Abstract：
UNASSIGNED: Psychotic symptoms in people with Parkinson\'s disease (PD) have attracted increasing. Recommendations on treating psychosis often fail to take into account what psychotic symptoms require treatment, which has been complicated by the increasing number of reports documenting the frequency of \'minor\' hallucinations.
UNASSIGNED: This article focuses both on the phenomenology of psychotic symptoms and their management.
UNASSIGNED: Understanding the nature and implications of the types of psychotic symptoms in PD is the key to proper treatment. Evidence and experience-based data on the effect of anti-psychotic medications will be reviewed and how the various clinical settings should determine the treatment approach. The evidence base consists of all reported blinded trials recorded in PubMed and the experience-based studies are those chosen by the author from PubMed as illustrative. Specific recommendations for the treatment of psychosis will be listed for specific situations. Pimavanserin is the first-line choice for mild symptoms; quetiapine for symptoms that require improvement in a short period and clozapine for urgent problems or those which fail the other approaches.
Psychotic symptoms are common in PD, affecting the majority of patients by the time of death. ‘Minor hallucinations’ rarely require treatment but formed hallucinations and delusions often do. The vast majority of patients requiring treatment are on medications for PD motor problems. Some patients can be treated with reduction of psychoactive medications that are unrelated to PD, and some may tolerate reductions in PD medications without intolerable worsening of motor function. The remainder require treatment with medications that reduce psychotic symptoms, which include cholinesterase inhibitors, clozapine, pimavanserin, and possibly quetiapine and electroconvulsive therapy. Only clozapine and pimavanserin have unequivocal evidence for efficacy and motor tolerance. Data will be reviewed in support of each of these medications will be reviewed and pragmatic suggestions based on a large experience on when each might be used, and in what order they may be tried if initial approaches fail.
UNASSIGNED: This article focuses both on the phenomenology of psychotic symptoms and their management.
UNASSIGNED: Understanding the nature and implications of the types of psychotic symptoms in PD is the key to proper treatment. Evidence and experience-based data on the effect of anti-psychotic medications will be reviewed and how the various clinical settings should determine the treatment approach. The evidence base consists of all reported blinded trials recorded in PubMed and the experience-based studies are those chosen by the author from PubMed as illustrative. Specific recommendations for the treatment of psychosis will be listed for specific situations. Pimavanserin is the first-line choice for mild symptoms; quetiapine for symptoms that require improvement in a short period and clozapine for urgent problems or those which fail the other approaches.
Psychotic symptoms are common in PD, affecting the majority of patients by the time of death. ‘Minor hallucinations’ rarely require treatment but formed hallucinations and delusions often do. The vast majority of patients requiring treatment are on medications for PD motor problems. Some patients can be treated with reduction of psychoactive medications that are unrelated to PD, and some may tolerate reductions in PD medications without intolerable worsening of motor function. The remainder require treatment with medications that reduce psychotic symptoms, which include cholinesterase inhibitors, clozapine, pimavanserin, and possibly quetiapine and electroconvulsive therapy. Only clozapine and pimavanserin have unequivocal evidence for efficacy and motor tolerance. Data will be reviewed in support of each of these medications will be reviewed and pragmatic suggestions based on a large experience on when each might be used, and in what order they may be tried if initial approaches fail.
摘要：
■帕金森病（PD）患者的精神病症状越来越多。关于治疗精神病的建议往往没有考虑到哪些精神病症状需要治疗，越来越多的报告记录了“轻微”幻觉的频率，这变得更加复杂。
■本文重点介绍精神病症状的现象学及其管理。
■了解PD中精神病性症状类型的性质和含义是正确治疗的关键。将审查有关抗精神病药物效果的证据和经验数据，以及各种临床环境应如何确定治疗方法。证据基础由PubMed中记录的所有报告的盲法试验组成，基于经验的研究是作者从PubMed中选择的那些作为说明。针对具体情况，将列出治疗精神病的具体建议。Pimavanserin是轻度症状的一线选择；喹硫平用于需要在短期内改善的症状，氯氮平用于紧急问题或其他方法失败的症状。
精神病症状在PD中很常见，影响大多数患者的死亡时间。“轻微幻觉”很少需要治疗，但形成的幻觉和妄想经常需要治疗。绝大多数需要治疗的患者正在服用PD运动问题的药物。一些患者可以通过减少与PD无关的精神活性药物来治疗，有些人可以耐受PD药物的减少，而不会出现不可忍受的运动功能恶化。其余的需要用减轻精神病症状的药物治疗，其中包括胆碱酯酶抑制剂，氯氮平,匹马色林,可能还有喹硫平和电惊厥治疗。只有氯氮平和匹马色林对疗效和运动耐受性有明确的证据。将审查数据，以支持这些药物中的每一种将被审查和务实的建议，基于大量的经验，当每一个可能被使用，以及如果最初的方法失败，他们可以以什么顺序尝试。
■本文重点介绍精神病症状的现象学及其管理。
■了解PD中精神病性症状类型的性质和含义是正确治疗的关键。将审查有关抗精神病药物效果的证据和经验数据，以及各种临床环境应如何确定治疗方法。证据基础由PubMed中记录的所有报告的盲法试验组成，基于经验的研究是作者从PubMed中选择的那些作为说明。针对具体情况，将列出治疗精神病的具体建议。Pimavanserin是轻度症状的一线选择；喹硫平用于需要在短期内改善的症状，氯氮平用于紧急问题或其他方法失败的症状。
精神病症状在PD中很常见，影响大多数患者的死亡时间。“轻微幻觉”很少需要治疗，但形成的幻觉和妄想经常需要治疗。绝大多数需要治疗的患者正在服用PD运动问题的药物。一些患者可以通过减少与PD无关的精神活性药物来治疗，有些人可以耐受PD药物的减少，而不会出现不可忍受的运动功能恶化。其余的需要用减轻精神病症状的药物治疗，其中包括胆碱酯酶抑制剂，氯氮平,匹马色林,可能还有喹硫平和电惊厥治疗。只有氯氮平和匹马色林对疗效和运动耐受性有明确的证据。将审查数据，以支持这些药物中的每一种将被审查和务实的建议，基于大量的经验，当每一个可能被使用，以及如果最初的方法失败，他们可以以什么顺序尝试。
