PDF(Pubmed)
Abstract：
Drug-induced movement disorders (DIMDs) are associated with use of dopamine receptor blocking agents (DRBAs), including antipsychotics. The most common forms are drug-induced parkinsonism (DIP), dystonia, akathisia, and tardive dyskinesia (TD). Although rare, neuroleptic malignant syndrome (NMS) is a potentially life-threatening consequence of DRBA exposure. Recommendations for anticholinergic use in patients with DIMDs were developed on the basis of a roundtable discussion with healthcare professionals with extensive expertise in DIMD management, along with a comprehensive literature review. The roundtable agreed that \"extrapyramidal symptoms\" is a non-specific term that encompasses a range of abnormal movements. As such, it contributes to a misconception that all DIMDs can be treated in the same way, potentially leading to the misuse and overprescribing of anticholinergics. DIMDs are neurobiologically and clinically distinct, with different treatment paradigms and varying levels of evidence for anticholinergic use. Whereas evidence indicates anticholinergics can be effective for DIP and dystonia, they are not recommended for TD, akathisia, or NMS; nor are they supported for preventing DIMDs except in individuals at high risk for acute dystonia. Anticholinergics may induce serious peripheral adverse effects (e.g., urinary retention) and central effects (e.g., impaired cognition), all of which can be highly concerning especially in older adults. Appropriate use of anticholinergics therefore requires careful consideration of the evidence for efficacy (e.g., supportive for DIP but not TD) and the risks for serious adverse events. If used, anticholinergic medications should be prescribed at the lowest effective dose and for limited periods of time. When discontinued, they should be tapered gradually.
摘要：
药物诱发的运动障碍（DIMD）与多巴胺受体阻断剂（DRBA）的使用有关，包括抗精神病药.最常见的形式是药物诱发的帕金森病（DIP），肌张力障碍,静坐不能,和迟发性运动障碍（TD）。虽然罕见，抗精神病药恶性综合征(NMS)是DRBA暴露可能危及生命的后果.在DIMD患者中使用抗胆碱能药物的建议是在与在DIMD管理方面具有广泛专业知识的医疗保健专业人员进行圆桌讨论的基础上制定的。以及全面的文献综述。圆桌会议同意“锥体外系症状”是一个非特异性术语，涵盖了一系列异常运动。因此，它导致了一种误解，即所有DIMD都可以以相同的方式对待，可能导致抗胆碱能药物的滥用和过量使用。DIMD是神经生物学和临床上不同的，不同的治疗模式和不同水平的抗胆碱能使用的证据。尽管有证据表明抗胆碱能药物对DIP和肌张力障碍有效，它们不推荐用于TD，静坐不能,或NMS；除了急性肌张力障碍高危人群，它们也不支持预防DIMD。抗胆碱能药可能会引起严重的外周不良反应（例如，尿潴留)和中枢效应(例如，认知受损)，所有这些都可能引起高度关注，尤其是在老年人中。因此，适当使用抗胆碱能药物需要仔细考虑疗效的证据(例如，支持DIP而不是TD)和严重不良事件的风险。如果使用,抗胆碱能药物应以最低有效剂量和有限的时间处方。当停产时,它们应该逐渐变细。
