帕金森病患者的奥赛罗综合征。

Othello syndrome in patients with Parkinson's disease.

机构信息

Department of Neurology, University Medical Centre Ljubljana, Zaloska cesta 2, 1000 Ljubljana, Slovenia.

出版信息

Psychiatr Danub. 2010 Mar;22(1):94-8.

PMID:20305599

Abstract

BACKGROUND

Othello syndrome (OS) is an organic delusional disorder with prevailing jealousy symptoms presumably appearing as side effect of antiparkinsonian therapy. The clinical spectrum of psychiatric symptoms in Parkinson's disease (PD) is very wide, including symptoms of depression and anxiety, hallucinations, delusions, with prevalent paranoid symptoms, agitation, delirium and sleep disorders. At our knowledge, just a few cases of patients with PD and OS were reported till now.

METHODS

three neurologists working in a tertiary referral centre were asked to report cases of pathological jealousy as defined by the DSM IV criteria (Kaplan et al. 1994). The following data were collected retrospectively: sex, age at PD onset, age at OS onset, duration of PD, duration of PD treatment, duration of treatment with dopamine agonists (DAs), treatment of OS, past history of alcoholism, premorbid personality disorder, family history of psychiatric disorders and data about general cognitive condition.

RESULTS

Five PD patients (three males) with OS were investigated. The mean age of the patients at the PD onset was 46.80+/-8.87 (SD), the mean age at the OS onset was 56.40+/-8.76 (SD). Before the onset of OS, all of them were taking dopamine agonists. The first patient was treated with pramipexole, apomorphine infusion and levodopa/carbidopa, the second with apomorphine infusion plus levodopa/carbidopa/entacapone, the third with pramipexole, the fourth and fifth with ropinirole. Decrease of dopamine agonist led to clinical improvement in three patients (complete reduction of the symptoms in two, reduction of symptoms in one patients). In two patients, the symptoms remained the same. In three patients atypical neuroleptics had to be added: clozapine in two and quetiapine in one patient.

CONCLUSIONS

We believe that OS is a more common psychiatric side effect in PD patients on treatment with dopamine agonists than usually believed, particulary in those with early disease onset. It is a very disturbing symptom for patients and their partners, often underestimated by them, and should therefore be actively searched for.

摘要

背景

奥赛罗综合征（OS）是一种器质性妄想障碍，主要表现为抗帕金森病药物治疗的副作用。帕金森病（PD）的精神症状谱非常广泛，包括抑郁和焦虑、幻觉、妄想，以偏执症状为主，激越、意识混乱和睡眠障碍。据我们所知，目前为止只有少数几例 PD 和 OS 患者的病例报告。

方法

我们请三位在三级转诊中心工作的神经科医生根据 DSM-IV 标准（Kaplan 等人，1994 年）报告病理性嫉妒的病例。我们回顾性地收集了以下数据：性别、PD 发病年龄、OS 发病年龄、PD 病程、PD 治疗持续时间、多巴胺激动剂（DA）治疗持续时间、OS 治疗、酒精中毒史、病前人格障碍、精神疾病家族史以及一般认知状况的数据。

结果

研究了 5 名 PD 患者（3 名男性）伴 OS。患者 PD 发病时的平均年龄为 46.80+/-8.87（SD），OS 发病时的平均年龄为 56.40+/-8.76（SD）。在 OS 发病前，他们都在服用多巴胺激动剂。第一例患者接受普拉克索、阿朴吗啡输注和左旋多巴/卡比多巴治疗，第二例患者接受阿朴吗啡输注加左旋多巴/卡比多巴/恩他卡朋治疗，第三例患者接受普拉克索治疗，第四例和第五例患者接受罗匹尼罗治疗。减少多巴胺激动剂使 3 名患者的临床症状改善（2 名患者症状完全缓解，1 名患者症状减轻）。在 2 名患者中，症状保持不变。在 3 名患者中，需要添加非典型神经阻滞剂：氯氮平 2 例，喹硫平 1 例。