抗精神病药致静坐不能临床探究.docVIP

抗精神病药致静坐不能临床探究 　　　摘　要：目的　探讨抗精神病药(APD)致静坐不能的临床特征及相关因素。方法　采用临床标准化评定工具对260例精神分裂症住院病人进行3个月的观察研究。结果　静坐不能发生率为23.5%，不伴焦虑症状者为36.1%。发生时间在治疗后4周内及下午、晚上较多(P＜0.01)；静坐不能组的APD治疗剂量、治疗前BPRS评分较高(P＜0.05或P＜0.01)；静坐不能评分与各临床变量无显著相关性。单发组与伴发组临床资料有一定差异；心得安治疗静坐不能效果良好，单发组疗效优于伴发组(P＜0.01)，而对其他锥体外系症状疗效差。结论　静坐不能发生受生物时间、精神症状、药物及个体素质等因素的影响。静坐不能多数应归属于急性锥体外系反应，部分可能为药源性精神副反应的运动不宁状态。作者提出了静坐不能不同类别与处理措施。 A clinical study of akathisia caused by antipsychotics 　　Abstract：Objective 　To explore the clinical features and the factors associate with akathisia caused by antipsychotics drug (APD).Methods A clinical observational study was carried out in 260 schizophrenc inpatients with the CCMD-2-R, the modified Sampson’s extrapyramidal side effect rating scale, brief psychiatric rating scale (BPRS), Hamiton anxiety scale for three months.Results　The incidence of akathisia was 23.5%, and of these 36.1% was not accompanied by anxiety. Akathisia happened four weeks after treatment, in the afternoon or in the evening (P＜0.01). The dosage of APD and BPRS score before treatment were higher in the akathisic group (P＜0.05 or P＜0.01). There was no obvious relation betweenamp;nbs p;akathisia score and clinical features. The efficacy of propranolol for treating akathisia was better and its efficiency for treating other extrapramindal symtops was poor. Its effecacy in the akathisia-only group was superior to that of the complicated group (P＜0.01).Conclusions　The occurrence of akathisia was affected by biological time, psychiatric symptom, drug and personal diathesis. Most akathisia was due to the acute extrapramidal reaction arising from the use of drugs. The author moved the different categories and treating measnres of akathisia. 　　Key words：Antipsychotic agents Akathisia Schizophrenia Clinical studies 　　急性锥体外系反应(EPS)是抗精神病药(APD)较常见的神经系统副反应。其中静坐不能因症状表现的特殊性，在临床中易被误认为精神症状波动而加大APD治疗剂量。因此导致病人的痛苦体验加重，使治疗方案的实施搁浅，甚至出现严重的自杀意外［1］；也有人观察到预防性或盲目投用抗胆碱药治疗，可与某些APD的抗胆碱能毒性产生协同作用，导致抗胆碱能中毒综合征［2］。为探讨APD致静坐不能的临床特征及相关因素，以便在治疗中正确识别和处理，我们对260