Morgante Francesca, Barbui Corrado, Tinazzi Michele
Dipartimento di Medicina Clinica e Sperimentale, University of Messina, Italy; Institute of Molecular and Clinical Sciences, St George's University of London, London, United Kingdom.
WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Motor Sciences, Section of Psychiatry, University of Verona, Italy.
Parkinsonism Relat Disord. 2017 Mar;36:89-92. doi: 10.1016/j.parkreldis.2016.12.022. Epub 2016 Dec 23.
We have recently demonstrated evidence of nigro-striatal denervation, disease progression and response to levodopa in a subgroup of patients with schizophrenia who developed parkinsonism.
In the present study, we investigated whether axial parkinsonian signs might be an early manifestation of parkinsonism in schizophrenia not necessarily related to chronic administration of antipsychotic drugs (AP) drugs.
From a baseline cohort of 299 schizophrenic patients who did not satisfy the diagnostic criteria for parkinsonism (presence of at least two of the following appendicular signs: bradykinesia, tremor, rigidity), we identified a group of patients who manifested two out of three axial parkinsonian signs (abnormality of trunk posture, hypomimia and short-step gait). Accordingly, we obtained two sub-groups of patients with schizophrenia, with (Schiz-Axial, N = 26), and without parkinsonian axial signs (Schiz-NO-Axial, N = 273). Clinical and demographical variables were compared between groups. The motor section of the Unified Parkinson's disease rating scale (UPDRS) was employed to measure motor disability.
Schiz-Axial patients were significantly older (p = 0.007) and had longer disease duration (p = 0.04) compared to Schiz-NO-Axial. The two groups did not differ for variables related to AP treatment. Total UPDRS motor score (p < 0.0001) as well as limb (p < 0.0001) and axial (p < 0.0001) UPDRS sub-scores were increased in Schiz-Axial patients compared to Schiz-NO-Axial.
Our findings provide evidence that axial parkinsonian signs might be an early manifestation of parkinsonism in schizophrenia associated to older age and longer disease duration.
我们最近在一组患帕金森症的精神分裂症患者中证实了黑质纹状体去神经支配、疾病进展及对左旋多巴反应的证据。
在本研究中，我们调查了轴性帕金森体征是否可能是精神分裂症中帕金森症的早期表现，而不一定与长期服用抗精神病药物（AP）有关。
从299名不符合帕金森症诊断标准（存在以下至少两种肢体体征：运动迟缓、震颤、僵直）的精神分裂症患者基线队列中，我们确定了一组表现出三种轴性帕金森体征中的两种（躯干姿势异常、表情减少和短步幅步态）的患者。据此，我们获得了两组精神分裂症患者，有轴性帕金森体征的（精神分裂症 - 轴性组，N = 26）和无轴性帕金森体征的（精神分裂症 - 无轴性组，N = 273）。对两组之间的临床和人口统计学变量进行了比较。采用统一帕金森病评定量表（UPDRS）的运动部分来测量运动功能障碍。
与精神分裂症 - 无轴性组相比，精神分裂症 - 轴性组患者年龄显著更大（p = 0.007）且病程更长（p = 0.04）。两组在与抗精神病药物治疗相关的变量方面无差异。与精神分裂症 - 无轴性组相比，精神分裂症 - 轴性组患者的UPDRS运动总分（p < 0.0001）以及肢体（p < 0.0001）和轴性（p < 0.0001）UPDRS子评分均升高。
我们的研究结果提供了证据，表明轴性帕金森体征可能是精神分裂症中与年龄较大和病程较长相关的帕金森症的早期表现。
