School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
Parkinsonism Relat Disord. 2022 Oct;103:69-72. doi: 10.1016/j.parkreldis.2022.08.024. Epub 2022 Aug 24.
Previous studies have assessed antipsychotic use after Parkinson's disease (PD) diagnosis, but incident antipsychotic use before PD diagnosis is unknown. The objective is to study the incidence of antipsychotic use among community-dwelling persons with and without PD 10 years before and after the PD diagnosis.
The study was based on the nationwide register-based FINPARK-study including 20,994 persons with PD (diagnosed 1996-2015) and 142,944 comparison persons who had not used antipsychotics during one-year washout before the follow-up. PD was diagnosed according to the United Kingdom's Parkinson's disease Society Brain Bank's criteria. Antipsychotic initiations in six-month time-windows was assessed.
26.9% (n = 5,654) of people with PD initiated antipsychotics in comparison to 9.7% (n = 13,887) of people without PD during the entire follow-up. The incidence rate increased in people with PD approximately four years before the PD diagnosis. The most commonly initiated antipsychotic was quetiapine (n = 3,642, 64.4%) in persons with PD and risperidone (n = 5,232, 37.7%) in comparison persons. The initiation rates were higher in persons with PD before (6.5 and 3.0/1000 person-years for persons with and without PD, respectively, incidence rate ratio 2.18, 95%CI 2.03-2.33) and after the index date (43.3 and 11.7/1000 person-years for persons with and without PD, respectively, IRR 3.70, 95%CI 3.57-3.83).
Persons with PD have symptoms treated with antipsychotics both before and after diagnosis. Psychotic symptoms may be challenging to recognize as prodromal symptoms since they can occur years before the motor symptoms and thus, they cannot be clinically associated with the diagnosis of PD.
先前的研究评估了帕金森病（PD）诊断后的抗精神病药物使用情况，但 PD 诊断前的新发抗精神病药物使用情况尚不清楚。本研究旨在研究 PD 诊断前 10 年和诊断后 10 年，社区居住的 PD 患者和无 PD 患者使用抗精神病药物的发生率。
本研究基于全国范围内的基于登记的 FINPARK 研究，纳入了 20994 名 PD 患者（1996-2015 年诊断）和 142944 名在随访前一年洗脱期内未使用抗精神病药物的对照者。PD 按照英国帕金森氏病学会脑库的标准诊断。评估了六个月时间窗内的抗精神病药物起始情况。
5654 名（26.9%）PD 患者在整个随访期间开始使用抗精神病药物，而 13887 名（9.7%）无 PD 患者开始使用抗精神病药物。PD 患者的发病率在 PD 诊断前约四年增加。PD 患者中最常起始的抗精神病药物是喹硫平（n=3642，64.4%），而对照者中最常起始的抗精神病药物是利培酮（n=5232，37.7%）。PD 患者在指数日期之前（6.5 和 3.0/1000 人年，PD 患者和无 PD 患者分别，发病率比 2.18，95%CI 2.03-2.33）和之后（43.3 和 11.7/1000 人年，PD 患者和无 PD 患者分别，发病率比 3.70，95%CI 3.57-3.83）的起始率更高。
PD 患者在诊断前后都有抗精神病药物治疗的症状。精神病症状可能难以识别为前驱症状，因为它们可能在运动症状出现多年前出现，因此不能与 PD 的诊断临床相关。
