Fernandez H H, Friedman J H, Jacques C, Rosenfeld M
Department of Neurology, Brown University School of Medicine, Memorial Hospital of Rhode Island, Pawtucket 02860, USA.
Mov Disord. 1999 May;14(3):484-7. doi: 10.1002/1531-8257(199905)14:3<484::aid-mds1016>3.0.co;2-b.
Quetiapine is an atypical antipsychotic with clozapine-like pharmacology but without associated agranulocytosis. We report our complete experience with quetiapine for the treatment of drug-induced psychosis (DIP) in Parkinson's disease (PD). Thirty-five patients with PD and DIP aged 75 years (range, 58-89) with a mean PD duration of 8.4 years on an average of 427 mg levodopa per day received a mean dose of 40.6 mg quetiapine daily. Twenty of 24 neuroleptic-naive patients reported marked improvement of psychosis without a decline in motor function as assessed by the Unified Parkinson's Disease Rating Scale (UPDRS-motor). Ten patients had a baseline and 4-week follow-up assessment using the Mini-Mental Status Examination (MMSE) and Brief Psychiatric Rating Scale (BPRS). The improvement in BPRS score (32.6 versus 22.8) was clinically and statistically significant (p = 0.024). Three of 24 were unable to tolerate quetiapine because of orthostatic hypotension, headache, nausea, and persistence of hallucinations. One patient died of an unrelated cause. We also tried to switch 11 psychiatrically stable patients on clozapine (eight) and olanzapine (three). Five patients made this transition without a loss of effect as measured on BPRS and MMSE. Six did not (five on clozapine, one on olanzapine) because of confusion, erratic behavior, and increased hallucinations. No crossover failure had worsened PD except for increased tremor in one. Quetiapine is useful and well-tolerated as a first drug to treat DIP in PD but must be used cautiously to replace other atypical antipsychotic drugs.
喹硫平是一种非典型抗精神病药物，具有与氯氮平相似的药理学特性，但不会引起粒细胞缺乏症。我们报告了使用喹硫平治疗帕金森病（PD）所致药物性精神病（DIP）的完整经验。35例患有PD和DIP的患者，年龄75岁（范围58 - 89岁），平均PD病程8.4年，平均每天服用427毫克左旋多巴，平均每天接受40.6毫克喹硫平治疗。24例未使用过抗精神病药物的患者中，有20例报告精神病症状明显改善，且根据统一帕金森病评定量表（UPDRS - 运动部分）评估，运动功能未下降。10例患者使用简易精神状态检查表（MMSE）和简明精神病评定量表（BPRS）进行了基线和4周随访评估。BPRS评分的改善（从32.6降至22.8）在临床和统计学上均具有显著意义（p = 0.024）。24例中有3例因体位性低血压、头痛、恶心和幻觉持续存在而无法耐受喹硫平。1例患者死于无关原因。我们还尝试让11例病情稳定的使用氯氮平（8例）和奥氮平（3例）的精神病患者换药。5例患者换药后，BPRS和MMSE测量结果显示效果未丧失。6例患者（5例使用氯氮平，1例使用奥氮平）因出现精神错乱、行为不稳定和幻觉增加而未能换药。除1例震颤加重外，无换药失败导致PD病情恶化的情况。喹硫平作为治疗PD中DIP的首选药物是有用且耐受性良好的，但在替代其他非典型抗精神病药物时必须谨慎使用。
