Since the 1950s neuroleptic medication has been extensively used to treat people with chronic mental illnesses such as schizophrenia. These drugs, however, have been also associated with a wide range of adverse effects, including movement disorders such as tardive dyskinesia (TD). Various strategies have been examined to reduce a person's cumulative exposure to neuroleptics. These studies include dose reduction, intermittent dosing strategies such as drug holidays, and neuroleptic cessation.
To determine whether a reduction or cessation of neuroleptic drugs is associated with a reduction in TD, for people with schizophrenia (or other chronic mental illnesses) who have existing TD. Our secondary objective was to determine whether the use of specific neuroleptics for similar groups of people could be a treatment for TD that was already established.
We updated previous searches of the Cochrane Schizophrenia Groups Register (1997), Biological Abstracts (1982-1997), EMBASE (1980-1997), LILACS (1982-1996), MEDLINE (1966-1997), PsycLIT (1974-1997), and SCISEARCH (1997) by searching the Cochrane Schizophrenia Groups Register (July 2003). We searched references of all identified studies for further trial citations. We also contacted the principal authors of trials for further unpublished trials.
We included reports if they assessed people with schizophrenia or other chronic mental illnesses who had established neuroleptic-induced TD, and had been randomly allocated to (a) neuroleptic maintenance versus neuroleptic cessation (placebo or no intervention), (b) neuroleptic maintenance versus neuroleptic reduction (including intermittent strategies), and (c) specific neuroleptics for the treatment of TD versus, placebo or intervention. A post hoc decision was made to broaden comparison (c) to include specific neuroleptics versus other neuroleptics for the treatment of TD.
Data collection and analysis
We (KSW, JR) independently inspected citations and, where possible, abstracts, ordered papers, and re-inspected and quality assessed these and extracted data. We analysed dichotomous data using random effects relative risk (RR) and estimated the 95% confidence interval (CI). Where possible we calculated the number needed to treat (NNT) or number needed to harm statistic (NNH). We excluded continuous data if more than 50% of people were lost to follow up, but, where possible, we calculated the weighted mean difference (WMD). It was assumed that those leaving the study early showed no improvement.
We included five trials and excluded 102. One small two week study (n=18), reported on the 'masking' effects of molindone and haloperidol on TD, which favoured haloperidol (RR 3.44 CI 1.1 to 5.8). Two (total n=17) studies found no reduction in TD associated with neuroleptic reduction (RR 0.38 CI 0.1 to 1.0). One study (n=20) found no significant differences in oral dyskinesia (RR 2.45 CI 0.3 to 19.7) when neuroleptics were compared as a specific treatment for TD. Dyskinesia was found to be not significantly different (n=32, RR 0.62 CI 0.3 to 1.26) between quetiapine and haloperidol when these neuroleptics were used as specific treatments for TD, although the need for additional neuroleptics was significantly lower in the quetiapine group (n=47, RR 0.49 CI 0.2 to 1.0) than in those given haloperidol.
Limited data from small studies using neuroleptic reduction or specific neuroleptic drugs as treatments for TD did not provide any convincing evidence of the value of these approaches. There is a need for larger trials of a longer duration in order to fully investigate this area.
1950年開始抗精神病藥物廣泛使用於慢性精神病如精神分裂症. 這些藥物有廣泛副作用,包含運動障礙如遲發性運動障礙 (TD). 有許多策略想減少抗精神病藥物累積劑量. 包含藥物減少,間斷劑量策略如停藥假期和停藥.
更新之前搜尋,搜尋範圍:Cochrane Schizophrenia Groups Register (1997), Biological Abstracts (1982 – 1997), EMBASE (1980 – 1997), LILACS (1982 – 1996), MEDLINE (1966 – 1997), PsycLIT (1974 – 1997), and SCISEARCH (1997) by searching the Cochrane Schizophrenia Groups Register (July 2003). 搜尋鎖定的試驗中的文獻是否有更多是豔文憲. 也連絡主要作者得到更多位發表試驗
納入評估有抗精神病藥誘發的TD的精神分裂症病患或其他慢性精神病患. 病患要經隨機分配到(a)穩定劑量抗精神病藥組和停藥組(安慰劑或沒有治療),(b). 穩定劑量抗精神病藥組和減藥組(間斷劑量策略)和(c)特定抗精神病藥治療TD組和安慰劑或沒有治療. 後來決定擴大(c)包含特定抗精神病藥組和其他精神病藥治療TD組
KSW和JR獨立檢查文獻,摘要,排序論文和重新評估研究品質及擷取資料. 計算二元資料的隨機效果RR和95%CI.可行則計算需要治療人數或致成危害需要人?.若超過50%受試者失去追蹤則排除連續資料. 可行的話就計算加權平均差異. 提早離開試驗的人假設為沒有進步.
納入5個試驗,排除102個. 一個小型兩週試驗包含18位受試者得到molindone和 haloperidol對TD的面具效應. 結論為haloperidol較優(RR 3.44 CI 1.1 to 5.8).2個試驗(共17人)研究發現neuroleptic減量與TD減少無關 (RR 0.38 CI 0.1 to 1.0). 1個20人試驗發現口服dyskinesia和以neuroleptics噹TD治療相比沒有顯著差異(RR 2.45 CI 0.3 to 19.7). Dyskinesia, quetiapine 和 haloperidol最為TD專屬藥物時沒有顯著差異(樣本數為32, RR 0.62 CI 0.3 to 1.26)但quetiapine組同時抗經病藥物額外需求劑量,比haloperidol組顯著降低(樣本數為47, RR 0.49 CI 0.2 to 1.0)
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
總結: 抗精神病藥物已經廣泛使用於精神病如精神分裂症超過50年. 這些藥物有效控制或減少某些症狀,但仍有副作用.,包含嚴重程度不同但可以使患者失能的運動障礙如遲發性運動障礙,會使重複臉部動作. 因此患者遵醫囑性受限. 應找到藥物或用藥策略以預防或減少遲發性運動障礙和/或停藥,特定要誤治療已經有遲發性運動障礙病患. 我們找到隨機試驗比較減藥物劑量到標準劑量,和使用特定藥物治療遲發性運動障礙. 但應有更大規模試驗.