Ruggieri S, De Pandis M F, Bonamartini A, Vacca L, Stocchi F
Mediterranean Institute of Neuroscience Neuromed, Pozzilli, Italy.
Clin Neuropharmacol. 1997 Jun;20(3):204-9. doi: 10.1097/00002826-199706000-00003.
Dopaminergic psychosis frequently complicates the pharmacological treatment of Parkinson's disease. Dose reduction of dopaminomimetic therapy or treatment with conventional neuroleptics improves psychosis but worsens parkinsonism. In an open-label 12-month trial, the clinical antipsychotic efficacy of the atypical neuroleptic clozapine was investigated in 36 parkinsonian patients (age range 46-85 years) with symptoms of dopaminergic psychosis including delusions, vivid dreams, hallucinations, frank paranoid delirium, and hypersexuality. Clozapine, given orally at bedtime, was started at a dose of 6.25 mg and titrated upward to the minimal effective dose. In all patients, psychosis responded to very low clozapine doses (mean 10.59 +/- 6.48 mg/day). Clozapine doses correlated with the severity of psychosis. During clozapine treatment, parkinsonian disabilities and levodopa dosage remained statistically unchanged. During the 12-month study, no patient had clozapine-induced agranulocytosis or other severe side effects. These findings indicate that even at low doses, clozapine effectively controls dopaminergic psychosis in Parkinson's disease patients without compromising motor function.
多巴胺能精神病常使帕金森病的药物治疗复杂化。减少多巴胺模拟疗法的剂量或使用传统抗精神病药物治疗可改善精神病症状，但会加重帕金森病症状。在一项为期12个月的开放标签试验中，对36例（年龄范围46 - 85岁）患有多巴胺能精神病症状（包括妄想、生动梦境、幻觉、明显的偏执性谵妄和性欲亢进）的帕金森病患者，研究了非典型抗精神病药物氯氮平的临床抗精神病疗效。氯氮平于睡前口服，起始剂量为6.25毫克，并向上滴定至最小有效剂量。在所有患者中，精神病症状对非常低剂量的氯氮平有反应（平均10.59 +/- 6.48毫克/天）。氯氮平剂量与精神病严重程度相关。在氯氮平治疗期间，帕金森病残疾情况和左旋多巴剂量在统计学上保持不变。在为期12个月的研究中，没有患者出现氯氮平引起的粒细胞缺乏症或其他严重副作用。这些发现表明，即使在低剂量下，氯氮平也能有效控制帕金森病患者的多巴胺能精神病，而不损害运动功能。
