Sobrido M J, Dias-Silva J J, Quintáns B
Fundación Pública Galega de Medicina Xenómica. La Choupana, s/n. E-15706 Santiago de Compostela, A Coruña.
Rev Neurol. 2009 Jan 23;48 Suppl 1:S43-8.
Patients with Parkinson's disease (PD) may present neuropsychiatric and conduct disorders at different stages of the development of the disease that make treatment even more difficult.
The neurologist must be on the lookout for the possible appearance of alterations affecting impulse control, even from the early stages of the disease, so as to be able to prevent them or to plan a suitable adjustment of treatment. Some of the most common impulsivity disorders include hypersexuality, compulsive gambling and other addictive behaviours which, if left undetected and untreated, can end up having a destructive effect on the patient's socio-familial surroundings. Psychotic disorders (hallucinations, delusions) are often associated to advanced phases of PD and to the effect of dopamine therapy, and they are associated to a higher morbidity and mortality rate. Factors of a genetic or pharmacogenetic nature or a gene-environment interaction may account for the different individual susceptibility to disorders in the neuropsychiatric realm among patients with PD. It is wise to bear in mind the possible medico-legal implications that may stem from behavioral disorders, both for the patient and his or her family and for the physician, because situations could arise that trigger conflicts between confidentiality and preventing third parties from being harmed, as well as harm that can be attributed to the side effects of medicines.
The specialist must be familiar with, foresee and propose suitable treatment for behavioral and neuropsychiatric disorders in PD with potential medico-legal implications.
帕金森病（PD）患者在疾病发展的不同阶段可能出现神经精神和行为障碍，这使得治疗更加困难。
神经科医生必须留意即使在疾病早期阶段可能出现的影响冲动控制的改变，以便能够预防这些改变或计划适当调整治疗方案。一些最常见的冲动性障碍包括性欲亢进、强迫性赌博和其他成瘾行为，如果未被发现和治疗，最终可能会对患者的社会家庭环境产生破坏性影响。精神障碍（幻觉、妄想）通常与帕金森病的晚期阶段以及多巴胺治疗的效果有关，并且它们与更高的发病率和死亡率相关。遗传或药物遗传学性质的因素或基因 - 环境相互作用可能解释帕金森病患者在神经精神领域对障碍的不同个体易感性。明智的做法是牢记行为障碍可能对患者及其家人以及医生产生的潜在医疗法律影响，因为可能会出现引发保密与防止第三方受到伤害之间冲突的情况，以及可归因于药物副作用的伤害。
专家必须熟悉、预见并为具有潜在医疗法律影响的帕金森病行为和神经精神障碍提出合适的治疗方法。
