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Forgotten but not gone: new developments in the understanding and treatment of tardive dyskinesia

机译：遗忘但没有走出去：迟钝的动脉紊乱的理解和治疗的新发展

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The broad use of atypical antipsychotics was expected to dramatically reduce the prevalence and incidence of tardive dyskinesia (TD), but data show that TD remains an important challenge due the persistent nature of its symptoms and resistance to numerous treatment modalities, including antipsychotic discontinuation. Recent insights on genetic risk factors and new concepts surrounding pathophysiology have spurred interest in the possibility of targeted treatment for TD. As will be reviewed in this article, the number of evidence-based strategies for TD treatment is small: only clonazepam, amantadine, ginkgo biloba extract, and the vesicular monoamine transporter 2 (VMAT2) inhibitor tetrabenazine have compelling data. Using new insights into the metabolism of tetrabenazine and the properties of its active metabolites, 2 modifications of tetrabenazine have been synthesized to improve the kinetic profile, and are currently involved in double-blind placebo controlled studies aimed at U.S. Food and Drug Administration (FDA) regulatory approval. The possible availability of these new agents, deuterated tetrabenazine and valbenazine, significantly widens the range of treatment choices for patients with TD. For clinicians with patients at risk for TD due to dopamine antagonist exposure, experience has shown that the problem of TD will be an ongoing issue in modern psychiatry, and that an appreciation of new developments in the pathophysiology of, risk factors for, and treatment of TD is crucial to managing this condition.
机译：广泛使用非典型抗精神病药物预计会显着降低迟发性失育障碍（TD）的患病率和发病率，但数据表明，TD仍然是由于其症状和抗性对众多治疗方式的持续性质，包括抗精神病药的性质。最近关于遗传危险因素和围绕病理生理学的新概念的见解对TD的有针对性处理的可能性产生了兴趣。根据本文将审查，TD治疗的基于循证策略的数量小：只有克隆泮，甘氨酸，银杏叶植物萃取物和脉络膜单胺转运蛋白2（VMAT2）抑制剂四甲嗪具有引人注目的数据。利用新的见解对四丁嗪的新陈代谢和其活性代谢物的性质，已经合成了四丁嗪的修饰，以改善动力学型材，目前涉及针对美国食品和药物管理局（FDA）的双盲安慰剂受控研究监管批准。这些新药可能的可用性，氘代四萘嗪和缬沙嗪，显着扩大了TD患者的治疗选择范围。对于由于多巴胺拮抗剂暴露而导致TD风险患者的临床医生，经验表明，TD的问题将是现代精神病学的持续问题，并欣赏对危险因素的病理生理学，危险因素的新发展TD对于管理这种情况至关重要。

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