Klinische Charakteristika von Patienten mit tardiven Dyskinesien

T. Held; T. Weber; H. Krausz; G. Ahle; B. Hager; D. Alfter; T. Schulze; M. Knapp; W. Maier; M. Rietschel

doi:10.1055/s-2000-11805

Fortschritte der Neurologie · Psychiatrie, Inhaltsverzeichnis

Fortschr Neurol Psychiatr 2000; 68(7): 321-331
DOI: 10.1055/s-2000-11805

ORIGINALARBEIT

Georg Thieme Verlag Stuttgart · New York

Klinische Charakteristika von Patienten mit tardiven Dyskinesien

T. Held¹ , T. Weber¹ , H. Krausz² , G. Ahle² , B. Hager¹ , D. Alfter² , T. Schulze² , M. Knapp³ , W. Maier² , M. Rietschel²

¹Rheinische Kliniken, Bonn (Ärztl. Leiter: Prof. Dr. T. Held)
²Klinik und Poliklinik für Psychiatrie und Psychotherapie der Rheinischen Friedrich-Wilhelms-Universität Bonn(Direktor: Prof. Dr. W. Maier)
³Institut für Medizinische Biometrie, Informatik undEpidemiologie der Rheinischen Friedrich-Wilhelms-Universität Bonn (Direktor: Prof. Dr. M. P. Baur)

Abstract

Zusammenfassung:

Wenngleich eine große Zahl von Arbeiten zum Zusammenhang zwischen tardiven Dyskinesien und Patientencharakteristika existiert, ist ihre Aussagekraft häufig durch mangelnde operationalisierte Phänotypisierung der Patienten und ihrer Befunde eingeschränkt. Speziell im Zusammenhang mit neurobiologischer und molekulargenetischer Fragestellung ist aber eine reliable Phänotypisierung von äußerster Bedeutung. 241 Patienten mit den DSM-IV-Diagnosen Schizophrenie und Schizoaffektive Störung wurden mit den Instrumenten SADS-L, OPCRIT, BPRS und PANSS untersucht. Zur Untersuchung der Motorik wurden an 2 unterschiedlichen Tagen innerhalb von 3 Monaten die Befunde mit folgenden Skalen erhoben: TDRS, AIMS, SAS, BAS. Die Diagnose „tardive Dyskinesie” wurde nach den Forschungskriterien von Schooler u. Kane gestellt. Die Lebenszeitmedikation mit Neuroleptika und Anticholinergika wurde möglichst genau quantitativ erfasst. Ergebnisse: 97 von 233 Probanden (= 41,6 %) wiesen tardive Dyskinesien auf. Bei der univariaten Analyse wiesen folgende unabhängige Variablen einen statistisch signifikanten Zusammenhang mit der Zielvariablen „persistent tardive dyskinesia” auf (stärkere Merkmalsausprägung = Risikofaktor): Alter (p = 0,001), Jahre seit Krankheitsbeginn (p = 0.001), Gesamtdauer stationärer Behandlung (p = 0,001), PANSS (Einzelskalen und Summenscore) (p = 0,0001), Neuroleptika-Gesamtdosis in CPZ-Äquivalenten (p = 0,004). Die logistische Regressionsanalyse ergab, dass einzig „Alter” und „Negativsymptomatik nach PANSS” einen Zusammenhang mit tardiven Dyskinesien aufweisen, der nicht durch die Kovariation mit anderen unabhängigen Variablen erklärbar ist. Wurde anstelle der dichotomen Zielvariablen „tardive Dyskinesien ja/nein” der Zahlenwert der TDRS-Skala gewählt, so ergaben sich dieselben Zusammenhänge. Unsere Arbeit verweist auf die Wichtigkeit, neurobiologische Korrelate von „Alter” und „Negativsymptomatik” in Bezug auf die Disposition zu tardiven Dyskinesien zu suchen.

Clinical Characteristics of Patients with Tardive Dyskinesia:

Although there is a great number of studies on the relationship between tardive dyskinesia and patient characteristics, too often their validity is impaired by the lack of operationalized criteria for the description of patients and signs. Reliable phenotyping is of utmost importance for linking clinical data with data from methods in neurobiology or molecular genetics. 241 patients with the DSM IV diagnosis “schizophrenia” or “schizoaffective disorder” were examined with the instruments SADS-L, OPCRIT, BPRS and PANSS. Motor phenomena were analyzed on 2 separate days within 3 months with the scales TDRS, AIMS, SAS, BAS. Tardive dyskinesia was diagnosed following the research criteria of Schooler and Kane. Lifetime medication with neuroleptics and anticholinergic drugs was assessed quantitatively. Results: 97 out of 233 patients (= 41,6 %) displayed persistent tardive dyskinesia. In univariate analysis, signifikant associations were found between tardive dyskinesia and the following independent variables (higher values means greater risk): Age (p = 0,0001), years from onset of the disorder (p = 0,001), total length of stay in hospital (p = 0,001), PANSS (single scales and sum score) (p = 0,0001), total amount of neuroleptics expressed as CPZ equivalents (p = 0,004). Logistic regression analysis showed that only the variables “age” and “negative symptoms” expressed as score on the PANSS negative subscale showed an association with tardive dyskinesia that could not be explained by covariation with other variables. The same results were found when, instead of the dichotomous variable “tardive dyskinesia yes/no” the associations with the TDRS score were analyzed. Future research should aim to approach the neurobiological correlates of “age” and “negative symptoms” in relationship to tardive dyskinesia.

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Referenzen

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Prof. Dr. T. Held

Rheinische Kliniken Bonn

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