Ondo William G, Levy Joel K, Vuong Kevin Dat, Hunter Christine, Jankovic Joseph
Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
Mov Disord. 2002 Sep;17(5):1031-5. doi: 10.1002/mds.10217.
Atypical antipsychotic medications with lower affinities for D2 receptors are considered useful alternatives to treat drug-induced hallucinations in Parkinson's disease (PD). We conducted a double-blind, placebo-controlled, unforced titration, parallel design study (2:1 drug to placebo randomization ratio) using olanzapine (2.5-10 mg/day to effect) in 30 PD patients with drug-induced hallucinations. We performed an extensive battery of neuropsychological tests, the Unified Parkinson's Disease Rating Scale (UPDRS), assessments of on and off time at baseline and at 9 weeks after starting the medication. Sixteen patients on olanzapine (mean dose, 4.6 mg/night) and 11 on placebo completed the study. Compared with placebo, performance on the UPDRS item 2 (thought disorder), and a structured interview for hallucinations, both tended to improve on drug but neither reached statistical significance. A neuropsychological test battery did not show any significant differences. Total on UPDRS motor scores (P < 0.05) and timed tapping (P < 0.01) worsened while on drug compared to placebo. Bradykinesia (P < 0.01) and gait (P < 0.001) items on the UPDRS largely accounted for this deterioration. After completion of the study, 8 of 16 patients randomly assigned to drug continued olanzapine at a mean dose of 2.4 mg/day. However, at the last recorded visit only 5 of 24 (20.8%) of all patients exposed to drug (including those originally randomly assigned to placebo) remained on olanzapine. In patients with PD, low-dose olanzapine did not significantly improve hallucinations but did worsen motor function.
对D2受体亲和力较低的非典型抗精神病药物被认为是治疗帕金森病（PD）药物所致幻觉的有用替代药物。我们进行了一项双盲、安慰剂对照、非强制滴定、平行设计研究（药物与安慰剂随机化比例为2:1），使用奥氮平（2.5 - 10毫克/天，根据效果调整）治疗30例患有药物所致幻觉的PD患者。我们进行了一系列广泛的神经心理学测试、统一帕金森病评定量表（UPDRS），并在基线和开始用药9周后评估了开期和关期时间。16例服用奥氮平（平均剂量，4.6毫克/晚）的患者和11例服用安慰剂的患者完成了研究。与安慰剂相比，UPDRS第2项（思维障碍）以及针对幻觉的结构化访谈结果在用药后均有改善趋势，但均未达到统计学显著性。一组神经心理学测试未显示任何显著差异。与安慰剂相比，用药期间UPDRS运动总分（P < 0.05）和定时敲击测试（P < 0.01）变差。UPDRS中的运动迟缓（P < 0.01）和步态（P < 0.001）项目在很大程度上导致了这种恶化。研究结束后，随机分配到药物组的16例患者中有8例继续服用奥氮平，平均剂量为2.4毫克/天。然而，在最后一次记录的访视时，所有接受药物治疗的患者（包括最初随机分配到安慰剂组的患者）中只有24例中的5例（20.8%）仍在服用奥氮平。在PD患者中，低剂量奥氮平并未显著改善幻觉，但确实使运动功能恶化。
