Friedman Joseph H
Department of Neurology, Movement Disorders Program, Butler Hospital, Alpert Medical School of Brown University, Providence, RI 02906, USA.
J Pharm Pract. 2011 Dec;24(6):534-40. doi: 10.1177/0897190011426556. Epub 2011 Nov 17.
Parkinson's disease (PD) patients often develop psychotic symptoms that severely affect quality of life and limit the use of medications to ameliorate motor symptoms. Psychotic symptoms are a major cause for nursing home placement. While these symptoms do not always require treatment, they often do but antipsychotic drugs all share the common pharmacological mechanism of blocking dopamine D2 receptors which may worsen motor problems in this very vulnerable population. Double blind, placebo controlled trials (DBPCT) have shown that clozapine is effective at controlling the psychotic symptoms at doses far below those used in schizophrenia, without worsening motor function, even improving tremor. DBPCT have demonstrated that olanzapine worsens motor function without improving psychosis. Quetiapine has been shown in DBPCT to be free of motor side effects in PD patients but not effective, whereas many open label studies have indicated that quetiapine is effective. The other atypical have been the subjects of conflicting open label reports. The effects of the atypicals in PD psychosis is reviewed.
帕金森病（PD）患者常出现精神症状，这些症状严重影响生活质量，并限制了用于改善运动症状的药物的使用。精神症状是患者入住疗养院的主要原因。虽然这些症状并非总是需要治疗，但通常确实需要治疗，然而抗精神病药物都具有共同的药理机制，即阻断多巴胺D2受体，这可能会使这个非常脆弱的人群的运动问题恶化。双盲、安慰剂对照试验（DBPCT）表明，氯氮平在远低于用于精神分裂症治疗的剂量下就能有效控制精神症状，且不会使运动功能恶化，甚至能改善震颤。DBPCT已证明奥氮平会使运动功能恶化，却无法改善精神病症状。DBPCT显示喹硫平在PD患者中无运动副作用，但效果不佳，而许多开放标签研究表明喹硫平是有效的。其他非典型抗精神病药物则存在相互矛盾的开放标签报告。本文对非典型抗精神病药物在PD精神病中的作用进行了综述。
