Anticholinergics for neuroleptic-induced acute akathisia

 

Abstract

Background

Neuroleptic-induced akathisia is one of the most common and distressing early-onset adverse effects of first generation 'typical' antipsychotic drugs. It is associated with poor compliance with treatment, and thus, ultimately, with an increased risk of relapse. We assessed the role of anticholinergic drugs as an adjunct therapy to standard antipsychotic medication in the pharmacological treatment of this adverse effect.

Objectives

To review anticholinergic drugs for neuroleptic-induced acute akathisia.

Search methods

We searched the Cochrane Schizophrenia Group's Register (October 1999), Biological Abstracts (1982-1999), CINAHL (1982-1999), Cochrane Library (Issue 4 1999), EMBASE (1980-1999), LILACS (1982-1999), MEDLINE (1966-1999) and PsycLIT (1974-1999). References of all identified studies were inspected for more trials and we contacted first authors. Each included study was sought as a citation on the Science Citation Index database. For this 2005-6 update, we searched the Cochrane Schizophrenia Group's Register (July 2005).

Selection criteria

We included all randomised clinical trials of adjunctive anticholinergic drugs in addition to antipsychotic medication compared with placebo, for people with neuroleptic-induced acute akathisia.

Data collection and analysis

We quality assessed and extracted data independently. We calculated the fixed effects relative risk (RR), the 95% confidence intervals (CI) and, where appropriate, the number needed to treat (NNT) for homogeneous dichotomous data on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD).

Main results

We identified no relevant randomised controlled trials.

Authors' conclusions

At present, there is no reliable evidence to support or refute the use of anticholinergics for people suffering from neuroleptic-induced acute akathisia. Akathisia is a distressing movement disorder that remains highly prevalent in people with schizophrenia, both in the developed and developing world. This review highlights the need for well designed, conducted and reported clinical trials to address the claims of open studies as regards the effects of the anticholinergic group of drugs for akathisia.

 

Plain language summary

Anticholinergics for neuroleptic-induced acute akathisia

Akathisia is a common and distressing adverse effect of antipsychotic drugs and is characterised by restlessness and mental unease, both of which can be intense. Akathisia is associated with patterns of restless movement, including rocking, walking on the spot when standing, shuffling and tramping, or swinging one leg on the other when sitting. People may constantly pace up and down in an attempt to relieve the sense of unrest. Several strategies have been used to decrease akathisia, and this review is one in a series addressing the effects of drug treatments on such symptoms. We found no trial-based evidence for the use of anticholinergic drugs for akathisia, thus rendering firm treatment recommendations impossible.

 

摘要

背景

抗乙醯膽鹼藥物治療抗精神病藥物誘發之急性靜坐不能

抗精神病藥物誘發之急性靜坐不能是一種第一代‘典型’抗精神病藥物最常見和早期發生令人痛苦的副作用。這個和治療的藥物順從性不佳相關，因此最後造成了復發危險性的增加。我們評估了抗乙醯膽鹼藥物作為標準抗精神病藥物的附加治療角色來治療這個副作用的藥物治療

目標

回顧抗乙醯膽鹼藥物治療抗精神病藥物誘發之急性靜坐不能

搜尋策略

我們搜索了the Cochrane Schizophrenia Group's Register(1999年10月)，Biological Abstracts(1982 – 1999年)，CINAHL(1982 – 1999年)，Cochrane Library(Issue 4 1999年)，EMBASE(1980 – 1999年)，LILACS(1982 – 1999年)，MEDLINE(1966 – 1999年)及PsycLIT (1974 – 1999年)。為了審查更多的試驗，我們檢視了所有被認可研究的參考文獻也聯絡了第一作者。以Science Citation Index database基礎，每一個研究都被當作引證. 這個於2005 – 6年的更新，我們搜索了the Cochrane Schizophrenia Group's Register(2005年7月)

選擇標準

我們納入了比較附加抗乙醯膽鹼藥物和安慰劑來治療抗精神病藥物誘發之急性靜坐不能所有隨機臨床試驗的病患

資料收集與分析

我們各自獨立地合格地評估和擷取資料。我們計算了固定效應，相對風險(relative risk)，95%信賴區間(95% confidence intervals)和,如果可以的話，以治療意向為基礎來計算益一需治數(the number needed to treat)來同質二分資料。為了延續資料，我們計算了加權平均差異(calculated weighted mean differences)

主要結論

我們確認無恰當的隨機對照試驗

作者結論

目前為止，並無可信的證據去支持或否決抗乙醯膽鹼藥物治療抗精神病藥物誘發之急性靜坐不能病患的使用。靜坐不能的病患是在已開發國家和發展中國家的精神分裂症病患中仍有高盛行率的一種令人難以忍受的運動疾患。這個回顧顯現出設計良好，有指引性的和能報告的臨床試驗來指出抗乙醯膽鹼藥物對於靜坐不能的效果是需要的

翻譯人

本摘要由彰化基督教醫院王智仁翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

抗乙醯膽鹼藥物治療抗精神病藥物誘發之急性靜坐不能。靜坐不能是一種抗精神病藥物常見且令人難受的副作用它的特徵為坐立不安和精神上的不安，兩種均為強烈的，靜坐不能和坐立不安的運動特徵相關，包括了震動、站立時原地踏步、曳步、踩步、站立時交替抖腿。病患不時的跺步來減緩無法靜止的感覺。很多策略被使用來減少靜坐不能，而這個回顧是一個注重藥物治療這個症狀的系列。我們發現並無使用抗乙醯膽鹼藥物治療靜坐不能試驗為基礎的證據，所以提供一個明確治療的建議是不可能的