psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»10.30629/2618-6667-2020-18-2-32-38psychiatry-473Research ArticleПСИХОПАТОЛОГИЯ, КЛИНИЧЕСКАЯ И БИОЛОГИЧЕСКАЯ ПСИХИАТРИЯPSYCHOPATHOLOGY, CLINICAL AND BIOLOGICAL PSYCHIATRYРоль антипсихотической терапии в развитии акатизии у больных шизофрениейThe Role of Antypsychotic Therapy in the Development of Akathisia in Patients with Schizophreniahttps://orcid.org/0000-0001-5260-5245ГончароваА. А.GoncharovaA. A.

Гончарова Анастасия Александровна, аспирант

Томск

Anastasya A. Goncharova, Graduate, Postgraduate Student

Tomsk

goncharanastasya@gmail.comhttps://orcid.org/0000-0002-5179-9727КорнетоваЕ. Г.KornetovaE. G.

Корнетова Елена Георгиевна, доктор медицинских наук

Томск

Elena G. Kornetova, PhD, MD, Dr. of Sci. (Med.)

Tomsk

kornetova@sibmail.comФГБНУ «Научно-исследовательский институт психического здоровья», Томский национальный исследовательский медицинский центр Российской академии наукРоссияFSBSI “Tomsk National Research Medical Center, Russian Academy of Sciences”, Mental Health Research InstituteRussian FederationФГБНУ «Научно-исследовательский институт психического здоровья», Томский национальный исследовательский медицинский центр Российской академии наук; ФГБОУ ВО «Сибирский государственный медицинский университет» МЗ РФРоссияFSBSI “Tomsk National Research Medical Center, Russian Academy of Sciences”, Mental Health Research Institute; Siberian State Medical UniversityRussian Federation2020220720201823238Copyright © Гончарова А.А., Корнетова Е.Г., 20202020Гончарова А.А., Корнетова Е.Г.Goncharova A.A., Kornetova E.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journalpsychiatry.com/jour/article/view/473

Использование антипсихотической терапии у пациентов с шизофренией сопряжено с развитием широкого спектра нежелательных явлений, среди которых акатизия является одним из наиболее часто встречающихся симптомов. Цель работы: оценить риск развития акатизии у больных шизофренией, получающих различную антипсихотическую терапию. Пациенты и методы: сплошным методом обследовано 250 стационарных пациентов с верифицированным диагнозом шизофрении. Оценка акатизии выполнена с использованием шкалы оценки акатизии Барнса (BARS). Оценка отношения шансов выполнена с использованием онлайн-калькулятора MedCalc®. Результаты: акатизия выявлена у 92 (36,8%) обследованных. Комбинация двух антипсихотических препаратов повышала риск развития акатизии у больных шизофренией ОШ = 1,69 (95% ДИ: 1,0–2,88; p = 0,04), однако назначение конвенционального и атипичного препаратов было связано со снижением риска (ОШ = 0,45 (95% ДИ: 0,21–0,95; p = 0,037)). У пациентов, получающих в качестве базисной терапии зуклопентиксол деканоат, обнаружено повышение риска развития акатизии в 4 раза по сравнению с галоперидолом деканоатом (ОШ = 3,85 (95% ДИ: 1,26–12,22; p = 0,021)). Выводы: показано, что выбор антипсихотической терапии должен базироваться не только на актуальном психическом состоянии пациента, но и с учетом потенциального риска развития акатизии.

The use of antipsychotic therapy in patients with schizophrenia is associated with the development of a wide range of adverse events, among which akathisia is one of the most common. Objective: to assess the risk of akathisia in patients with schizophrenia receiving various antipsychotic therapy. Patients and methods. A continuous method examined 250 inpatients with a verified diagnosis of schizophrenia. The akathisia assessment was performed using the Barnes Akathisia Rating Scale (BARS). The odds ratio was estimated using the MedCalc® online calculator. Results: akathisia was detected in 92 (36.8%) examined. The combination of two antipsychotic drugs has an increased risk of akathisia in patients with schizophrenia OR = 1.69 (95% CI: 1.0–2.88; p = 0.04), however the use of conventional and atypical drugs was associated with a reduction in risk (OR = 0.45 (95% CI: 0.21–0.95; p = 0.037)). Patients receiving basic therapy zuclopenthixol decanoate had increased risk of akathisia 4 times as compared to haloperidol decanoate (OR = 3.85 (95% CI: 1,26–12,22; p = 0.021)). Conclusions: It was shown that the choice of antipsychotic therapy should be based not only on the actual mental state of the patient, but also considering the potential risk of akathisia.

