Etiological characteristics and treatment of tardive dyskinesia

Zhe Li; Xueli Sun; Che Zhou

摘要：OBJECTIVE:The pathogenesis of tardive dyskinesia(TD)is complicated and uncertain.Thus,there is not any effective treatment for it.The psychiatrists pay more and more attention to TD,which lasts for a long time and is difficult to treat.DATA SOURCES: A computer-based online search of Medline database was undertaken to jdentify articles about the feature of etiology and the progression of treatment for TD published in English by using the keywords of"TD,etiology.pathogenesis"and"TD,therapy,drug treatment".Meanwhile,Chinese articles about the feature of etiologY and the progression of treatment for TD were searched in Wanfang database and China joumal full-text database,and the keywords were"TD,etiology,pathogenesis"and"TD,therapy,drug Treatment".-in Chinese.STUDY SELECTION:Articles met the following inclusion cdteda were selected in this paper.Inclusion cdteda:①Researches of randomized blind control design,before and after control design and retrospective.②Researches of the feature of etiology and the progression of treatment for TD.Exclusion cdteda:the repetitive researches and individual reports,DATA EXTRACTION:Totally 65 articles related the feature of etiology and the progression of treatment for TD of randomized blind control design,before and after control design and retrospective studies were collected,and 53 of them were accorded with the inclusion criteda.Of the 12 excluded ones,8 were concerning with genetics,4 were repetitive researches.DATA SYNTHESIS:The feature of etiology for TD includes:①Hypothesis of dopamine receptor super-sensitivity:The dopamine recaptor is persistently blocked,so it wi¨result in functional disorder in CNS,and then TD may take place.②Hypothesis of neuronal degeneration:The concentration of aminosucoinic acid and glutamic acid wi¨;ncrease after the antipsychotic used for a Iong time and this wilI result in neuronal degeneration through glutamic acid receptor in the postsynaptic membrane;meanwhile with free radical.the nerve cells of corpus striatum may degenerate and become necrosis.③Sex and age:The females and gerontal patients are liability to the TD disease.Its may related to the Iower estrogen.④Molecule heredity:TD may association 、Ⅳith the dopamine and 5-HT receptor gene polymorphism.⑤0ther theodes:Hypofunction of γ-amino-butyrdc acid(GABA).hypothesis of noradrenaline 5-serotonin and nutrition metabolism can cause TD disease.Treatment for TD:①Dopamine receptor agonist:The therapeutic effect is not satisfactory.especially for gerontism females.②Oxygen free radical scavenger:As represent of vitamin E.it can clear out free radicals and reduce the potential cytotoxic effect of free radicals.③Calcium channel blocker:This maybe related to block calcium ions releasing from muscle calls and inhibit muscle convulsion;therefore.it can be used for symptomatic treatment.④GABA receptor agonist:it is more effective for the prominent dysmyotonia than dancing slowly symptom.⑤Antipsychotic:There is some therapeutic effect with clozapine.but the effect wi¨reduce because of the age grcwing up and the symptom exacerbating.⑥Other therapies:Valproate sodium,cyproheptadine,melatonin,branched chain amino acid,ahalysantinfarctasum,electric acupuncture and injection ad acumen.traditional Chinese drug have a certain effects on TD.Prevention of TD:The serum creatine phosphokinase(CPK) combined with symptoms should be checked regularly s0 as to early discovery TD.CONCLUSION:①iology of TD:The hypothesis of dopamine receptor super-sensitivity is denyed;the hypothesis of neuronal degeneration is approved in academic circles;the sex and age is a finding of generally received; but the dopamine and 5-HT receptor gene polymorphism,hypofunction of GABA, noradrenaline.5-serotonin and nutrition metabolism cannot explain the pathogenesis of TD.②Treatment for TD:The therapeutic effect of dopamine receptor agonist is not satisfactory;the oxygen free radical scavenger maybe effective;calcium channel blocker maybe used for symptomatic treatment;GABA receptor agonist maybe more ef.feclive for the prominent dysmyotonia than dancing slowly symptom:the consequence of antipsychotic is discrepancy other therapies maybe use to adjunctive therapies.③As far as prevention of TD is concomed,and the serum CPK combined with symptoms should be checked regularly so as to eady discovery TD.