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neuropsychiatrie

, Volume 29, Issue 1, pp 1–13 | Cite as

Parkinson-Krankheit und Psychosen

  • Jacopo Vittoriano Bizzarri
  • Giancarlo Giupponi
  • Ignazio ManiscalcoEmail author
  • Patrizia Schroffenegger
  • Andreas Conca
  • Hans Peter Kapfhammer
übersicht

Zusammenfassung

Psychotische Symptome stehen bei der Parkinson-Krankheit (PD) in Zusammenhang mit erhöhter Beeinträchtigung, einer Verschlechterung der Lebensqualität und einen schlechteren Langzeitprognose. In diesem Artikel wird über klinische Merkmale, Hypothesen über die Pathogenese, und aktuelle Strategien für die Behandlung der Parkinson-Krankheit Psychose (PDP) berichtet. Nach epidemiologischen Studien liegt die Prävalenz von PDP zwischen 20 bis 40 %. Komplexe visuelle Halluzinationen sind die häufigsten psychotischen Symptome und bei 17 bis 72 % der Patienten vorhanden. Andere sensorische Störungen umfassen taktile Halluzinationen, das Gefühl der Präsenz und visuelle Illusionen. Halluzinationen sind häufig von Wahnvorstellungen, deren häufigsten Themen Verfolgung und Eifersucht sind, begleitet. Die Pathophysiologie der PDP bleibt unklar. Verschiedene Faktoren sind beteiligt, darunter Levo-Dopa und Dopamin-Medikamente, Neurotransmitter Ungleichgewichte, neuroanatomische Veränderungen, abnormale visuell-räumliche Prozesse und genetische Veranlagung. Der erste Schritt bei der Behandlung von anhaltenden und problematischen PDP ist die Reduktion der Anti-PD-Medikamente. Die Therapiewahl fällt auf Antipsychotika der zweiten Generation, wobei sich Clozapin als effektivstes und verträglichstes Medikament bei Parkinson-Patienten erwiesen hat.

Schlüsselwörter

Parkinsonsyndrom Organische Psychosen Krankheitbild Pathophysiologie Therapie 

Parkinson’s disease and psychoses

Summary

Psychotic symptoms are common in Parkinson’s disease (PD) and are associated with increased disability, worsened quality of life, and poor long-term prognosis. In this article, clinical features, hypotheses on pathogenesis, and current treatment strategies for Parkinson’s disease psychosis (PDP) are reviewed. According to epidemiological studies, the prevalence of PDP is between 20 to 40 %. Complex visual hallucinations are the most common psychotic symptoms and are present in 17–72 % of the patients. Other sensory disturbances encompass tactile hallucinations and minor hallucinatory phenomena, such as sense of presence and visual illusions. Hallucinations are often accompanied by delusions, whose most frequent themes are persecution and jealousy. The pathophysiology of PDP remains unclear. Different factors have been implicated, including Levo-dopa and dopaminergic medications, neurotransmitter imbalances, neuroanatomic alterations, abnormal visuospatial processes, and genetic predisposition. The first-line strategy in the treatment of persistent and problematic PDP is represented by reduction in anti-PD medications. Second-generation antipsychotics are the treatment of choice, with clozapine being demonstrated as the most effective and tolerable drug for PD patients.

Keywords

Parkinson’s syndrome Organic psychosis Clinical picture Pathophysiology Therapy 

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Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Jacopo Vittoriano Bizzarri
    • 1
  • Giancarlo Giupponi
    • 1
  • Ignazio Maniscalco
    • 1
    Email author
  • Patrizia Schroffenegger
    • 1
  • Andreas Conca
    • 1
  • Hans Peter Kapfhammer
    • 2
  1. 1.LKH S. MaurizioBozenItalien
  2. 2.Klinik für Psychiatrie, Medizinische Universität GrazGrazÖsterreich

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