акатизияшизофренияпсихофармакологияантипсихотикитерапияakathisiaschizophreniapsychopharmacologyantipsychoticstherapyИсследование выполнено при финансовой поддержке РФФИ в рамках научного проекта № 19-315-90010.The reported study was funded by RFBR, project number 19-315-90010.ReferencesIznak AF, Iznak EV, Damjanovich EV, Klyushnik TP, Kobel’kov GM, Oleichik IV, Abramova LI. Neurobiological parameters in quantitative prediction of treatment outcome in schizophrenic patients. J. Integr. Neurosci. 2018;17(3–4):317–329. https://doi.org/10.3233/JIN-170054Iznak AF, Iznak EV, Damjanovich EV, Klyushnik TP, Kobel’kov GM, Oleichik IV, Abramova LI. Neurobiological parameters in quantitative prediction of treatment outcome in schizophrenic patients. J. Integr. Neurosci. 2018;17(3–4):317–329. https://doi.org/10.3233/JIN-170054Марусин АВ, Корнетов АН, Сваровская МГ, Вагайцева КВ, Павленюк ЕС, Степанов ВА. Ассоциация генов подверженности к алкоголизму, шизофрении и болезни Альцгеймера с психодиагностическими признаками в популяции русских. Бюллетень сибирской медицины. 2016;15(5):83–96. https://doi.org/10.20538/1682-0363-2016-5-83-96Marusin AV, Kornetov AN, Swarovskaya MG, Vagaitseva KV, Pavlenyuk ES, Stepanov VA. Genetic predisposition to alcoholism, schizophrenia and Alzheimer’s disease with psychodiagnostic characteristics in Russian population. Bjulleten’ sibirskojmediciny. 2016;15(5):83–96. https://doi.org/10.20538/1682-0363-2016-5-83-96 (In Russ.).Семке АВ, Ветлугина ТП, Иванова СА, Рахмазова ЛД, Гуткевич ЕВ, Лобачева ОА, Корнетова ЕГ. Биопсихосоциальные основы и адаптационно-компенсаторные механизмы шизофрении в регионе Сибири. Сибирский вестник психиатрии и наркологии. 2009;5(56):15–20.Semke AV, Vetlugina TP, Ivanova SA, Rakhmazova LD, Gutkevich EV, Lobacheva OA, Kornetova EG. Biopsychosocial bases are considered and adaptive-compensator mechanisms of schizophrenia are described in regional perspective. Siberian Herald of Psychiatry and Addiction Psychiatry. 2009;5(56):15–20. (In Russ.).Смирнова ЛП, Паршукова ДА, Бородюк ЮН, Корнетова ЕГ, Ткачёва ГД, Серегин АА, Бурдовицина ТГ, Семке АВ. Изменения липидного спектра и ЭКГ у больных параноидной шизофренией в процессе терапии атипичными антипсихотиками. Журнал неврологии и психиатрии имени С.С. Корсакова. 2015;115(3):49–53. https://doi.org/10.17116/jnevro20151153149-53Smirnova LP, Parshukova DA, Borodyuk YuN, Kornetova EG, Tkacheva GD, Seregin AA, Burdovitsina TG, Semke AV. Lipid spectrum changes and ECG in patients with paranoid schizophrenia in the course of therapy with atypical antipsychotics. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2015;115(3):49–53. https://doi.org/10.17116/jnevro20151153149-53 (In Russ.).Lohr JB, Eidt CA, Abdulrazzaq Alfaraj A, Soliman MA. The clinical challenges of akathisia. CNS Spectrums. 2015;20(1):1–16. https://doi.org/10.1017/S1092852915000838Lohr JB, Eidt CA, Abdulrazzaq Alfaraj A, Soliman MA. The clinical challenges of akathisia. CNS Spectrums. 2015;20(1):1–16. https://doi.org/10.1017/S1092852915000838Zhang J-P, Gallego JA, Robinson DG, Malhotra AK, Kane JM, Correll CU. Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis. The International Journal of Neuropsychopharmacology. 