Merims D, Shabtai H, Korczyn A D, Peretz C, Weizman N, Giladi N
Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Neural Transm (Vienna). 2004 Oct;111(10-11):1447-53. doi: 10.1007/s00702-004-0209-9.
It was commonly assumed that psychotic phenomena in Parkinson's disease (PD) are mainly drug related. Accumulating evidence suggests the existence of other risk factors for psychosis in PD. Aims. To evaluate the contribution of the drug profile of patients with PD to emergence of hallucinations.
We compared patients with and without hallucinations, using Cox proportional hazards model, concerning drug profile at the time of hallucinations emergence.
Of 422 consecutive patients, 113 had dementia, while 90 patients experienced hallucinations (46 had both dementia and hallucinations). The mean levodopa dose for the group of patients with hallucinations was 650 +/- 279 mg/day at the time of hallucinations onset, which was not significantly different from the levodopa dose at last visit for the group without hallucinations (621 +/- 326 mg/day). Supplementary treatment with amantadine, selegiline, dopamine agonists, entacapone and anticholinergics did not increase the risk for the development of hallucinations.
We did not confirm drug treatment as a risk factor for hallucinations in PD. Our study suggests the existence of "endogenic" factors as substantial contributors in the genesis of PD hallucinations. The clinical implications may be earlier administration of antipsychotic treatment and not as traditionally accepted, dose reduction of antiparkinsonian drugs.
人们普遍认为帕金森病（PD）中的精神症状主要与药物有关。越来越多的证据表明，PD 中存在其他导致精神错乱的风险因素。目的：评估 PD 患者的药物使用情况对幻觉出现的影响。
我们使用 Cox 比例风险模型，比较了出现幻觉和未出现幻觉的患者在幻觉出现时的药物使用情况。
在 422 例连续患者中，113 例患有痴呆症，90 例出现幻觉（46 例同时患有痴呆症和幻觉）。出现幻觉的患者组在幻觉发作时左旋多巴的平均剂量为 650±279 毫克/天，这与未出现幻觉的患者组上次就诊时的左旋多巴剂量（621±326 毫克/天）没有显著差异。使用金刚烷胺、司来吉兰、多巴胺激动剂、恩他卡朋和抗胆碱能药物进行辅助治疗不会增加出现幻觉的风险。
我们没有证实药物治疗是 PD 患者出现幻觉的风险因素。我们的研究表明，存在“内生性”因素，它们在 PD 幻觉的发生中起重要作用。其临床意义可能是更早地给予抗精神病治疗，而不是像传统观点认为的那样，减少抗帕金森病药物的剂量。
