PD的精神症状ppt演示课件

Parkinsons disease psychosis,1,.,Psychosis in PD,In a recent meta-analysis of prospective studies, visual hallucinations were reported in 16-37% of patients, auditory in less than 2-22% and delusions in about 1-14%. The number of variables that differed among studies make any estimate very approximate. Visual hallucinations tend to be complex and formed, may be clearly seen or not, tend to be stereotyped, tend to occur when the patient is in a low sensory environment and are thus more state-dependent than related to drug dose . Auditory hallucinations are often indistinct, with party sounds heard coming from another room, people talking indistinctly outside, music of various types. Sometimes the visual hallucinations talk to the patient and may carry on conversations. Delusions tend to be paranoid. The most common delusions are of stealing, thinking their house is not really theirs, spousal infidelitv, and being abandoned.,Friedman J H. Parkinsons disease psychosis 2010: a review articleZ. 2010:16,553560,2,.,Differential,Schizophrenia :Psychotic symptoms present in schizophrenia such as thought broadcasting, delusions of grandeur, voices talking about the patient, mind reading, being controlled by foreign forces, religiosity, are almost never seen other than in patients who have comorbid psychiatric problem. The number of cases of schizophrenia who develop IPD is difficult to determine due to the fact that all neuroleptics other than clozapine and quetiapine cause parkinsonism in some patients, so that the diagnosis of IPD on clinical grounds is often impossible in a patient on an anti-psychotic drug. SPECT scanning with cocaine analogs can reliably distinguish the drug induced from the cases of IPD exacerbated by the drugs. Bonnets syndrome, a disorder in which elderly people with visual impairment have benign visual hallucinations as “release“ phenomena can be impossible to distinguish from PDP. Vivid dreams, REM intrusions, hypnogogic and hypnopompic hallucinations can also be described in ways that are difficult or impossible to distinguish from PDP hallucinations.,Friedman J H. Parkinsons disease psychosis 2010: a review articleZ. 2010:16,553560,3,.,Risk factors of psychosis in PD,Disease duration, Medication for PD, Dementia , Sleep disturbances, Abnormalities of visual perception and processing, Older age, pathological changes in the medial temporal lobe. 1 dopaminergic agonists, cognitive impairment, older age/longer duration of PD, disease severity, altered dream phenomena, daytime somnolence, and possibly depression and dysautonomia. 2 药物暴露、认知功能下降、年龄增加、病程长、视觉障碍，伴随焦虑、抑郁和睡眠障碍者易出现精神病性症状。3 目前认为老龄、PD病程、病情的严重程度、认知功能障碍、睡眠障碍是PD患者出现精神症状的危险因素。4,1 Friedman J H. Parkinsons disease psychosis 2010: a review articleZ. 2010:16,553560 2 Fnelon G, Alves G. Epidemiology of psychosis in Parkinsons diseaseJ. Journal of the Neurological Sciences,2010,289(1-2):1217 3 中华医学会神经病学分会神经心理学与行为神经病学组，中华医学会神经病学分会帕金森病及运动障碍学组. 帕金森病抑郁、焦虑及精神病性障碍的诊断标准及治疗指南Z. 2013:46,5660 4 孟莉，刘娜，李艳敏，等. 帕金森病的非运动症状精神症状的研究进展J. 临床神经病学杂志,2012(02):156158,4,.,帕金森中的精神性障碍,帕金森病患者的精神病性症状主要表现为幻觉、错觉、妄想和存在的错误观念。 帕金森病幻觉可涉及任何感觉形式，但以视幻觉最为常见，帕金森病视幻觉常为生动的人或者动物，很少为无生命的物体。 听幻觉类型可以为低语、音乐或威胁的声音，一般与视幻觉伴发，很少单独出现，据此可以与听幻觉型精神分裂症相鉴别。 帕金森病幻觉可间歇出现，每次发生持续数秒至数分钟，常反复发生。夜间或患者独处在安静的环境中易发生幻觉。 存在的错误观念是一种体验，即感觉某人或某物在周围，但实际上该人或该物此刻并不在周围，其感知模式(如听觉、视觉)并不明确。,中华医学会神经病学分会神经心理学与行为神经病学组，中华医学会神经病学分会帕金森病及运动障碍学组. 帕金森病抑郁、焦虑及精神病性障碍的诊断标准及治疗指南Z. 2013:46,5660,5,.,帕金森病精神病性障碍诊断标准,符合以下1一5条者即可考虑帕金森病精神病性障碍。 1.符合英国帕金森病协会脑库诊断标准或中国帕金森病诊断标准确诊的原发性帕金森病。 2.出现至少1个以下症状:幻觉、错觉、妄想以及存在的错误观念。 3.精神病性症状在帕金森病发生之后出现，至少为帕金森病诊断1年后出现，多数为帕金森病诊断10年以后出现。 4.持续时间:幻觉、错觉和妄想以及存在的错误观念反复发生，或持续1个月。 5.需排除其他疾病导致的精神病性症状，如路易体痴呆、精神分裂症、精神分裂样疾病、伴有精神病性症状的情感障碍及药物导致的精神病性障碍或谵妄状态。 6.伴发情况:应注明有或无自知力，有或无痴呆，是否在抗帕金森病治疗。,中华医学会神经病学分会神经心理学与行为神经病学组，中华医学会神经病学分会帕金森病及运动障碍学组. 帕金森病抑郁、焦虑及精神病性障碍的诊断标准及治疗指南Z. 2013:46,5660,6,.,治疗帕金森的药物出现精神症状的危险性,PD精神病性症状的出现可能与年龄大，病程长，合并全身疾病，多巴丝肼(美多芭)、苯海索的剂量高有关。吡贝地尔（泰舒达）的症状出现可能性稍高。1 多巴丝肼精神病性症状出现率为:2. 63%,吡贝地尔为:20. 69%，苯海索为:20. 00%，卡左双多巴（息宁）:9. 09%。吡贝地尔的精神病性症状出现率明显高于除了苯海索外的其他抗帕金森药物，有显著性差异(P0. 05 )2 在多巴胺能药物中，多巴胺比左旋多巴更容易引起这些精神症状，不同的多巴胺能药物诱发精神症状的风险各不相同，培高利特具有较高的风险，普拉克索（森福罗）相比罗匹尼罗致幻觉的风险也较高。在其他抗PD药物中，司来吉兰（米多吡）、金刚烷胺、抗胆碱能药物、儿茶酚胺-O-转甲基酶抑制剂（琼丹）均可加重精神症状.甚至可加快其进展。 3,1 黄中坚. 帕金森病精神病性症状的原因分析J. 中外医疗,2009,28(3):90 2 钟静玫，武绍远，马莎，等. 抗帕金森药物精神病性症状出现率的观察Z. 北京:2008161162 3 孟莉，刘娜，李艳敏，等. 帕金森病的非运动症状精神症状的研究进展J. 临床神经病学杂志,2012(02):156158,7,.,帕金森病精神病性障碍的治疗,1.