Rongve Arvid, Auning Eirik, Ehrt Uwe, Arsland Dag
Seksjon for alderspsykiatri, Klinikk for psykisk helsevern, Haugesund sykehus, Norway.
Tidsskr Nor Laegeforen. 2012 Jan 24;132(2):155-8. doi: 10.4045/tidsskr.11.0723.
Psychosis is common in Parkinson's disease, and occurs with increasing frequency as the disease progresses. Assessment and treatment are often complicated and involve several clinical specialists in addition to the general practitioner. We describe the prevalence, form, causes and treatment of psychosis in Parkinson's disease.
The article is based on a literature search in PubMed for controlled pharmacological treatment studies and a discretionary selection of articles based on the authors' clinical and research experience.
About 1 % of patients with newly diagnosed Parkinson's disease have psychotic symptoms. In later stages, complicated by dementia, these symptoms occur in about half of the patients. A false sense of presence, optical illusions and visual hallucinations occur most frequently, but delusions and hallucinations involving other senses have been reported. Various theories to explain the underlying etiology and pathology are explored. A further medical assessment is recommended when psychotic symptoms occur. Clozapine is still the only antipsychotic drug documented effective against psychotic symptoms in Parkinson's disease.
The prevalence of psychotic symptoms in various stages of Parkinson''s disease has been thoroughly documented. Non-pharmacological treatment is often effective, but the documentation is inadequate. Pharmacological treatment with clozapine has proved effective against psychosis in Parkinson's disease, but new drugs that are easier to administer are needed.
精神病在帕金森病中很常见，且随着疾病进展其发生率不断增加。评估和治疗通常很复杂，除了全科医生外还需要多名临床专科医生参与。我们描述了帕金森病中精神病的患病率、形式、病因及治疗方法。
本文基于在PubMed上对对照药物治疗研究的文献检索，并根据作者的临床和研究经验酌情选择文章。
约1%新诊断的帕金森病患者有精神病症状。在疾病后期，若并发痴呆，约半数患者会出现这些症状。存在感错觉、视错觉和视幻觉最为常见，但也有涉及其他感觉的妄想和幻觉的报道。探讨了各种解释潜在病因和病理的理论。出现精神病症状时建议进一步进行医学评估。氯氮平仍是唯一被证明对帕金森病精神病症状有效的抗精神病药物。
帕金森病各阶段精神病症状的患病率已有充分记录。非药物治疗通常有效，但相关记录不足。已证明氯氮平药物治疗对帕金森病精神病有效，但需要更易于给药的新药。
