Frieling Helge, Hillemacher Thomas, Ziegenbein Marc, Neundörfer Bernhard, Bleich Stefan
Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
Eur Neuropsychopharmacol. 2007 Feb;17(3):165-71. doi: 10.1016/j.euroneuro.2006.08.007. Epub 2006 Oct 27.
Psychosis due to dopamimetic treatment is a difficult problem in patients with Parkinson's disease (PD). The aim of this structured review with meta-analysis was to evaluate which neuroleptic drugs can efficiently be used to treat drug-induced psychosis (DIP) in Parkinson's disease. Electronic databases were screened for the key words Parkinson's disease and psychosis. Only 7 trials with a satisfactory allocation concealment and data reporting were included into the study. Two trials compared low-dose clozapine versus placebo with a significantly better outcome for clozapine regarding efficacy and motor functioning. In one trial clozapine was compared against quetiapine showing equivalent efficacy and tolerability. However, in two placebo controlled trials quetiapine failed to show efficacy. In two further placebo controlled trials olanzapine did not improve psychotic symptoms and significantly caused more extrapyramidal side effects. Based on randomized trial-derived evidence which is currently available, only clozapine can be fully recommended for the treatment of DIP in PD. Olanzapine should not be used in this indication.
多巴胺能治疗所致的精神病是帕金森病（PD）患者面临的一个难题。本项带有荟萃分析的结构化综述旨在评估哪些抗精神病药物可有效用于治疗帕金森病中的药物性精神病（DIP）。通过电子数据库筛选帕金森病和精神病的关键词。本研究仅纳入了7项分配隐藏和数据报告令人满意的试验。两项试验比较了低剂量氯氮平与安慰剂，结果显示氯氮平在疗效和运动功能方面有显著更好的结果。在一项试验中，将氯氮平与喹硫平进行比较，显示出等效的疗效和耐受性。然而，在两项安慰剂对照试验中，喹硫平未能显示出疗效。在另外两项安慰剂对照试验中，奥氮平并未改善精神症状，且显著导致更多锥体外系副作用。基于目前可得的随机试验证据，仅氯氮平可被完全推荐用于治疗帕金森病中的药物性精神病。奥氮平不应在此适应症中使用。
