帕金森病冻结步态与躯体形式障碍临床分析

Clinical Analysis of the Freezing Gait and Somatoform Disorders in Parkinson's Disease Patients

目的探讨帕金森病(parkingson’s disease,PD)患者冻结步态与躯体转化形式障碍是否相关及是否有相互促进作用,以期对帕金森病患者的冻结步态体征尽早地进行干预治疗.方法选取(1.云南省第三人民医院门诊及住院的、明确诊断为帕金森病,同时伴有冻结步态及躯体转化形式障碍的患者20例,给予抗抑郁药艾司西酞普兰(10~20 mg/d)加心理暗示治疗(森田疗法),同时给服抗帕金森病药(多巴丝肼及普拉克索等)共6周,继而采用改良Hoehn-Yahr分级量表评价治疗前后帕金森病症状及冻结步态体征有无变化.结果 20例患者中抗帕金森病治疗联合抗躯体转化形式障碍治疗后,18例患者由改良Hoehn-Yahr分级评估4级转为2.5-3级,有1例患者因不能耐受药物副作用而停止治疗,1例患者药物依从性不好,放弃治疗.结论帕金森病患者冻结步态与躯体形式障碍相关,与焦虑抑郁障碍相关,躯体形式障碍加重帕金森病患者的冻结步态,规范化治疗躯体形式障碍可以改善帕金森病冻结步态症状.抗帕金森病治疗应重视情绪障碍治疗,该治疗能提高帕金森病患者的生活质量.

Objective To explore the relationship between freezing gait and somatoform disorders inParkinson's disease patients,aiming to intervene the freezing gait of Parkinson's disease with therapy strategy asearly as possible.Methods A total of20cases of outpatient and hospitalized patients diagnosed as Parkinson's disease(PD)accompanied with freezing gait and somatoform disorders were selected as research objects.All patients wereadministrated with antidepressants escitalopram citalopram(10-20mg/d)+psychological suggestion therapy(morita therapy),anti-Parkinson's drug drugs(dopa silk hydrazine and pramipexole,etc.),after a total of6weeks,before and after the treatment were observed by using the modified Hoehn-Yahr rating scale evaluation forParkinson's disease symptoms and freezing gait.Results After treatment,modified Hoehn-Yahr class assessmentshowed that the levels of18cases changed from4to2.5-3.(1patient stopped treatment because he couldn'ttolerate drug side effects,1patient gave up treatment because of poor adherence).Conclusions Parkinson'sdisease freezing gait is associated with somatoform disorder and anxiety and depression disorders.Somatoformdisorder may aggravate freezing gait of patients.Standardized treatment of somatoform disorders can improve the symptoms ofParkinson's disease freezing gait.The treatment of Parkinson's disease should pay attention to mood disorders,it willimprove the quality of life of Parkinson's patients.