7547Saint Louis University School of Medicine, Saint Louis, MO, USA.
Department of Psychiatry and Behavioral Neuroscience, 7547Saint Louis University School of Medicine, MO, USA.
J Geriatr Psychiatry Neurol. 2021 Jul;34(4):274-279. doi: 10.1177/08919887211018280.
Parkinson's disease (PD) is the second most common neurodegenerative disease seen in older adults after Alzheimer's disease, with increasing prevalence worldwide. Parkinson's disease psychosis (PDP) is a common, non-motor feature of PD, which increases caregiver stress and is a risk-factor for nursing home placement. In this paper we review PDP epidemiology, features, diagnosis, and treatment. PDP most often presents with sequential development of minor and then increasingly complex visual hallucinations mediated by dopaminergic-serotonergic interactions activating the mesolimbic pathway, with contributions from other structures and neurotransmitters. Appropriate evaluation of differential diagnoses for psychosis is vital before diagnosing PDP. Initial treatment should involve non-pharmacologic approaches. If these are unsuccessful and PDP symptoms significantly impact the patient's and or their caregivers' quality of life and functions, then pharmacotherapy is indicated. Pimavanserin is a recently FDA-approved pharmacologic treatment for PDP with a better profile of balanced effectiveness and safety compared to previous use of atypical antipsychotics. Early diagnosis and safer, more effective treatments for PDP should help reduce caregiver burden and enable caregivers to continue to provide care at home versus institutionalization.
帕金森病（PD）是仅次于阿尔茨海默病（AD）的第二大常见于老年人的神经退行性疾病，在全球范围内的患病率不断增加。帕金森病精神病（PDP）是 PD 的一种常见非运动特征，它会增加护理人员的压力，也是入住养老院的一个风险因素。在本文中，我们回顾了 PDP 的流行病学、特征、诊断和治疗。PDP 最常表现为多巴胺-5-羟色胺相互作用介导的轻微且逐渐复杂的视觉幻觉的顺序发展，激活中脑边缘通路，其他结构和神经递质也有贡献。在诊断 PDP 之前，对精神病的鉴别诊断进行适当的评估至关重要。初始治疗应包括非药物治疗方法。如果这些方法不成功，并且 PDP 症状显著影响患者及其护理人员的生活质量和功能，那么就需要药物治疗。Pimavanserin 是最近获得美国食品和药物管理局（FDA）批准的用于治疗 PDP 的药物，与之前使用的非典型抗精神病药物相比，其在疗效和安全性方面具有更好的平衡特征。早期诊断和更安全、更有效的 PDP 治疗方法应有助于减轻护理人员的负担，并使护理人员能够继续在家中而不是在机构中提供护理。
