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首页> 外文期刊>Journal of neurology >Treatment options for depression and psychosis in Parkinson's disease.
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Treatment options for depression and psychosis in Parkinson's disease.

机译：帕金森氏症抑郁和精神病的治疗选择。

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Neuropsychiatric symptoms are a frequent feature of advancing Parkinson's disease (PD). The reported prevalence of depression varies greatly between different studies but there is general consensus that between 40 and 50% of patients will be affected. Depression may antedate motor manifestations of Parkinson's disease and is usually of moderate or mild intensity. However, depression is of major impact on the quality of life in PD patients according to a recent survey. Drug-induced psychosis is one of the major therapeutic challenges in Parkinson's disease and may occur in up to 6% in otherwise uncomplicated de novo patients when first receiving dopaminergic therapy. It increases in frequency, in advanced disease and particularly in patients with dementia where up to 22% may be affected. There is an amazing lack of controlled clinical trials assessing the effects of antidepressants in clinical trials including more than 20 patients and assessing efficacy of antidepressants specifically in the context of mood changes in Parkinson's disease. A comprehensive literature search yielded only a total of 17 articles of which a majority included less than 20 patients and/or did not use valid depression ratings. The only randomized controlled trial was conducted more than 20 years ago using nortryptiline while no controlled trials were available on the use of serotonin reuptake inhibitors. Studies assessing the antidepressant action of dopaminergic therapies are few and inconclusive. Thus, while tricyclic antidepressants or SSRIs are widely used in clinical practice, there is still a need for controlled clinical trials proving their efficacy specifically in parkinsonian depression. Three randomized controlled trials are now available assessing the efficacy of the atypical neuroleptics clozapine and olanzapine in the treatment of drug-induced psychosis. While clozapine is of proven efficacy at least in the short-term management of this complication without negative impact on the motor symptoms, olanzapine in currently used doses of 2.5 to 15 mg/d seems to aggravate motor symptoms with lesser effect on psychosis compared to clozapine. Currently, clozapine is the atypical neuroleptic of choice for the treatment of drug-induced psychosis in Parkinson's disease.
机译：神经精神症状是进展性帕金森氏病（PD）的常见特征。在不同的研究中，据报道抑郁症的患病率差异很大，但普遍共识是40％至50％的患者会受到影响。抑郁症可能早于帕金森氏病的运动表现，通常为中度或轻度。然而，根据最近的一项调查，抑郁症对PD患者的生活质量有重大影响。药物引起的精神病是帕金森氏病的主要治疗挑战之一，初次接受多巴胺能疗法的其他原发性无并发症患者中可能会发生高达6％的疾病。在晚期疾病中，尤其是在痴呆症患者中，这种疾病的发生频率会增加，最多可能会影响22％。缺乏对照临床试验来评估抗抑郁药在包括20多名患者的临床试验中的作用，并且尤其是在帕金森氏病情绪变化的情况下评估抗抑郁药的功效。全面的文献检索仅产生了总共17篇文章，其中大多数包括少于20名患者和/或未使用有效的抑郁评分。唯一的随机对照试验是在20多年前使用去甲肾上腺素进行的，而没有关于使用5-羟色胺再摄取抑制剂的对照试验。评估多巴胺能疗法的抗抑郁作用的研究很少且尚无定论。因此，尽管三环抗抑郁药或SSRIs在临床实践中被广泛使用，但仍需要进行对照临床试验以证明其在帕金森氏抑郁症中的功效。现在有三项随机对照试验用于评估非典型抗精神病药氯氮平和奥氮平在药物性精神病治疗中的功效。尽管氯氮平已证明至少在短期内可有效治疗并发症，而对运动症状没有负面影响，但与氯氮平相比，奥氮平目前使用的剂量为2.5至15 mg / d，似乎加重了运动症状，对精神病的影响较小。目前，氯氮平是治疗帕金森氏病药物性精神病的非典型抗精神病药。

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