Danielczyk W
Ludwig Boltzmann Institute for Geriatric Research, Vienna, Austria.
J Neural Transm Suppl. 1992;38:115-27.
Certain psychiatric complications are associated with various stages of PD. The possible causes known to date are analysed. Depression, isolated cognitive impairments, pharmacotoxic psychosis and dementia-related changes are the predominant mental disorders in PD. PD and depression syndrome occur very frequently in old age. Behaviour and mimicry of patients with progressive PD and of patients with depression syndrome are sometimes so similar that the two conditions can be differentiated only by long-term monitoring. In addition, PD and depression may occur simultaneously. However, frequency and intensity of depressive phases do not differ in PD patients and aged-matched depressed patients without PD. About one third of patients hospitalized at the neurological department of the Geriatric Hospital Lainz require antidepressant drug treatment. Similar percentages were found for other chronic cerebral and extracerebral diseases in the aged. Major depressions are independent of the parkinsonian disability and can be successfully managed only by antidepressant medication. Pharmacotoxic psychoses are not only serious conditions, they also reveal the limitations of therapeutic options. The unusual frequency of such acute psychoses, i.e. 30 to 60% in the terminal stages of the disease, indicates a special relation between antiparkinson medication and increasing neurotransmitter disturbances. Permanent pronounced depression in the sense of DSM III is not one of the symptoms of typical PD. States of dementia occur only in connection with a second or third cerebral pathology, mostly in combination with SDAT and MID.
某些精神科并发症与帕金森病（PD）的不同阶段相关。本文分析了目前已知的可能病因。抑郁、孤立性认知障碍、药物毒性精神病以及与痴呆相关的变化是PD中主要的精神障碍。PD和抑郁综合征在老年人群中极为常见。进展性PD患者与抑郁综合征患者的行为及面部表情有时非常相似，以至于只能通过长期监测来区分这两种情况。此外，PD和抑郁可能同时发生。然而，PD患者与年龄匹配的非PD抑郁患者在抑郁发作的频率和强度上并无差异。在Lainz老年医院神经科住院的患者中，约有三分之一需要抗抑郁药物治疗。在老年人中，其他慢性脑部和脑外疾病也有类似的比例。重度抑郁症与帕金森病导致的残疾无关，只能通过抗抑郁药物治疗才能成功控制。药物毒性精神病不仅病情严重，还揭示了治疗选择的局限性。此类急性精神病在疾病终末期的发生率异常高，即30%至60%，这表明抗帕金森药物与神经递质紊乱加剧之间存在特殊关系。按照《精神疾病诊断与统计手册》第三版（DSM III）的定义，持续性明显抑郁并非典型PD的症状之一。痴呆状态仅与第二种或第三种脑部病变相关，大多与老年性痴呆（SDAT）和多发梗死性痴呆（MID）合并出现。
