在帕金森病的病理生理学和治疗精神病:复习一下。

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Zahodne磅,费尔南德斯HH

在帕金森病的病理生理学和治疗精神病:复习一下。

衰老药物。2008;25 (8):665 - 82。doi: 10.2165 / 00002512-200825080-00004。

PubMed ID
18665659 (在PubMed
]
文摘

精神病症状的帕金森病(PD)是相对常见,除了创建一个干扰病人的日常生活,一直是与贫穷相关的结果。我们理解病理生理学的精神病PD急剧扩大在过去的15年里,从最初的解释症状的多巴胺能药物不良反应当前视图外在之间复杂的相互作用和疾病相关因素。PD精神病具有独特的临床特征,即它出现在一个上下文明确的感觉器官和留存的洞察力,有相对突出的视觉幻觉和发生发展。PD精神病倾向于出现在发病的晚些时候,和疾病持续时间的发展代表一个危险因素。使用anti-PD药物(尤其是多巴胺受体受体激动剂)最广泛被PD精神病的风险因素。在文献中讨论的其他危险因素包括年龄、疾病严重程度、睡眠障碍、认知障碍、痴呆和/或抑郁。最近的努力旨在探索复杂的病理生理学PD精神病,目前涉及外在之间的交互,毒品和内在疾病相关组件。最重要的外在因素是使用多巴胺能药物治疗,在PD精神病中起着重要的作用。内在因素包括视觉处理赤字(例如低视力,色彩和对比识别赤字,眼部病变和脑功能异常识别中产生幻觉PD患者);睡眠失调(例如睡眠破碎和改变梦现象);神经化学(多巴胺、5 -羟色胺、乙酰胆碱等)和结构异常涉及特定站点路易体沉积; and genetics (e.g. apolipoprotein E epsilon4 allele and tau H1H1 genotype). Preliminary reports have also shown a potential relationship between deep brain stimulation surgery and PD psychosis.When reduction in anti-PD medications to the lowest tolerated dose does not improve psychosis, further intervention may be warranted. Several atypical antipsychotic agents (i.e. clozapine, olanzapine) have been shown to be efficacious in reducing psychotic symptoms in PD; however, use of clozapine requires cumbersome monitoring and olanzapine leads to motor worsening. Studies of ziprasidone and aripiprazole are limited to open-label trials and case reports and are highly variable; however, it appears that while each may be effective in some patients, both are associated with adverse effects. While quetiapine has not been determined efficacious in two randomized controlled trials, it is a common first-line treatment for PD psychosis because of its tolerability, ease of use and demonstrated utility in numerous open-label reports. Cholinesterase inhibitors currently represent the most promising pharmacological alternative to antipsychotics. Tacrine is rarely tried because of hepatic toxicity, and controlled trials with donepezil have not shown significant reductions in psychotic symptoms, due perhaps to methodological limitations. However, results from an open-label study and a double-blind, placebo-controlled trial involving 188 hallucinating PD patients support the efficacy of rivastigmine. With regard to non-pharmacological interventions, case reports suggest that electroconvulsive therapy has the potential to reduce psychotic symptoms and may be considered in cases involving concurrent depression and/or medication-refractory psychosis. Limited case reports also suggest that specific antidepressants (i.e. clomipramine and citalopram) may improve psychosis in depressed patients. Finally, studies in the schizophrenia literature indicate that psychological approaches are effective in psychosis management but, to date, this strategy has been supported only qualitatively in PD, and further studies are warranted.

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