Department of Psychiatry, Taipei Veterans General Hospital, Taipei 112, Taiwan.
Gen Hosp Psychiatry. 2011 Jul-Aug;33(4):411.e3-5. doi: 10.1016/j.genhosppsych.2011.02.006. Epub 2011 Apr 1.
Extrapyramidal symptoms are frequently found in patients with schizophrenia. Most are attributed as drug-induced parkinsonism, but comorbidity of idiopathic Parkinson's disease is also possible. We report a 59-year-old male with a diagnosis of schizophrenia for 32 years. Progressive hand tremor was noted from age 53; and then masked face, bradykinesia, dysphagia, sialorrhea; and unsteady shuffling gait became markedly exacerbated, even after discontinuing all antipsychotics for 6 months. The diagnosis of idiopathic Parkinson's disease was confirmed by Tc99m TRODAT SPECT. The dilemma of psychopharmacological treatment to control both disorders was encountered. Based on the review of treatment for Parkinson's disease psychosis (PDP), the recommended treatments suggest the utilization of quetiapine, clozapine, or aripiprazole. However, monotherapy with each of the three atypical antipsychotics failed due to poor efficacy or worsening of parkinsonism symptoms. After a 2-month cautious titration, a combination of quetiapine 50 mg/day and clozapine 37.5 mg/day finally achieved satisfactory efficacy. This case report illustrates the dilemma of treating a patient with schizophrenia and comorbid idiopathic Parkinson's disease, which differed from PDP and required more clinical data for a proper treatment recommendation.
锥体外系症状在精神分裂症患者中很常见。大多数被归因于药物引起的帕金森病，但也可能同时患有特发性帕金森病。我们报告了一名 59 岁男性，患有精神分裂症 32 年。他从 53 岁开始出现进行性手部震颤；随后出现面具脸、运动迟缓、吞咽困难、流涎；以及不稳定的拖曳步态，即使在停用所有抗精神病药物 6 个月后，这些症状也明显恶化。通过 Tc99m TRODAT SPECT 确诊为特发性帕金森病。遇到了同时控制两种疾病的精神药理学治疗的困境。基于对帕金森病精神病（PDP）治疗的回顾，建议使用喹硫平、氯氮平或阿立哌唑进行治疗。然而，由于疗效不佳或帕金森病症状恶化，三种非典型抗精神病药物的单一疗法均失败。经过 2 个月的谨慎滴定，喹硫平 50mg/天和氯氮平 37.5mg/天的联合治疗最终达到了满意的疗效。本病例报告说明了治疗同时患有精神分裂症和特发性帕金森病的患者所面临的困境，这与 PDP 不同，需要更多的临床数据来提出适当的治疗建议。
