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Parkinson-psychose: een complex samenspel van ziekte- en medicatie-gerelateerde factoren

  • Published:
Tijdschrift voor Neuropsychiatrie en Gedragsneurologie

Samenvatting

Psychotische verschijnselen zijn een van belangrijkste non-motorische symptomen van de ziekte van Parkinson. Met de juiste behandeling kunnen het functioneren en de kwaliteit van leven aanzienlijk verbeterd worden. In dit artikel geven wij inzicht in het ontstaan, de differentiaaldiagnostische overwegingen en de behandelingsmogelijkheden, met een work-up voor in de kliniek.

Psychotische verschijnselen komen frequent voor bij de ziekte van Parkinson met een life-time prevalentie oplopend tot 50%, variërend van minor psychotische verschijnselen tot hallucinaties en wanen. Deze psychotische verschijnselen worden veroorzaakt door een complex samenspel van intrinsieke factoren, gerelateerd aan de aandoening zelf en extrinsieke factoren. Intrinsieke factoren zijn functiestoornissen van het ventrale visuele systeem, verstoring van de slaap-waakcyclus, autonome dysfunctie, executieve functiestoornissen, een verminderde mentale flexibiliteit, neurochemische veranderingen zoals cholinerge deficiëntie, structurele afwijkingen, zoals stapeling van Lewy-lichaampjes in de cortex, ziekteprogressie en dementie. Extrinsieke factoren zijn met name medicatie en ook omgevingsfactoren.

Diagnostiek vindt plaats op basis van NINDS-NIMH-criteria. Hierbij moet worden voldaan aan de aanwezigheid van minstens één van de volgende symptomen: illusies, onjuist gevoel van aanwezigheid, hallucinaties en wanen. De psychotische verschijnselen moeten zich openbaren na het ontstaan van de ziekte van Parkinson en andere oorzaken moeten zijn uitgesloten.

De behandeling bestaat uit het optimaliseren van non-farmacologische interventies, het staken van anticholinergica, MAO-remmers en amantadine. Catechol-O-methyltransferase (COMT) remmers verlagen, dopamine-agonisten te verlagen of te staken. Uiteindelijke verlaging levodopa/decarboxylase en toevoeging van clozapine of quetiapine.

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Authors and Affiliations

  1. Afdeling Psychiatrie, UMC St. Radboud, Nijmegen, The Netherlands

    Thomas Knuijver,  Indira Tendolkar & Philip van Eijndhoven

  2. Donders Institute for Brain, Cognition and Behavior, Center for Neuroscience, Nijmegen, The Netherlands

    Indira Tendolkar, Rianne Esselink & Philip van Eijndhoven

  3. Afdeling Neurologie, UMC St. Radboud, Nijmegen, The Netherlands

    Rianne Esselink

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  1. Thomas Knuijver
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  2. Indira Tendolkar
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  3. Philip van Eijndhoven
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Correspondence to Indira Tendolkar.

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Knuijver, T., Tendolkar, I., Esselink, R. et al. Parkinson-psychose: een complex samenspel van ziekte- en medicatie-gerelateerde factoren. Tijdsvoor Neuropsy en Gedragsneuro 1, 45–50 (2013). https://doi.org/10.1007/s40533-013-0010-x

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