Morgante Letterio, Epifanio Antonio, Spina Edoardo, Zappia Mario, Di Rosa Antonio E, Marconi Roberto, Basile Giorgio, Di Raimondo Giorgio, La Spina Paolo, Quattrone Aldo
Department of Neuroscience, Psychiatry and Anesthesiology, University of Messina, Policlinico Universitario, Italy.
Clin Neuropharmacol. 2004 Jul-Aug;27(4):153-6. doi: 10.1097/01.wnf.0000136891.17006.ec.
This study aimed to compare the efficacy and safety of quetiapine and clozapine in parkinsonian patients with dopaminergic psychosis in a randomized, open-label, blinded-rater, parallel group trial.
Forty-five patients with Parkinson disease (PD) and psychosis induced by antiparkinsonian drugs were randomly assigned to receive either quetiapine or clozapine. The duration of the trial was 12 weeks. Forty patients, 20 in each treatment group, completed the study. The final dose of quetiapine (mean +/- SD) was 91 +/- 47 mg/d and that of clozapine 26 +/- 12 mg/d. The severity of psychosis was assessed using the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression Scale-Severity Subscale (CGI-S). The Unified Parkinson's Disease Rating Scale (UPDRS) III was used to assess motor conditions during the study period. The Abnormal Involuntary Movement Scale (AIMS) was performed to evaluate dyskinesias.
Forty patients, 20 on clozapine and 20 on quetiapine, completed the study. The psychopathologic state improved significantly (P < 0.001) from baseline in both treatment groups. No differences were found between clozapine and quetiapine at any assessment time. Motor conditions remained unchanged after clozapine and quetiapine. Dyskinesias decreased significantly (P < 0.05) in both groups. Side effects were mild, generally transient, and well tolerated.
Quetiapine and clozapine appear equally efficacious for treatment of dopaminergic psychosis in patients with PD.
本研究旨在通过一项随机、开放标签、盲法评分、平行组试验，比较喹硫平和氯氮平治疗帕金森病伴多巴胺能精神病患者的疗效和安全性。
45例帕金森病（PD）及抗帕金森病药物所致精神病患者被随机分配接受喹硫平或氯氮平治疗。试验为期12周。40例患者完成了研究，每个治疗组各20例。喹硫平的最终剂量（均值±标准差）为91±47mg/d，氯氮平为26±12mg/d。采用简明精神病评定量表（BPRS）和临床总体印象量表严重程度分量表（CGI-S）评估精神病的严重程度。在研究期间使用统一帕金森病评定量表（UPDRS）III评估运动状况。采用异常不自主运动量表（AIMS）评估异动症。
40例患者完成了研究，其中20例服用氯氮平，20例服用喹硫平。两个治疗组的精神病理状态均较基线有显著改善（P<0.001）。在任何评估时间，氯氮平和喹硫平之间均未发现差异。服用氯氮平和喹硫平后运动状况保持不变。两组的异动症均显著减少（P<0.05）。副作用轻微，通常为一过性，且耐受性良好。
喹硫平和氯氮平在治疗帕金森病患者的多巴胺能精神病方面似乎同样有效。
