幻觉、妄想和帕金森病中的冲动控制障碍。

Hallucinations, Delusions and Impulse Control Disorders in Parkinson Disease.

机构信息

The Edmond J. Safra Program in Parkinson Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Division of Neurology, Department of Medicine, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada; Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester, Rochester, New York, United States; Center for Health + Technology (CHeT), University of Rochester, Rochester, New York, United States.

出版信息

Clin Geriatr Med. 2020 Feb;36(1):105-118. doi: 10.1016/j.cger.2019.09.004. Epub 2019 Sep 6.

DOI:10.1016/j.cger.2019.09.004

PMID:31733691

Abstract

Psychotic and compulsive symptoms in Parkinson disease are highly prevalent and associated with poor outcomes and greater caregiver burden. When acute, delirium should be ruled out or treated accordingly. When chronic, comorbid systemic illnesses, dementia, and psychiatric disorders should be considered. Reduction and discontinuation of anticholinergics, amantadine, dopamine agonists, and levodopa as tolerated, as well as adjunctive clozapine or quetiapine are frequently effective to manage Parkinson disease psychosis. Pimavanserin appears effective but is not widely available, and more experience is needed. Dopamine agonist discontinuation is usually successful for impulse control disorders, but requires frequent monitoring, documentation, and caregiver involvement.

摘要

帕金森病患者中出现的精神和强迫症状非常普遍，与不良预后和更大的 caregiver负担有关。如果是急性的，应排除谵妄或进行相应治疗。如果是慢性的，应考虑合并的系统性疾病、痴呆和精神障碍。如果耐受，应减少或停用抗胆碱能药物、金刚烷胺、多巴胺激动剂和左旋多巴，并酌情辅助使用氯氮平或喹硫平，这些方法通常对治疗帕金森病精神病有效。普拉克索对帕金森病精神病有效，但尚未广泛应用，需要更多经验。停用多巴胺激动剂通常对冲动控制障碍有效，但需要频繁监测、记录并让护理人员参与。