2013;16:1205–1218. https://doi.org/10.1017/S1461145712001277Zhang J-P, Gallego JA, Robinson DG, Malhotra AK, Kane JM, Correll CU. Efficacy and safety of individual second-generation vs. first-generation antipsychotics in first-episode psychosis: a systematic review and meta-analysis. The International Journal of Neuropsychopharmacology. 2013;16:1205–1218. https://doi.org/10.1017/S1461145712001277Hirjak D, Kubera KM, Bienentreu S, Thomann PA, Wolf RC. Antipsychotic-induced motor symptoms in schizophrenic psychoses. Part 1: Dystonia, akathisia und parkinsonism. Der Nervenartz. 2019;90(1):1–11. https://doi.org/10.1007/s00115-018-0582-5Hirjak D, Kubera KM, Bienentreu S, Thomann PA, Wolf RC. Antipsychotic-induced motor symptoms in schizophrenic psychoses. Part 1: Dystonia, akathisia und parkinsonism. Der Nervenartz. 2019;90(1):1–11. https://doi.org/10.1007/s00115-018-0582-5Oh GH, Yu JC, Choi KS et al. Simultaneous Comparison of Efficacy and Tolerability of Second-Generation Antipsychotics in Schizophrenia: Mixed-Treatment Comparison Analysis Based on Head-to-Head Trial Data. Psychiatry Investigation. 2015;12(1):46–54. https://doi.org/10.4306/pi.2015.12.1.46Oh GH, Yu JC, Choi KS et al. Simultaneous Comparison of Efficacy and Tolerability of Second-Generation Antipsychotics in Schizophrenia: Mixed-Treatment Comparison Analysis Based on Head-to-Head Trial Data. Psychiatry Investigation. 2015;12(1):46–54. https://doi.org/10.4306/pi.2015.12.1.46Martino D, Karnik V, Osland S, Barnes TRE, Pringsheim TM. Movement Disorders Associated With Antipsychotic Medication in People With Schizophrenia: An Overview of Cochrane Reviews and Meta-Analysis. The Canadian Journal of Psychiatry. 2018;1:706743718777392. https://doi.org/10.1177/0706743718777392Martino D, Karnik V, Osland S, Barnes TRE, Pringsheim TM. Movement Disorders Associated With Antipsychotic Medication in People With Schizophrenia: An Overview of Cochrane Reviews and Meta-Analysis. The Canadian Journal of Psychiatry. 2018;1:706743718777392. https://doi.org/10.1177/0706743718777392Grover S, Sahoo S. Clozapine induced akathisia: a case report and review of the evidence. Indian Journal of Pharmacology. 2015;47(2):234–235. https://doi.org/10.4103/0253-7613.153441Grover S, Sahoo S. Clozapine induced akathisia: a case report and review of the evidence. Indian Journal of Pharmacology. 2015;47(2):234–235. https://doi.org/10.4103/0253-7613.153441Berna F, Misdrahi D, Boyer L, Aouizerate B, Brunel L, Capdevielle D, Chereau I, Danion JM, Dorey JM, Dubertret C, Dubreucq J, Faget C, Gabayet F, Lancon C, Mallet J, Rey R, Passerieux C, Schandrin A, Schurhoff F, Tronche AM, Urbach M, Vidailhet P, Llorca PM, Fond G; FACE-SZ (FondaMental Academic Centers of Expertise for Schizophrenia) group; FACE-SZ FondaMental Academic Centers of Expertise for Schizophrenia group. Akathisia: prevalence and risk factors in a community-dwelling sample of patients with schizophrenia. Results from the FACE-SZ dataset. Schizophrenia Research. 