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 identify articles about the feature of etiology and the progression of treatment for TD published in English by using the keywords of ＂rD, 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 journal full-text database, and the keywords were ＂TD, etiology, pathogenesis＂ and ＂TD, therapy, drug Treatment＂ in Chinese. STUDY SELECTION： Articles met the following inclusion criteria were selected in this paper. Inclusion criteria： （1） Researches of randomized blind control design, before and after control design and retrospective. （2） Researches of the feature of etiology and the progression of treatment for TD. Exclusion criteria： 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 criteria. Of the 12 excluded ones, 8 were concerning with genetics, 4 were repetitive researches. DATA SYNTHESIS ： The feature of etiology for TD includes：（1） Hypothesis of dopamine receptor super-sensitivity： The dopamine receptor is persistently blocked, so it will result in functional disorder in CNS, and then TD may take place. （2）） Hypothesis of neuronal degeneration： The concentration of aminosuccinic acid and glutamic acid will increase after the antipsychotic used for a long time and this will 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. （3） Sex and age： The females and gerontal patients are liability to the TD disease. It is may related to the lower estrogen. （4） Molecule heredity： TD may association with the dopamine and 5-HT receptor gene polymorphism. （5） Other theories： Hypofunction of γ-amino-butyri acid （GABA）, hypothesis of noradrenaline 5-serotonin and nutrition metabolism can cause TD disease. Treatlent for TD： （1） Dopamine receptor agonist： The therapeutic effect is not satisfactory, especially for gerontism females. （2） Oxygen free radical scavenger： As represent of vitamin E, it can clear out free radicals and reduce the potential cytotoxic effect of free radicals. （3） Calcium channel blocker： This maybe related to block calcium ions releasing from muscle cells and inhibit muscle convulsion; therefore, it can be used for symptomatic treatment. （4） GABA receptor agonist： It is more effective for the prominent dysmyotonia than dancing slowly symptom. （5） Antipsychotic： There is some therapeutic effect with ciozapine, but the effect will reduce because of the age growing up and the symptom exacerbating. （6） Other 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 so as to early discovery TD. CONCLUSION ： （1） Etiology 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. （2） Treatment 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 effective for the prominent dysmyotonia than dancing slowly symptom; the consequence of antipsychotic is discrepancy; other therapies maybe use to adjunctive therapies. （3） As far as prevention of TD is concerned, and the serum CPK combined with symptoms should be checked regularly so as to early discovery TD.
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 identify articles about the feature of etiology and the progression of treatment for TD published in English by using the keywords of ＂rD, 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 journal full-text database, and the keywords were ＂TD, etiology, pathogenesis＂ and ＂TD, therapy, drug Treatment＂ in Chinese. STUDY SELECTION： Articles met the following inclusion criteria were selected in this paper. Inclusion criteria： （1） Researches of randomized blind control design, before and after control design and retrospective. （2） Researches of the feature of etiology and the progression of treatment for TD. Exclusion criteria： 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 criteria. Of the 12 excluded ones, 8 were concerning with genetics, 4 were repetitive researches. DATA SYNTHESIS ： The feature of etiology for TD includes：（1） Hypothesis of dopamine receptor super-sensitivity： The dopamine receptor is persistently blocked, so it will result in functional disorder in CNS, and then TD may take place. （2）） Hypothesis of neuronal degeneration： The concentration of aminosuccinic acid and glutamic acid will increase after the antipsychotic used for a long time and this will 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. （3） Sex and age： The females and gerontal patients are liability to the TD disease. It is may related to the lower estrogen. （4） Molecule heredity： TD may association with the dopamine and 5-HT receptor gene polymorphism. （5） Other theories： Hypofunction of γ-amino-butyri acid （GABA）, hypothesis of noradrenaline 5-serotonin and nutrition metabolism can cause TD disease. Treatlent for TD： （1） Dopamine receptor agonist： The therapeutic effect is not satisfactory, especially for gerontism females. （2） Oxygen free radical scavenger： As represent of vitamin E, it can clear out free radicals and reduce the potential cytotoxic effect of free radicals. （3） Calcium channel blocker： This maybe related to block calcium ions releasing from muscle cells and inhibit muscle convulsion; therefore, it can be used for symptomatic treatment. （4） GABA receptor agonist： It is more effective for the prominent dysmyotonia than dancing slowly symptom. （5） Antipsychotic： There is some therapeutic effect with ciozapine, but the effect will reduce because of the age growing up and the symptom exacerbating. （6） Other 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 so as to early discovery TD. CONCLUSION ： （1） Etiology 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. （2） Treatment 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 effective for the prominent dysmyotonia than dancing slowly symptom; the consequence of antipsychotic is discrepancy; other therapies maybe use to adjunctive therapies. （3） As far as prevention of TD is concerned, and the serum CPK combined with symptoms should be checked regularly so as to early discovery TD.
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 journal full-text database, and the keywords were 'TD, etiology, pathogenesis' and 'TD, therapy, drug Treatment' in Chinese. STUDY SELECTION: Articles met the following inclusion criteria were selected in this paper. Inclusion criteria: ① Researches of randomized blind control design, before and after control design and retrospective. ② Researches of the feature of etiology and the progression of treatment for TD. Exclusion criteria: 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 criteria. Of the 12 excluded ones, 8 were concerning with genetics, 4 were repetitive researches. DATA SYNTHESIS: The feature of etiology for TD includes: ① Hypothesis of dopamine receptor super-sensitivity: The dopamine receptor is persistently blocked, so it will result in functional disorder in CNS, and then TD may take place. ② Hypothesis of neuronal degeneration: The concentration of aminosuccinic acid and glutamic acid will increase after the antipsychotic used for a long time and this will 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. ③ Sex and age: The females and gerontal patients are liability to the TD disease. It is may related to the lower estrogen. ④ Molecule heredity: TD may association with the dopamine and 5-HT receptor gene polymorphism. ⑤ Other theories: Hypofunction of γ-amino-butyric acid (GABA), hypothesis of noradrenaline 5-serotonin and nutrition metabolism can cause TD disease. Treatment for TD: ① Dopamine receptor agonist: The therapeutic effect is not satisfactory, especially for gerontism females. ② Oxygen free radical scavenger: As represent of vitamin E, it can clear out free radicals and reduce the potential cytotoxic effect of free radicals. ③ Calcium channel blocker: This maybe related to block calcium ions releasing from muscle cells and inhibit muscle convulsion
therefore, it can be used for symptomatic treatment. ④ GABA receptor agonist: It is more effective for the prominent dysmyotonia than dancing slowly symptom. ⑤ Antipsychotic: There is some therapeutic effect with clozapine, but the effect will reduce because of the age growing up and the symptom exacerbating. ⑥ Other 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 so as to early discovery TD. CONCLUSION: ① Etiology 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. ② Treatment 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 effective for the prominent dysmyotonia than dancing slowly symptom
the consequence of antipsychotic is discrepancy
other therapies maybe use to adjunctive therapies. ③ As far as prevention of TD is concerned, and the serum CPK combined with symptoms should be checked regularly so as to early discovery TD.
