University Department of Psychiatry, University Hospital Osijek, J Huttlera 4, 31000 Osijek, Croatia.
Psychiatr Danub. 2009 Dec;21(4):575-8.
The authors presented a patient with schizophrenia and with early parallel development of neurologic symptoms. At first, symptoms were manifested by extrapyramidal syndrome due to appliance of typical neuroleptics. Therefore, therapeutic approach was diverted to implementation of atipycal antiypsychotics. Consequently patient developed orofacial diskyinesias which progrediated in unilateral choreo-atetoid movements. This followed two hospitalizations for diagnostic workup and correction of therapy. Only repeated brain MR showed moderate cortical atrophy. However, even with different therapeutic changes and approaches, we were not able to reach any significant shift neither in psychiatric nor neurologic disturbances. The resistence on pharmacologic threapy led to suspicion of parallel development of neurologic disorder in form of Huntington chorea. Still remains the question whether primary neurologic disorder provoked psychotic process or there were two separate disorders where pharmacologic intervention accelerated expansion of neurologic disorder.
作者报告了一例伴有精神分裂症和早期神经症状平行发展的患者。起初,症状表现为锥体外系综合征,这是由于使用了典型的神经阻滞剂。因此,治疗方法转向使用非典型抗精神病药物。随后,患者出现口面运动障碍,进展为单侧舞蹈手足徐动症。这之后,患者进行了两次住院以进行诊断检查和治疗调整。只有反复的脑部磁共振成像显示出中度皮质萎缩。然而,即使进行了不同的治疗改变和方法,我们也无法在精神和神经障碍方面取得任何显著的改善。对药物治疗的抵抗导致了对神经障碍以亨廷顿舞蹈病形式平行发展的怀疑。仍然存在的问题是,原发性神经障碍是否引发了精神病过程,还是存在两种独立的障碍,而药物干预加速了神经障碍的扩展。