帕金森病合并精神病性症状的治疗

Management of Parkinson’s disease with psychotic symptoms

目的:探讨帕金森病合并精神病性症状(Psychosis associated with Parkinson’s disease,PDPsy)的处理进展,尤其关注药物治疗进展。方法:检索并分析近年来关于PDPsy流行病学、危害、发生机制及风险因素等方面的文献资料,并结合抗精神病药物引起锥体外系反应机制的研究进展,讨论PDPsy患者处理,尤其是抗精神病药物的合理选择。结果与结论:帕金森病合并精神病性症状发生率较高,与帕金森病病程、严重程度、认知功能障碍等相关。帕金森病的治疗药物里,多巴胺受体激动剂和金刚烷胺均增加精神病性症状的发生风险。非典型抗精神病药与第一代抗精神病药相比,锥体外系不良反应发生率较低。如果是帕金森病本身合并的精神病性症状,则考虑先用抗精神病药物;如果精神病性症状与抗帕金森病药物相关,则需先调整抗帕金森病药物。临床药师需根据精神病性症状的原因、各类药物的疗效特点、不良反应等协助医生进行抗精神病药物的合理选择。

OBJECTIVE To investigate the progress in the management of Psychosis Associated with Parkinson’s Disease(PDPsy),especially medication treatment.METHODS Literature data on the epidemiology,harm,pathogenesis and risk factors of PDPsy were retrieved and analyzed.The management of,PDPsy patients,especially the proper selection of antipsychotic drug for PDPsy patients was discussed combined with the mechanism of extra pyramidal symptoms induced by antipsychotic drug,therapy of PDPsy.RESULTS and CONCLUSION The incidence of Parkinson’s disease with psychotic symptoms is high,which is related to the course,severity and cognitive dysfunction of Parkinson’s disease.In Parkinson’s disease,both dopamine agonists and amantadine increase the risk of psychotic symptoms.Atypical antipsychotics are associated with a lower incidence of extrapyramidal adverse effects than first-generation antipsychotics.If it is Parkinson’s disease itself with psychotic symptoms,the use of antipsychotic drugs should be considered;if the psychotic symptoms are associated with anti-Parkinson’s disease drugs,it is necessary to adjust the anti-Parkinson’s disease drugs.Clinical pharmacists should assist physicians in the rational selection of antipsychotic drugs based on the causes of psychotic symptoms,the efficacy characteristics of various drugs,and adverse reactions.