奥氮平致迟发性肌张力障碍的诊断学特征并文献复习  

Diagnostic features and literature review of olanzapine-induced tardive dystonia

作　　者：孙振晓[1] 孙仕田[1] 孙波[1] Sun Zhenxiao;Sun Shitian;Sun Bo(Department of Psychiatry,Linyi Municipal Mental Health Center,Linyi 276005,China)

机构地区：[1]临沂市精神卫生中心精神科,276005

出　　处：《中华诊断学电子杂志》2018年第4期260-263,共4页Chinese Journal of Diagnostics(Electronic Edition)

摘　　要：目的探讨奥氮平致迟发性肌张力障碍(TDt)的诊断学特征。方法回顾性分析2018年4月11日临沂市精神卫生中心就诊的1例因奥氮平致TDt患者的临床资料,并检索"PubMed"及"中国知网"数据库对奥氮平致TDt的文献进行复习。结果患者既往无肌张力障碍病史及家族史,在应用奥氮平1. 5年后出现颈部发硬、向左扭转歪斜,根据病史、体格检查及辅助检查可排除其他原因所致的继发性肌张力障碍,诊断为奥氮平所致TDt。逐渐停用奥氮平,加用氯氮平治疗,首剂25 mg/d,渐增至125 mg/d治疗并应用乙哌立松50 mg,每日3次治疗,患者精神症状稳定,颈部向左扭转歪斜未恢复。国内外文献报道的15例患者中,男性8例,女性7例;年龄16～51岁,平均(28. 13±10. 27)岁;服用奥氮平剂量5～20 mg/d,平均(13. 33±5. 23) mg/d; TDt出现时间4 h至5年,出现于应用奥氮平1年以内者12例;临床类型:局灶型7例、节段型5例、多灶型1例、全身型2例;对TDt的治疗,除1例未停用奥氮平外,其余均停用奥氮平。结论奥氮平所致TDt尽管少见,但治疗困难,应采取有效措施,预防奥氮平所致TDt的发生。在应用奥氮平治疗期间应严密观察,及时发现,及时处理。Objective To explore the diagnostic features of olanzapine-induced tardive dystonia （TDt）. Methods The clinical data of an outpatient with olanzapine-induced TDt on April 11, 2018 at Linyi Municipal Mental Health Center were retrospectively analysed. Literatures of olanzapine-induced TDt were retrieved by PubMed and China National Knowledge Internet databases and reviewed. Results The patient had no personal or family history of dystonia, she developed neck stiffness, torticollis, with the neck turning around to the left after 1.5 years of olanzapine treatment. According to medical history, physical examination and accessory examination, secondary dystonia due to other reasons was ruled out. The diagnosis of olanzapine-induced TDt was made. The olanzapine was gradually discontinued, and clozapine was initiated on a daily dose of 25 mg and was titrated to 125 mg daily. Eperisone hydrochloride tablets was given 50 mg three times a day. The psychotic symptoms were stable, but the cervical dystonia was not recovered. Of the 15 cases reported in literatures, there were 8 males and 7 females. Their mean age was （28.13±10.27） years （range 16-51 years）. Their mean olanzapine dose was （13.33±5.23）mg daily （range 5-20 mg daily）. The onset of TDt occurred 4 hours to 5 years after treatment with olanzapine,12 cases developed TDt within one year. The dystonia was focal in 7 cases, segmental in 5cases,multifocal in 1case, generalized in 2 cases. After the development of TDt, 14 cases discontinued olanzapine. Conclusions Although olanzapine- induced TDt is uncommon, but therapeutic management is usually difficult. Effective measures should be taken to prevent the incidence of olanzapine- induced TDt. Careful assessments are required for tardive dystonia in patients receiving olanzapine, detecting timely and coping with timely.

关 键 词：奥氮平 迟发性肌张力障碍 诊断 治疗 

分 类 号：R749[医药卫生—神经病学与精神病学]