Kashihara Kenichi, Ohno Manabu, Katsu Yasuko
Department of Neurology, Okayama Kyokuto Hospital.
Rinsho Shinkeigaku. 2005 Jan;45(1):1-5.
The frequency, phenomenology, and risk factors of hallucinations and delusions were investigated in 64 consecutive inpatients with Parkinson's disease. Fifty patients were admitted to our hospital with symptoms related to Parkinson's disease: psychiatric problems 27 (psychosis 22; anxiety 2; depression 2; mania 1): motor symptoms, 20 (wearing-off 5; akinesia 4; freezing 4; postural instability 4; dyskinesia 2; tremor 2; dystonia 1), and sensory symptoms, 3. Fourteen patients were admitted with other medical problems (pneumonia 4; cerebral infarction 3; bone fracture 3; lumbago 2; seizure 1; cat bite 1). Totally 49 patients had psychiatric problems. Psychosis was present in 43 patients, dementia in 10, depression in 8, mania in 1, anxiety in 10, agitation in 6, stereotypy in 2, and hypersexuality in 2. Of the 43 patients with psychoses, 40 presented with visual hallucinations, 18 with auditory hallucinations, and 23 with delusions. To determine what the clinical correlates with the severity of psychosis were, we divided the patients into 3 groups: the severe group, 22 patients admitted because of psychotic symptoms; the mild group, 21 patients admitted because of problems other than psychosis but presenting psychotic symptoms; and the control group, 21 patients who had no psychotic symptoms. Incidences of auditory hallucinations and delusions were higher in the severe group as compared to the mild group. Patients in the severe group had higher Hoehn-Yahr stages, lower Mini-Mental State Examination scores, decreased H/M ratios of cardiac 123I-MIBG uptake, and lower frequencies of background activity on electroencephalograms. There were no differences in age at admission, age at onset of Parkinson's disease, duration of illness, amounts of levodopa and dopamine agonists received, Hamilton's depression rating scores, and brain MR findings, including atrophy and ischemic changes. Emergence of psychotic symptoms in parkinsonian patients appears to be clearly associated with impaired cognitive function. Therefore, it may be associated with the disease process itself. Terms such as dopaminomimetic or levodopa-induced psychosis may not be appropriate when describing psychosis in Parkinson's disease.
对64例帕金森病连续住院患者的幻觉和妄想的频率、现象学及危险因素进行了研究。50例因帕金森病相关症状入院：精神问题27例（精神病22例；焦虑2例；抑郁2例；躁狂1例）；运动症状20例（剂末现象5例；运动不能4例；冻结4例；姿势不稳4例；异动症2例；震颤2例；肌张力障碍1例），感觉症状3例。14例因其他内科问题入院（肺炎4例；脑梗死3例；骨折3例；腰痛2例；癫痫发作1例；猫咬伤1例）。共有49例患者有精神问题。43例有精神病，10例有痴呆，8例有抑郁，1例有躁狂，10例有焦虑，6例有激越，2例有刻板行为，2例有性欲亢进。在43例有精神病的患者中，40例有视幻觉，18例有听幻觉，23例有妄想。为了确定与精神病严重程度相关的临床因素，我们将患者分为3组：重度组，22例因精神病症状入院；轻度组，21例因非精神病问题入院但有精神病症状；对照组，21例无精神病症状。与轻度组相比，重度组听幻觉和妄想的发生率更高。重度组患者的Hoehn-Yahr分期更高，简易精神状态检查表得分更低，心脏123I-MIBG摄取的H/M比值降低，脑电图背景活动频率更低。入院年龄、帕金森病起病年龄、病程、左旋多巴和多巴胺激动剂的用量、汉密尔顿抑郁评定量表得分以及脑磁共振成像结果（包括萎缩和缺血性改变）均无差异。帕金森病患者精神病症状的出现似乎与认知功能受损明显相关。因此，它可能与疾病过程本身有关。在描述帕金森病中的精神病时，诸如多巴胺能模拟或左旋多巴诱发的精神病等术语可能并不合适。
