Giménez-Roldán S, Navarro E, Mateo D
Servicion de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Rev Neurol. 2003;36(5):401-4.
Quetiapine is a novel neuroleptic drug with pharmacological properties close to clozapine, the most effective drug in the management of psychotic symptoms in patients with Parkinson s disease (PD). Unlike clozapine, however, quetiapine does not induce agranulocytosis and therefore no haematologic controls are required.
To assess tolerability and effectiveness of low dose quetiapine on psychotic symptoms, sleep disturbances and stress of the caregiver in PD patients with dopaminomimetic psychosis.
We carried out a 16 week, prospective, open label study on the effects of quetiapine in 7 consecutive PD patients with psychosis. A ceiling dose was arbitrarily established at 25 mg/d. Antiparkinsonian medication remained unchanged throughout the study. Motor symptoms were assessed with UPDRS motor subscale portion, Schwab England scale, and Hoehn Yahr diseases staging. The effects on hallucinations and paranoia, sleep disorder, and stress in the caregiver were scored separately, aside from a global score on the Neuropsychiatric Inventory (NPI). Global impression of both, investigators and caregiver was obtained at study conclusion. A patient died from unrelated causes.
Under a mean quetiapine dose of 24.9 mg/d (12.5 37.2) motor impairment during on periods remained unchanged, both according to patients and caregiver whereas mean UPDRS motor score remained unchanged (35.5 4.5 versus 32.8 5.2). Levodopa induced dyskinesias disappeared in the single patient with this complication. Improvement occurred in mean NPI global score, as well as subscores for hallucinations and paranoia, and caregiver stress. In over half the patients, effectiveness was scored as very good or good both by examiners and caregivers. A confusional episode occurred in one patient under 25 mg/d but readily resolved while maintaining the benefit following dose reduction to 12.5 mg.
Quetiapine at low doses appears a useful alternative for psychotic symptoms, sleep disorders and stress of the caregiver in patients with PD
喹硫平是一种新型抗精神病药物，其药理特性与氯氮平相近，氯氮平是治疗帕金森病（PD）患者精神症状最有效的药物。然而，与氯氮平不同的是，喹硫平不会诱发粒细胞缺乏症，因此无需进行血液学监测。
评估低剂量喹硫平对患有拟多巴胺能性精神病的PD患者的精神症状、睡眠障碍及照料者压力的耐受性和有效性。
我们对7例连续的患有精神病的PD患者进行了一项为期16周的前瞻性开放标签研究，观察喹硫平的疗效。任意设定的最大剂量为25毫克/天。在整个研究过程中，抗帕金森病药物保持不变。使用统一帕金森病评定量表（UPDRS）运动子量表部分、施瓦布-英格兰量表和霍恩-亚尔疾病分期来评估运动症状。除了使用神经精神科问卷（NPI）的总体评分外，还分别对幻觉和妄想、睡眠障碍以及照料者压力的影响进行评分。在研究结束时获得研究者和照料者的总体印象。有1例患者死于无关原因。
喹硫平的平均剂量为24.9毫克/天（12.5 - 37.2），根据患者和照料者的评估，服药期间的运动障碍均保持不变，而UPDRS运动平均评分也保持不变（35.5 ± 4.5对32.8 ± 5.2）。左旋多巴诱发的异动症在唯一有此并发症的患者中消失。NPI总体评分以及幻觉和妄想子评分及照料者压力均有改善。超过半数的患者，研究者和照料者均将疗效评为非常好或好。1例患者在25毫克/天剂量下出现了一次意识模糊发作，但在剂量减至12.5毫克后发作迅速缓解且仍保持疗效。
低剂量喹硫平似乎是治疗PD患者精神症状、睡眠障碍及照料者压力的一种有用的替代药物
