帕金森病是一种以运动和非运动症状为特征的进行性神经退行性疾病,包括幻觉.使用抗精神病药物是治疗与帕金森病精神病(PDP)相关的幻觉的常用策略。然而,由于与可用治疗方案相关的潜在风险,在选择最合适的药物时需要仔细考虑。非典型抗精神病药(AAP),如匹马色林和氯氮平,有效控制PDP症状。相反,对喹硫平应用的支持不如其他抗精神病药物那么重要,因为专门调查喹硫平应用的研究仍在兴起,而且相对较新.AAP的广泛作用机制,涉及多巴胺和5-羟色胺受体,与典型的抗精神病药物相比,提供改善的结果和更少的副作用。相反,其他抗精神病药物,包括利培酮,奥氮平,阿立哌唑,齐拉西酮,还有Lurasidone,已发现加重运动症状,通常不推荐用于PDP。虽然AAP提供有利的好处,它们与特定的不良反应有关。锥体外系症状,嗜睡,低血压,便秘,使用AAP时通常观察到认知障碍。氯氮平,特别是,有粒细胞缺乏症的风险,需要密切监测血细胞计数。匹马色林,一种选择性的5-羟色胺反向激动剂,避免了受体相关的副作用,但与校正的QT(QTc)间期延长有关,而喹硫平被报道与死亡风险增加有关.这篇综述旨在分析收益,风险,以及抗精神病药物的作用机制,以帮助临床医生做出明智的决定并加强患者护理。
Parkinson\'s disease is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms, including
hallucinations. The use of antipsychotic medications is a common strategy to manage
hallucinations associated with Parkinson\'s disease psychosis (PDP). However, careful consideration is necessary when selecting the most appropriate drug due to the potential risks associated with the available treatment options. Atypical antipsychotics (AAPs), such as Pimavanserin and Clozapine, have effectively controlled PDP symptoms. On the contrary, the support for utilizing quetiapine is not as substantial as other antipsychotics because research studies specifically investigating its application are still emerging and relatively recent. The broad mechanisms of action of AAPs, involving dopamine and serotonin receptors, provide improved outcomes and fewer side effects than typical antipsychotics. Conversely, other antipsychotics, including risperidone, olanzapine, aripiprazole, ziprasidone, and lurasidone, have been found to worsen motor symptoms and are generally not recommended for PDP. While AAPs offer favorable benefits, they are associated with specific adverse effects. Extrapyramidal symptoms, somnolence, hypotension, constipation, and cognitive impairment are commonly observed with AAP use. Clozapine, in particular, carries a risk of agranulocytosis, necessitating close monitoring of blood counts. Pimavanserin, a selective serotonin inverse agonist, avoids receptor-related side effects but has been linked to corrected QT (QTc) interval prolongation, while quetiapine has been reported to be associated with an increased risk of mortality. This
review aims to analyze the benefits, risks, and mechanisms of action of antipsychotic medications to assist clinicians in making informed decisions and enhance patient care.