Department of Neurology, Assaf Harofe Medical Center, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv 70300, Israel.
Parkinsonism Relat Disord. 2009 Dec;15 Suppl 4:S105-10. doi: 10.1016/S1353-8020(09)70846-6.
Although Parkinson's disease (PD) is considered mainly a movement disorder, robust information accumulated during the last 30 years has shown that about 30% of PD patients may also suffer from psychosis, which deeply affects their quality of life and eventually brings them to permanent hospitalization in nursing homes. PD psychosis (PDPsy) mainly occurs after 10 or more years of treatment. The main features of PDPsy include recurrent and continuous hallucinations and delusions for at least 1 month. In addition, a recent consensus of the National Institute of Neurological Disorders and Stroke and National Institute of Mental Health Working Group also included illusions and a false sense of presence as "minor symptoms" supporting the diagnosis. In addition, accumulated clinical data have shown that "minor symptoms" and benign hallucinations also imply a bad prognosis with time. In the diagnostic criteria for PDPsy, it is considered that patients suffer from PD for at least more than 1 year before psychosis develops. If this is not the case, there is an unsolved problem of an overlapping diagnosis with Dementia with Lewy Bodies. Most clinicians consider that the main cause of psychosis is chronic exposure to dopaminergic medication. However, from an operational point of view there remain difficulties in defining a specific time of exposure and dose of treatment and the occurrence of PDPsy. Specific rating scales have been developed for the evaluation of PDPsy, such as the Parkinson Psychosis Rating Scale. The Scale for the Assessment of Positive Symptoms usually applied in schizophrenic patients has also proved useful for scoring psychotic symptomatology in PD. Clozapine in low doses has been proven to be the most effective antipsychotic medication for PDPsy. However, its use may cause neutropenia. Therefore, new atypical antipsychotic drugs with serotonin 5-HT2A receptor inverse agonist properties have been developed. Recently, pimavanserin--a 5-HT2A inverse agonist--has been studied. We hope that soon we will have the possibility to include new agents for the management of PDPsy.
虽然帕金森病（PD）被认为主要是一种运动障碍，但在过去 30 年中积累的大量信息表明，约 30%的 PD 患者也可能患有精神病，这深深地影响了他们的生活质量，并最终导致他们永久性地住院在养老院。PD 精神病（PDPsy）主要发生在治疗 10 年以上后。PDPsy 的主要特征包括至少 1 个月的反复和持续幻觉和妄想。此外，美国国立神经病学与中风研究所和美国国立精神卫生研究所工作组的一项最新共识还将幻觉和虚假存在感纳入“次要症状”，支持诊断。此外，积累的临床数据表明，“次要症状”和良性幻觉也随着时间的推移暗示着预后不良。在 PDPsy 的诊断标准中，认为患者在精神病发作前至少患有 PD 1 年以上。如果不是这样，则与路易体痴呆重叠诊断的问题尚未解决。大多数临床医生认为，精神病的主要原因是慢性暴露于多巴胺能药物。然而，从操作的角度来看，定义特定的暴露时间、治疗剂量和 PDPsy 的发生仍然存在困难。已经开发了特定的量表来评估 PDPsy，例如帕金森精神病评定量表。通常应用于精神分裂症患者的阳性症状评定量表也被证明对 PD 中精神病症状的评分有用。低剂量氯氮平已被证明是治疗 PDPsy 最有效的抗精神病药物。然而，其使用可能导致中性粒细胞减少症。因此，开发了具有 5-HT2A 受体反向激动剂特性的新型非典型抗精神病药物。最近，研究了 pimavanserin——一种 5-HT2A 反向激动剂。我们希望很快我们将有可能为 PDPsy 的管理添加新的药物。
