Y Huang, L Pan, F Teng, G Wang, C Li and L Jin,
Shanghai archives of psychiatry, Oct 25 2017
Tardive dyskinesia (TD) is an abnormal involuntary movement disorder caused by patients' long-term use of antipsychotic medication. It diminishes the social functioning of patients with mental disorders, thereby affecting their compliance with antipsychotic medication. The cause and nosogenesis of TD remains unclear; furthermore, because the presentation differs greatly among individuals it often goes undiagnosed or can be easily misdiagnosed. The present study aims to evaluate the abnormal movement patterns in patients with TD, and analyze the differences among different TD patterns, in order to seek effective methods of preventing, diagnosing and treating TD.To describe the movement patterns of patients with chronic schizophrenia with TD, and analyze their clinical characteristics and risk factors.A cross-sectional study was carried out on a psychiatric unit of the Xuhui Mental Health Center with inpatients who had chronic schizophrenia as participants. Abnormal Involuntary Movement Scale (AIMS) was employed to screen for patients with schizophrenia who also had TD. These patients' movement disorders were evaluated, and they were divided into groups based on their movement patterns. Positive and Negative Syndrome Scale (PANSS) was used to assess the psychotic symptoms of patients, collect clinical information, compare the differences between the two groups and analyze the clinical characteristics and risk factors of TD.(1) A total of 448 patients met the inclusion criteria for chronic schizophrenia with 46 in the TD group and 402 in the control group. After the TD group and the control group was compared, significant differences were seen between the two groups in gender, age, total duration of illness, age of onset, dosage of antipsychotic medication (daily chlorpromazine equivalent), factor scores of negative symptoms on PANSS and PANSS total scores. (2) It was possible that age, factor scores of negative symptoms in PANSS, the amount of antipsychotic medication used (daily chlorpromazine equivalent) and gender are correlated with the occurrence of TD. (3) There were significant differences among the number of TD patients with movement disorders in facial and oral areas (67.4%), limbs (58.7%) and torso (37%). The AIMS scores corresponding with movement disorders in different parts of the body were also significantly different. (4) Comparing TD patients with single affected area and those with multiple affected areas, we found that they had significant differences in gender, age of onset, AIMS total scores, severity scores of abnormal movements and loss of range due to abnormal movements.(1) Compared to the control group, the TD group had more men, was older, had a longer duration of illness, later age of onset, generally took a higher dosage of antipsychotic medication and presented with more severe negative symptoms. It is possible that age, factor scores of negative symptoms on PANSS, dosage of antipsychotic medication (daily chlorpromazine equivalent) and gender are correlated with the occurrence of TD. (2) The occurrence of movement disorders in facial and oral areas for patients with chronic schizophrenia with TD was the most frequent, and the symptoms were the most severe. (3) Compared to TD patients with a single affected area, TD patients with multiple affected areas may have an earlier age of onset, more severe movement disorders, and more setbacks in their movement and functioning.迟发性运动障碍（Tardive Dyskinesia, TD）是由 于患者长期服用抗精神病药物后产生的一种异常不自 主运动障碍，它会加剧精神疾病患者的社会功能障碍， 并进一步影响患者对抗精神病药物的服药依从性。目 前对于TD 的病因及其发病机制尚不清楚，且TD 累及 部位多、个体差异性大，导致其极易被漏诊或误诊。 本研究旨在评估TD 患者的异常运动模式，进一步分析 TD 不同模式是否存在差异，为进一步寻找TD 预防和 早期诊断的方法，发现有效的治疗手段提供帮助。.描述伴发TD 的慢性精神分裂症患者的运动模式， 分析其临床特征及危险因素。.对徐汇区精神卫生中心精神科住院的慢性精神 分裂症患者进行横断面调查，运用异常不自主运动量 表（Abnormal Involuntary Movement Scale，AIMS） 筛 查出伴有TD 的慢性精神分裂症患者，对患者的运动 障碍进行评估，并按照疾病受累方式进行分组。采用 阳性和阴性症状量表（Positive and Negative Syndrome Scale，PANSS）对患者的精神症状进行评估，收集临床 资料，比较两组差异，分析TD 的临床特征和危险因素。.(1) 共448 例患者符合慢性精神分裂症入组标准， TD 组46 例，对照组402 例。TD 组与对照组比较，性 别、年龄、精神分裂症总病程、精神分裂症起病年龄、 抗精神病药物剂量（每日氯丙嗪当量）、PANSS 量表 阴性症状因子分、PANSS 量表总分的差异均有统计学 意义。(2) 年龄、PANSS 量表阴性症状因子分、抗精神 病药物剂量（每日氯丙嗪当量）、性别等四个因素可 能与TD 的发生有关。(3)TD 患者中存在面部及口腔部 位运动障碍的有67.4%，肢体运动障碍的有58.7%，躯 干运动障碍的有37%，差异有统计学意义，不同部位 运动障碍相应的AIMS 分量表评分结果差异有统计学意 义。（4) 单一部位受累的TD 患者与多部位受累的TD 患者比较，性别、精神分裂症起病年龄、AIMS 量表总分、 异常运动的严重程度评分及由于异常运动导致的运动 能力丧失程度的差异有统计学意义。.(1) 与对照组相比，TD 组中可能男性患者的比例 更高、年龄更大、总病程更长、起病年龄更晚、抗精 神病药物剂量更高、阴性症状更为突出。年龄、PANSS 量表阴性症状因子分、抗精神病药物剂量（每日氯丙 嗪当量）、性别等4 个因素可能是发生TD 的危险因素。 (2) 伴有TD 的慢性精神分裂症患者运动障碍以面部及 口腔部位障碍最为频发，异常运动的症状更严重。(3) 与单部位受累的TD 患者相比，多部位受累的TD 患者 可能起病年龄更早、运动障碍更加严重、对患者运动 功能的影响更大。.