Wolk S I, Douglas C J
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, N.Y.
J Clin Psychiatry. 1992 Oct;53(10):373-6.
Clozapine has gained acceptance as an antipsychotic in treatment-resistant schizophrenia. Its low propensity to induce extrapyramidal side effects makes clozapine an attractive treatment for patients with Parkinson's disease and dopaminomimetic psychosis. Recent evidence demonstrates that Parkinson's patients are exquisitely sensitive to both the antipsychotic and the potential extrapyramidal effects of clozapine. The uncontrolled studies suggest that low-dose clozapine may be efficacious in this population. The dose range, side effect profiles, and length of treatment varied in these reports.
We report our experience with five patients with Parkinson's disease and psychosis who were treated with clozapine in an open trial.
Three patients were successfully treated with clozapine (25-100 mg/day, mean = 66.7 mg) without worsening their parkinsonism. Adverse effects unrelated to the motor disability required discontinuation of clozapine in the other two patients. At 1- to 2-year follow-up, each patient had required increased dosages of clozapine (75-150 mg/day, mean = 125 mg) for continued management of their psychosis and parkinsonism. The higher dose range was well tolerated.
These results suggest that clozapine may effectively treat psychosis in Parkinson's disease.
氯氮平已被公认为是治疗难治性精神分裂症的一种抗精神病药物。其诱发锥体外系副作用的倾向较低，这使得氯氮平成为帕金森病和多巴胺模拟性精神病患者的一种有吸引力的治疗药物。最近的证据表明，帕金森病患者对氯氮平的抗精神病作用和潜在的锥体外系效应都极为敏感。非对照研究表明，低剂量氯氮平可能对该人群有效。这些报告中氯氮平的剂量范围、副作用情况和治疗时长各不相同。
我们报告了在一项开放性试验中使用氯氮平治疗5例帕金森病合并精神病患者的经验。
3例患者使用氯氮平（25 - 100毫克/天，平均 = 66.7毫克）治疗成功，且帕金森病症状未加重。另外2例患者因与运动障碍无关的不良反应而停用氯氮平。在1至2年的随访中，每位患者为持续控制精神病和帕金森病症状，氯氮平剂量均需增加（75 - 150毫克/天，平均 = 125毫克）。较高剂量范围耐受性良好。
这些结果表明，氯氮平可能有效治疗帕金森病合并的精神病。
