Pollak P
Département de Neurologie, Centre Hospitalier Universitaire de Grenoble, INSERM U 318, Université Joseph Fourier de Grenoble, 38043 Grenoble.
Rev Neurol (Paris). 2002 Dec;158 Spec no 1:S125-31.
Parkinson's disease is a neuropsychiatric disease with multiple psychic disorders. They mainly result from a combination between neuropathological lesions and antiparkinsonian drugs. The most frequent psychic disorders are depression and psychosis. So far, pharmacological treatments of depression has been poorly evaluated. It is suggested that the first-line treatment of depression in Parkinson's disease is the class of the Selective Serotonin Reuptake Inhibitors. The occurrence of worsening in parkinsonism and agitation in rare cases necessitates a meticulous clinical follow-up. The treatment of psychosis is based on the reduction of antiparkinsonian medications, by tapering and stopping, if necessary, the drugs with the highest risk-to-benefit ratio first. When psychosis persists despite a simple levodopa monotherapy, then an antipsychotic drug is added. Clozapine is the only officially approved drug for psychosis in Parkinson's disease. Two double blind studies showed a clear antipsychotic effect without worsening of parkinsonism. Quetiapine, another atypical neuroleptic drug without risk of blood dyscrasia may prove to be as effective than clozapine. Olanzapine and risperidone can aggravate parkinsonism and should be used only as a last resort. Future studies will precise the place of anticholinesterases in the treatment of psychosis associated with dementia.
帕金森病是一种伴有多种精神障碍的神经精神疾病。这些精神障碍主要由神经病理损害和抗帕金森病药物共同作用引起。最常见的精神障碍是抑郁和精神病。到目前为止，抑郁症的药物治疗评估效果不佳。有人建议，帕金森病抑郁症的一线治疗药物是选择性5-羟色胺再摄取抑制剂类。在极少数情况下，帕金森病症状恶化和出现激越需要进行细致的临床随访。精神病的治疗基于减少抗帕金森病药物用量，必要时首先逐渐减少并停用风险效益比最高的药物。当单纯左旋多巴单药治疗时精神病症状仍持续存在，则加用抗精神病药物。氯氮平是帕金森病精神病唯一官方批准的药物。两项双盲研究显示其有明确的抗精神病作用且不加重帕金森病症状。喹硫平是另一种无血液系统疾病风险的非典型抗精神病药物，可能证明与氯氮平效果相当。奥氮平和利培酮会加重帕金森病症状，应仅在万不得已时使用。未来研究将明确抗胆碱酯酶药物在治疗与痴呆相关的精神病中的地位。
