Abbar M, Courtet P, Castelnau D
Service de Psychiatrie A, CHU Caremeau, Nîmes.
Encephale. 1996 Jan-Feb;22(1):53-63.
Psychosis secondary to dopaminergic therapy can limit the ability to manage motor symptoms of advanced Parkinson's disease (PD). Scholz and Dichgans (1985) were the first to report the use of clozapine in drug-induced psychosis in PD. The rationale for use of clozapine in parkinsonian patients is supported by his original pharmacological profile with weak extra-pyramidal side effects. A Medline search was performed of literature from 1985 to 1994. The literature search was not limited to the English language. Numerous authors (23 articles) using case reports or open trials among more than 100 patients suggested that clozapine would be useful in treating drug-induced psychosis in PD. We analysed the available information addressing: 1) clinical efficacy, 2) clinical predictors of outcome, 3) delay of action, 4) influence of clozapine on extrapyramidal symptomatology, 5) adverse effects and treatment withdrawal causes, 6) long-term follow-up data. However, the partially negative result of the only double-blind placebo-controlled trials, it may be stated that in some clinical situation of psychosis in PD, the use of clozapine may represent an opportune alternative when other therapeutic strategies have failed.
多巴胺能治疗继发的精神病会限制对晚期帕金森病（PD）运动症状的控制能力。朔尔茨和迪希甘斯（1985年）首次报告了氯氮平用于治疗帕金森病药物所致精神病。氯氮平用于帕金森病患者的理论依据是其最初的药理学特性，即锥体外系副作用较弱。我们对1985年至1994年的文献进行了医学文献数据库检索。文献检索不限于英文文献。众多作者（23篇文章）通过病例报告或在100多名患者中进行的开放试验表明，氯氮平在治疗帕金森病药物所致精神病方面可能有用。我们分析了现有信息，涉及：1）临床疗效，2）结局的临床预测因素，3）起效延迟，4）氯氮平对锥体外系症状的影响，5）不良反应及停药原因，6）长期随访数据。然而，唯一一项双盲安慰剂对照试验的部分阴性结果表明，在帕金森病精神病的某些临床情况下，当其他治疗策略失败时，使用氯氮平可能是一个合适的选择。
