第三代抗精神病药物引发冲动控制障碍的研究进展

Research progress on impulse control disorders induced by third-generation antipsychotics

冲动控制障碍(ICDs)是一类在没有合理的动机下重复出现自己不能控制而伤害他人或自己利益行为的精神障碍,常见表现有病理性赌博、性欲亢进、强迫性购物、强迫性进食等,对患者自身、家庭和社会均造成沉重负担。第三代抗精神病药物(TGAs)包括阿立哌唑、布瑞哌唑和卡利拉嗪等,对多巴胺D2、D3和5-羟色胺1A受体存在激动或部分激动作用,可能引发ICDs,然而目前临床中仍存在识别不足、筛查工具不明确、干预手段有限等局限性,对TGAs引发ICDs的认知及疾病干预水平需进一步提升。本文从TGAs引发ICDs的流行病学、危险因素、生理机制、临床评估、诊断及治疗进展进行综述,以期提高临床医生对该疾病的了解与识别,及早采取合适的治疗手段,减轻患者痛苦,改善疾病预后。

Impulse control disorders(ICDs)are a group of mental disorders in which one repeatedly experiences behaviors that they cannot control and harm others'or their own interests without reasonable motivation.ICDs include pathological gambling,hypersexuality,compulsive shopping,compulsive eating and so on,which cause serious burdens on patients themselves,their families,and society.Third-generation antipsychotics(TGAs),including aripiprazole,brepiprazole,and caliprazine,with agonism or partial agonism on dopamine D2 and D3 receptors and 5-hydroxytryptamine 1A receptor,may induce ICDs.However,there are still limitations in clinical practice,such as insufficient identification,unclear screening tools,and limited interventions,and disease awareness and intervention for TGA-induced ICDs need to be further improved.This paper reviews the epidemiology,risk factors,physiological mechanisms,clinical evaluation,diagnosis,and treatment of TGAs-induced ICDs,in order to enhance clinicians'understanding of this disease and adopt appropriate treatments to alleviate patients'pain and improve disease prognosis.