Moser A, Hagenah J, Kömpf D
Klinik für Neurologie des Universitätsklinikums Schleswig-Holstein, Campus und Universität Lübeck, Lübeck.
Nervenarzt. 2003 Apr;74(4):376-85, quiz 385-6. doi: 10.1007/s00115-003-1511-8.
The appearance of psychiatric symptoms is not rare in the course and treatment of Parkinson's disease. In particular, therapy with L-dopa or dopamine agonists leads to increased dream activity. As with sleep disturbances, this can be a warning signal of paranoid hallucinatory psychosis.However, isolated visual hallucinations before manifest psychosis in Parkinson's must generally be regarded as resulting from medication. They occur in up to 30% of Parkinson's patients and often involve visual and figurative hallucinations. Visual hallucinations most probably result from the combined effect on dopaminergic and serotonergic systems in the CNS. Therapy consists in normalization of H(2)O and electrolyte levels, control of the accompanying medication, reduction of the evening doses of anti-Parkinson's medications, and serotonin antagonists such as clozapine.
精神症状在帕金森病的病程及治疗过程中并不罕见。特别是使用左旋多巴或多巴胺激动剂进行治疗会导致梦境活动增加。与睡眠障碍一样，这可能是偏执性幻觉精神病的一个警示信号。然而，帕金森病患者在明显精神病发作之前出现的孤立性视幻觉通常必须被视为由药物引起。它们发生在高达30%的帕金森病患者中，且常常涉及视觉和形象性幻觉。视幻觉很可能是中枢神经系统中多巴胺能和5-羟色胺能系统联合作用的结果。治疗包括使水和电解质水平正常化、控制伴随用药、减少帕金森病药物的晚间剂量，以及使用5-羟色胺拮抗剂如氯氮平。
