巴金森氏病精神症狀及其治療之最近文獻回顧

精神症狀是巴金森氏病常見的併發症，約有25～0%巴金森氏病病人會出現，是病人住進養護機構的最常見原因，也增加死亡率及照護者的負擔。臨床表現包括：幻覺、妄想、錯覺及錯誤的存在感，以視幻覺最常發生。其處理原則為評估並治療繼發性因素及簡化抗巴金森氏病藥品。若調整抗巴金森氏病藥品後仍無法有效改善精神症狀，就必須考慮加入抗精神病藥品治療。由於抗精神病藥品可能會加重運動症狀，如何選擇有效且不惡化運動症狀的抗精神病藥品，是治療上的一大挑戰。目前常用的非典型抗精神病藥品是以低劑量clozapine或quetiapine為主，clozapine可能導致顆粒性白血球低下，使用期間需監測絕對嗜中性細胞球。Pimavanserin為血清素受體5-HT_(2A)反致效劑，可有效改善精神症狀，且不會惡化運動功能，美國Food and Drug Administration (FDA)已於2016年核准。但長期使用的安全性及療效尚未確立。

關鍵字

巴金森氏病精神症狀；非典型抗精神病用藥； Pimavanserin ； 5-HT_(2A)反致效劑

並列摘要

Psychosis is a common complication of Parkinson's disease (PD), occurring in 25% to 60% of PD patients. It is the most frequent cause of nursing home admission for PD patients, and it increases mortality and caregiver burden. Psychotic symptoms in PD include hallucinations, delusions, illusions and false sense of presence. Among them, visual hallucinations are the most common manifestations. The principles of managing PD psychosis are to treat secondary causes of PD and to simplify the PD drug regimen. Antipsychotic agent should be considered if the adjustment of PD medications fails to improve psychosis. Choosing effective antipsychotic medications for PD patients is challenging due to the possibility of worsening PD motor symptoms. Of the atypical antipsychotics, low-dose clozapine and quetiapine are frequently used in clinical practice. Clozapine can cause granulocytopenia, and hence absolute neutrophil count must be monitored during use. Pimavanserin, a 5-HT_(2A) receptor inverse agonist, has been shown to reduce psychotic symptoms in PD patients without worsening motor symptoms. It was approved by the U.S. Food and Drug Administration in 2016 for the treatment of PD-related hallucinations and delusions. However, the long-term safety and efficacy of pimavanserin have not been established.

並列關鍵字

Parkinson's Disease Psychosis ； Atypical Antipsychotics ； Pimavanserin ； 5-HT_(2A) Inverse Agonist

國際替代計量

巴金森氏病精神症狀及其治療之最近文獻回顧

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