Menza M M, Palermo B, Mark M
Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway 08854, USA.
Ann Clin Psychiatry. 1999 Sep;11(3):141-4. doi: 10.1023/a:1022360027358.
There are many difficulties associated with the late stages of Parkinson's disease (PD), but psychosis and agitation may be the most disturbing for both patients and care givers, and often precipitate the pivotal decision for long-term nursing home placement. While the addition of antipsychotic drugs or the withdrawal of antiparkinsonian drugs may improve the behavioral problem, these strategies usually worsen the motor difficulties. Clozapine has been studied in PD for over a decade, and while it appears to be effective, there are safety and tolerability concerns associated with it. In addition, in New Jersey, Medicaid no longer pays for the home blood draws that are required for home-bound patients. This led to a situation in which we had patients who needed to stop clozapine and begin an alternative therapy. Because quetiapine seems particularly well suited to patients with PD based on in vitro and in vivo studies we have begun to try this medication in PD patients who need to stop clozapine. This article reports three case histories of patients with PD, confusion and dopamimetic psychosis who had been previously managed with clozapine and who were successfully switched to quetiapine. At doses from 12.5 to 150 mg/day quetiapine was well tolerated, resulting in behavioral improvement and no real increase in parkinsonism. These case histories raise the possibility that quetiapine may represent a viable alternative to clozapine in PD patients with dopamimetic psychosis and behavioral disturbances.
帕金森病（PD）晚期存在诸多困难，但精神病和激越状态可能对患者及护理人员来说是最令人困扰的，并且常常促使做出将患者长期安置在养老院的关键决定。虽然添加抗精神病药物或停用抗帕金森病药物可能改善行为问题，但这些策略通常会使运动困难恶化。氯氮平已在帕金森病患者中研究了十多年，虽然它似乎有效，但存在与之相关的安全性和耐受性问题。此外，在新泽西州，医疗补助不再支付居家患者所需的家庭采血费用。这导致了一种情况，即我们的患者需要停用氯氮平并开始替代疗法。基于体外和体内研究，喹硫平似乎特别适合帕金森病患者，因此我们已开始在需要停用氯氮平的帕金森病患者中试用这种药物。本文报告了3例帕金森病、意识模糊和多巴胺能性精神病患者的病例史，这些患者此前用氯氮平治疗，后来成功换用喹硫平。喹硫平剂量为每日12.5至150毫克时耐受性良好，行为得到改善，帕金森症状并未真正加重。这些病例史表明，对于患有多巴胺能性精神病和行为障碍的帕金森病患者，喹硫平可能是氯氮平的一种可行替代药物。
