Yoritaka Asako, Hayashi Tetsuo, Fusegi Keiko, Inami Rie, Hattori Nobutaka
Department of Neurology, Juntendo University Koshigaya Hospital, Saitama, Japan.
Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
Parkinsons Dis. 2022 May 26;2022:2727515. doi: 10.1155/2022/2727515. eCollection 2022.
It is difficult to distinguish patients with schizophrenia with neuroleptic-induced parkinsonism (NIP) from those with existing idiopathic Parkinson's disease when their striatal dopamine transporter uptake is reduced. There is a possibility of misdiagnosis of Parkinson's disease in patients with schizophrenia as schizophrenia with NIP, which leads to inappropriate treatment. This prospective study aimed at determining the underlying pathophysiology using detailed clinical and psychological assessments.
We enrolled six patients with schizophrenia who had parkinsonism and were diagnosed with Parkinson's disease according to the Movement Disorder Society Clinical Diagnostic Criteria, except for the fifth absolute exclusion criteria.
Five patients had been treated with neuroleptics for 20 years. One patient refused treatment for schizophrenia. All patients had impaired cognitive function at enrolment, olfactory dysfunction, and constipation. All patients were treated with dopaminergic therapy, and their parkinsonism substantially improved; one woman in her 40s experienced a wearing-off effect and dyskinesia. The uptake of dopamine transporter in the striatum decreased by 13%/year during the study period.
Some patients with schizophrenia and parkinsonism benefit from dopaminergic therapy. Some of these patients may also exhibit Lewy pathology.
当纹状体多巴胺转运体摄取减少时，很难将患有抗精神病药物所致帕金森综合征（NIP）的精神分裂症患者与患有原发性帕金森病的患者区分开来。精神分裂症患者有可能被误诊为患有NIP的精神分裂症，从而导致不恰当的治疗。这项前瞻性研究旨在通过详细的临床和心理评估来确定潜在的病理生理学机制。
我们纳入了6例患有帕金森综合征且根据运动障碍协会临床诊断标准被诊断为帕金森病的精神分裂症患者，但不包括第五条绝对排除标准。
5例患者接受抗精神病药物治疗已达20年。1例患者拒绝接受精神分裂症治疗。所有患者在入组时均有认知功能受损、嗅觉功能障碍和便秘。所有患者均接受多巴胺能治疗，其帕金森综合征症状明显改善；1例40多岁的女性出现了疗效减退和运动障碍。在研究期间，纹状体中多巴胺转运体的摄取量每年下降13%。
一些患有精神分裂症和帕金森综合征的患者从多巴胺能治疗中获益。其中一些患者也可能表现出路易体病理改变。
