接受奥氮平治疗的患者先前存在的帕金森病得到缓解的比例显着更高 (P = .047)。对于先前没有运动异常的患者，如果使用氟哌啶醇或利培酮治疗，则比使用奥氮平治疗更容易出现药物性帕金森病 (P = .001)，如果使用氟哌啶醇治疗，则比使用利培酮或奥氮平治疗更容易出现药物性肌张力障碍 (P = .014) 和静坐不能 (P = .013)。 结论：抗精神病药物与神经系统异常之间的关系比以前认识的更为复杂，因为抗精神病药物既可能改善先前存在的异常，又可能导致“从头”神经系统综合征。总体而言，奥氮平比利培酮具有更有利的神经运动特征，而利培酮又比氟哌啶醇具有更有利的特征。
OBJECTIVE: To examine the effect of antipsychotic medication on neuromotor abnormalities in a sample of psychotic patients never exposed to antipsychotic drugs.METHOD: One hundred psychotic patients were assessed (from January 1998 to December 2002) using DSM-IV criteria for parkinsonism, dyskinesia, akathisia, catatonia, and dystonia at baseline and after 4 weeks of treatment with haloperidol (n = 23), risperidone (n = 52), or olanzapine (n = 25). We examined change scores in neuromotor ratings over the treatment period across treatment groups and rates of drug-responsive and drug-emergent neuromotor syndromes in patients with and without preexisting neuromotor abnormalities.RESULTS: Overall time effects revealed a worsening of parkinsonism (P = .002) and akathisia (P = .002) ratings and an improvement of dyskinesia (P = .001) and catatonia (P < .001) ratings. Main treatment effects revealed that patients taking haloperidol had a significant mean increase in akathisia scores compared with those of patients taking risperidone (P = .002) or olanzapine (P < .001). A significantly greater percentage of olanzapine-treated patients experienced remission of preexisting parkinsonism than did the other treatment groups (P = .047). Patients without preexisting motor abnormalities were more likely to experience drug-emergent parkinsonism if they were treated with haloperidol or risperidone than with olanzapine (P = .001) and were more likely to experience drug-emergent dystonia (P = .014) and akathisia (P = .013) if they were treated with haloperidol than with risperidone or olanzapine.CONCLUSIONS: The relationship between antipsychotic medication and neurologic abnormalities is more complex than previously acknowledged since antipsychotic drugs may both improve preexisting abnormalities and cause "de novo" neurologic syndromes. Overall, olanzapine has a more favorable neuromotor profile than risperidone, which in turn has a more favorable profile than haloperidol.