2015;169(1–3):255–261. https://doi.org/10.1016/j.schres.2015.10.040Berna F, Misdrahi D, Boyer L, Aouizerate B, Brunel L, Capdevielle D, Chereau I, Danion JM, Dorey JM, Dubertret C, Dubreucq J, Faget C, Gabayet F, Lancon C, Mallet J, Rey R, Passerieux C, Schandrin A, Schurhoff F, Tronche AM, Urbach M, Vidailhet P, Llorca PM, Fond G; FACE-SZ (FondaMental Academic Centers of Expertise for Schizophrenia) group; FACE-SZ FondaMental Academic Centers of Expertise for Schizophrenia group. Akathisia: prevalence and risk factors in a community-dwelling sample of patients with schizophrenia. Results from the FACE-SZ dataset. Schizophrenia Research. 2015;169(1–3):255–261. https://doi.org/10.1016/j.schres.2015.10.040Demyttenaere K, Detraux J, Racagni G, Vansteelandt K. Medication-Induced Akathisia with Newly Approved Antipsychotics in Patients with a Severe Mental Illness: A Systematic Review and Meta-Analysis. CNS Drugs. 2019;33(6):549–566. https://doi.org/10.1007/s40263-019-00625-3Demyttenaere K, Detraux J, Racagni G, Vansteelandt K. Medication-Induced Akathisia with Newly Approved Antipsychotics in Patients with a Severe Mental Illness: A Systematic Review and Meta-Analysis. CNS Drugs. 2019;33(6):549–566. https://doi.org/10.1007/s40263-019-00625-3Fleischhacker WW, Uchida H. Critical review of antipsychotic polypharmacy in the treatment of schizophrenia. The International Journal of Neuropsychopharmacology. 2014;17(7):1083–1093. https://doi.org/10.1017/S1461145712000399Fleischhacker WW, Uchida H. Critical review of antipsychotic polypharmacy in the treatment of schizophrenia. The International Journal of Neuropsychopharmacology. 2014;17(7):1083–1093. https://doi.org/10.1017/S1461145712000399Prophylactic Use of Anticholinergics in Patients on Long-Term Neuroleptic Treatment: A Consensus Statement. World Health Organization heads of centres collaborating in WHO co-ordinated studies on biological aspects of mental illness. British Journal of Psychiatry. 1990;156(3):412–412. https://doi.org/10.1192/bjp.156.3.41Prophylactic Use of Anticholinergics in Patients on Long-Term Neuroleptic Treatment: A Consensus Statement. World Health Organization heads of centres collaborating in WHO co-ordinated studies on biological aspects of mental illness. British Journal of Psychiatry. 1990;156(3):412–412. https://doi.org/10.1192/bjp.156.3.41World Health Organization: The ICD-10 Classification of Mental and Behavioural Disorders — Diagnostic Criteria for Research. Geneva: WHO, 1993.World Health Organization: The ICD-10 Classification of Mental and Behavioural Disorders — Diagnostic Criteria for Research. Geneva: WHO, 1993.Barnes TR. A rating scale for drug-induced akathisia. The British Journal of Psychiatry. 1989;154(5):672–676. https://doi.org/10.1192/bjp.154.5.672Barnes TR. A rating scale for drug-induced akathisia. The British Journal of Psychiatry. 1989;154(5):672–676. https://doi.org/10.1192/bjp.154.5.672Andreasen NC, Pressler M, Nopoulos P, Miller D, Ho BC. Antipsychotic dose equivalents and doseyears: a standardized method for comparing exposure to different drugs. Biological Psychiatry. 2010;67:255–262. https://doi.org/10.1016/j.biopsych.2009.08.040Andreasen NC, Pressler M, Nopoulos P, Miller D, Ho BC. Antipsychotic dose equivalents and doseyears: a standardized method for comparing exposure to different drugs. Biological Psychiatry. 