Department of Neurology, NYU Langone Health, New York, NY, USA.
Department of Neurology, NYU Langone Health, New York, NY, USA.
Parkinsonism Relat Disord. 2018 Sep;54:40-45. doi: 10.1016/j.parkreldis.2018.04.008. Epub 2018 Apr 4.
Psychotic symptoms are underdiagnosed in Parkinson's disease (PD), and there is a need for a comprehensive PD psychosis rating scale.
Cross-sectional analysis of 199 consecutive PD outpatients. After a routine clinical visit that included the Unified Parkinson's Disease Rating Scale (UPDRS) and Non-Motor Symptoms Questionnaire (NMS-Quest), subjects completed the enhanced Scale for the Assessment of Positive Symptoms in PD (eSAPS-PD), a structured clinical interview that included the standard SAPS-PD with additional prompts for delusions and olfactory, gustatory, and minor hallucinations. Based on the combined results of these assessments, subjects were categorized as having major psychotic symptoms (hallucinations or delusions; PDP-major), isolated minor psychotic symptoms (passage hallucinations, presence hallucinations, or illusions; PDP-minor), or no psychotic symptoms (PD-controls).
We identified 58 subjects (29%) with psychotic symptoms, including 28 (14%) with major psychotic symptoms and 30 (15%) with isolated minor psychotic symptoms. Hallucinations were present in 56 subjects (28%); most commonly visual (24%, of which 21% were minor only), followed by olfactory (6%), tactile (4%), auditory (2%), and gustatory (1%). The eSAPS-PD detected psychotic symptoms in more subjects (n = 55, 28%) than all other assessments combined (clinical visit, UPDRS part 1, and NMS-Quest) (n = 22, 11%). Compared with PD-controls, PDP-minor subjects had a higher burden of other non-motor symptoms on the Non-Motor Symptoms Scale (37 [27-51] vs. 18 [9-36], p < 0.001) and lower quality of life scores on the PD Quality of Life Questionnaire (138 [125-151] vs. 149 [137-165], p = 0.01).
The eSAPS-PD can markedly improve detection of psychotic symptoms in PD.
在帕金森病（PD）中，精神病症状被漏诊的情况较为常见，因此需要一种全面的 PD 精神病评定量表。
对 199 例连续的 PD 门诊患者进行横断面分析。在进行常规临床访视后（包括统一帕金森病评定量表（UPDRS）和非运动症状问卷（NMS-Quest）），患者完成增强型 PD 阳性症状评定量表（eSAPS-PD），这是一种结构化的临床访谈，包括标准 SAPS-PD 以及针对妄想和嗅觉、味觉和轻度幻觉的附加提示。根据这些评估的综合结果，患者被归类为存在主要精神病症状（幻觉或妄想；PDP-主要）、孤立的轻度精神病症状（一过性幻觉、存在性幻觉或错觉；PDP-轻度）或没有精神病症状（PD-对照）。
我们发现 58 例（29%）患者存在精神病症状，其中 28 例（14%）存在主要精神病症状，30 例（15%）存在孤立的轻度精神病症状。56 例（28%）患者存在幻觉，最常见的是视觉（24%，其中 21%仅为轻度），其次是嗅觉（6%）、触觉（4%）、听觉（2%）和味觉（1%）。eSAPS-PD 检测到的精神病症状患者多于所有其他评估（临床访视、UPDRS 第 1 部分和 NMS-Quest）（n=22，11%）的总和（n=55，28%）。与 PD-对照相比，PDP-轻度患者的非运动症状量表（Non-Motor Symptoms Scale）上的其他非运动症状负担更高（37[27-51] vs. 18[9-36]，p<0.001），帕金森病生活质量问卷（PD Quality of Life Questionnaire）上的生活质量评分更低（138[125-151] vs. 149[137-165]，p=0.01）。
eSAPS-PD 可显著提高 PD 中精神病症状的检出率。
