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

迟发性运动障碍 (TD) 是一种迟发性神经系统综合征，可能是长期使用抗精神病药物的副作用。患有 TD 的人可能有重复的不自主运动，这些运动通常缓慢且扭动，或本质上像跳舞。这些运动最常发生在面部、嘴巴和舌头的肌肉中，但也可能出现在手臂、腿部或躯干中。对 TD 频率的估计不同，但范围从 7% 到 30%（长期服用抗精神病药的人）。1 发展为 TD 所需的暴露时间长短是可变的，但它可能在开始使用抗精神病药物治疗后数月甚至数年发生。一旦 TD 出现，它可能变得不可逆转。因此，早期发现和治疗迟发性运动障碍至关重要。

我很荣幸成为 CURESZ 的一员 迟发性运动障碍专家小组, but I haven’t always been adept at diagnosing TD. For years, no one in my current practice seemed to have “obvious” symptoms of TD, so I came to assume that it was more of a historical problem associated with the older first-generation antipsychotics that I rarely prescribe. In 2016, however, I began working with a young man with schizophrenia whose TD was unmistakable. With no FDA-approved medications at the time, the best I could offer was to remove or reduce one of the two antipsychotics he was taking. He and his father wouldn’t consider any change, because that combination was the only thing that had ever worked for him. When his father suddenly passed away months later, his grief inspired me to learn as much as I could about treating TD. I couldn’t give him his father back, but I could at least try to give him the dignity of control over his body.

I studied neurology journals and textbooks for months and realized that I had unconsciously set my bar for diagnosing TD at only the highest severity level. I had inadvertently become blind to detecting mild to moderate TD. Reading the numerous failed clinical trials of medications and supplements for treating TD, I gained an appreciation of the decades of powerlessness clinicians had felt in trying to treat it. It seemed that recognition of TD was gradually overshadowed by increased screening for other potential side effects of antipsychotics, such as blood sugar and cholesterol elevations– perhaps because the latter are problems for which we have long had good treatment options. In 2017, the FDA approved the first two medications for TD, and treating my patient with one of them benefitted him in profound ways I didn’t expect.

Every psychiatric provider trained in an era in which there was little or nothing we could do to address TD, so many didn’t have enough urgency looking for it. Our diagnostic skills withered, and many newer clinicians never established proficiency in the first place. Now that approved treatments exist, the mental health field will eventually enhance its recognition of TD, but if I didn’t have this unique experience when I did, it might have been years before I stepped up my screening. Until every provider makes a thorough examination for TD a standard part of their appointments, I urge everyone taking an antipsychotic, especially anyone experiencing unusual or unexpected movement problems, to be your own advocate and take the lead in discussing tardive dyskinesia treatment with your provider.

参考资料： 1. Carbon 等人。 J Clin Psychiatry 2017;78(3):e264–e278。