克雷格·切普克博士，CURESZ 基金会董事会成员，私人执业精神病医生和兼职助理教授
北卡罗来纳大学医学院精神病学

迟发性运动障碍：对患者生活的影响

我最近在教一位精神科医师助理有关迟发性运动障碍 (TD) 的知识，他告诉我他的临床主管，一位即将退休的经验丰富的精神科医生，表达了这样一种观点，“我不知道为什么每个人都对 TD 如此激动——这是远没有我以前在州立医院看到的那么糟糕。你们这些年轻人对事情的情绪反应太多了。”美国最近一直在努力应对早该对社会不公进行的清算，我希望医学领域也能改变它对 TD 患者所遭受的苦难的反应方式。

TD 患者面临着深远的社会和职业后果。我的一位患者是一位聪明、勤奋的 49 岁女性，她在办公室工作。长期以来，她一直觉得自己正在撞上“玻璃天花板”，试图在男性主导的职业中以女性身份攀登公司阶梯。当她患上 TD 时，她害怕这会成为阻碍她的上司和同事认真对待她的又一个障碍。她太自觉了，以至于她可能会在自己不注意的情况下不自觉地进行面部运动，因此她将智能手机放在办公桌上，整天记录自己的面部表情。她会在午餐时间或下班后浏览视频，只要有任何动静，她就会开始哭泣，并对自己永远无法实现自己的职业目标感到绝望。

She remarked that she felt lucky that she had a good job when she developed TD because she didn’t think anyone would hire her for even an entry-level position with TD. I have had other patients with TD feel discriminated against when applying for both blue- and white-collar jobs, and a recent clinical trial studied this situation1. Actors were filmed participating in a scripted interview that had two versions: one in which the actor imitated facial movements consistent with mild to moderate TD and another in which he did not. The 800 people were evenly randomized to watch either the imitated TD version or the non-TD version, and all participants were asked questions about their impressions of the interviewee in regards to employment, friendship, or dating.

该研究的结果令人沮丧，如果不是令人惊讶的话。虽然大约 65% 的人看到非 TD 版本认为受访者适合面向客户的工作，但只有 25% 的人看到同一个演员以同样的方式说同样的话——但有明显的轻度到中度非自愿面部表情动作——认为他适合同样的工作。该研究还表明，参与者认为模仿 TD 的演员明显不那么有趣、不友好，也不喜欢约会对象。

The 65 years that preceded the approval of VMAT2 inhibitors were filled with futility in treating TD, until minimizing or ignoring it became a habit. As with any suffering we turn a blind eye to, there are consequences we don’t perceive until a light is shined on them. Healthcare providers cannot give our patients with TD a job. Still, with safe and effective treatments now available, there is at least one form of social injustice we can remedy far more easily than most of those our society currently faces.

  1. Ayyagari 等。 “115 一项评估轻度至中度迟发性运动障碍的职业和社会后果的实验研究。” CNS 频谱 25.2 (2020)：275-275。