2010;67:255–262. https://doi.org/10.1016/j.biopsych.2009.08.040Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin. 1987;13(2):261–276. DOI: 10.1093/schbul/13.2.261Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin. 1987;13(2):261–276. DOI: 10.1093/schbul/13.2.261Foster A, Buckley P, Lauriello J, Looney S, Schooler N. Combination Antipsychotic Therapies: An Analysis From a Longitudinal Pragmatic Trial. Journal of Clinical Psychopharmacology. 2017;37(5):595–599. https://doi.org/10.1097/JCP.0000000000000766Foster A, Buckley P, Lauriello J, Looney S, Schooler N. Combination Antipsychotic Therapies: An Analysis From a Longitudinal Pragmatic Trial. Journal of Clinical Psychopharmacology. 2017;37(5):595–599. https://doi.org/10.1097/JCP.0000000000000766Musco S, Ruekert L, Myers J, Anderson D, Welling M, Cunningham EA. Characteristics of Patients Experiencing Extrapyramidal Symptoms or Other Movement Disorders Related to Dopamine Receptor Blocking Agent Therapy. Journal of Clinical Psychopharmacology. 2019;39(4):336–343. https://doi.org/10.1097/JCP.0000000000001061Musco S, Ruekert L, Myers J, Anderson D, Welling M, Cunningham EA. Characteristics of Patients Experiencing Extrapyramidal Symptoms or Other Movement Disorders Related to Dopamine Receptor Blocking Agent Therapy. Journal of Clinical Psychopharmacology. 2019;39(4):336–343. https://doi.org/10.1097/JCP.0000000000001061Cunningham Owens DG. A Guide to the Extrapyramidal Side-Effects of Antipsychotic Drugs. University of Edinburgh. 2014:383.Cunningham Owens DG. A Guide to the Extrapyramidal Side-Effects of Antipsychotic Drugs. University of Edinburgh. 2014:383.Sajatovic M, Levin J, Ramirez LF, Hahn DY, Tatsuoka C, Bialko CS, Cassidy KA, Fuentes-Casiano E, Williams TD. Prospective trial of customized adherence enhancement plus long-acting injectable antipsychotic medication in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder. The Journal of Clinical Psychiatry. 2013;74(12):1249–1255. https://doi.org/10.4088/JCP.12m08331Sajatovic M, Levin J, Ramirez LF, Hahn DY, Tatsuoka C, Bialko CS, Cassidy KA, Fuentes-Casiano E, Williams TD. Prospective trial of customized adherence enhancement plus long-acting injectable antipsychotic medication in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder. The Journal of Clinical Psychiatry. 2013;74(12):1249–1255. https://doi.org/10.4088/JCP.12m08331Huhn M, Nikolakopoulou A, Schneider-Thoma J, Krause M, Samara M, Peter N, Arndt T, Bäckers L, Rothe P, Cipriani A, Davis J, Salanti G, Leucht S. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet. 2019;394(10202):939–951. https://doi.org/10.1016/S0140-6736(19)31135-3Huhn M, Nikolakopoulou A, Schneider-Thoma J, Krause M, Samara M, Peter N, Arndt T, Bäckers L, Rothe P, Cipriani A, Davis J, Salanti G, Leucht S. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet. 2019;394(10202):939–951. https://doi.org/10.1016/S0140-6736(19)31135-3Stroup TS, Bareis NA, Rosenheck RA, Swartz MS, McEvoy JP. Heterogeneity of Treatment Effects of Long-Acting Injectable Antipsychotic Medications. The Journal of Clinical Psychiatry. 2018;80(1):pii:18m12109. https://doi.org/10.4088/JCP.18m12109Stroup TS, Bareis NA, Rosenheck RA, Swartz MS, McEvoy JP. Heterogeneity of Treatment Effects of Long-Acting Injectable Antipsychotic Medications. The Journal of Clinical Psychiatry. 2018;80(1):pii:18m12109. https://doi.org/10.4088/JCP.18m12109

The authors declare that there are no conflicts of interest present.