QUETIAPINE IMPROVES VISUAL HALLUCINATIONS IN PARKINSON DISEASE BUT NOT THROUGH NORMALIZATION OF SLEEP ARCHITECTURE: RESULTS FROM A DOUBLE-BLIND CLINICAL-POLYSOMNOGRAPHY STUDY

奎硫平 多导睡眠图 安慰剂 心理学 临床全球印象 简明精神病评定量表 富马酸奎硫平 睡眠开始 麻醉 评定量表 失眠症 非定型抗精神病薬 医学 精神科 精神病 精神分裂症(面向对象编程) 抗精神病药 呼吸暂停 发展心理学 病理 替代医学
作者
Hubert H. Fernandez,Michael S. Okun,Ramon L. Rodriguez,Irene A. Malaty,Janet Romrell,Anqi Sun,Samuel S. Wu,SANDEEP PILLARISETTY,ANAND NYATHAPPA,Stephan Eisenschenk
出处
期刊:International Journal of Neuroscience [Informa]
卷期号:119 (12): 2196-2205 被引量:106
标识
DOI:10.3109/00207450903222758
摘要

Polysomnographic studies of Parkinson's disease (PD) patients with visual hallucinations (VH) usually reveal short, fragmented rapid eye movement (REM) sleep, with lower sleep efficiency and reduced total REM sleep. Quetiapine has been demonstrated in open-label trials to be effective for the treatment of insomnia and VH in PD. To confirm quetiapine's efficacy in improving VH, and to determine whether the mechanism was due to its effect on REM sleep architecture, we performed a pilot, double-blind, placebo-controlled study. Sixteen PD patients experiencing VH were recruited. Eight patients were randomized to quetiapine and eight patients to placebo. Patients underwent pre- and post-treatment polysomnography. The Clinical Global Impression Scale (CGIS), Brief Psychiatric Rating Scale (BPRS), and Unified Parkinson Disease Rating Scale (UPDRS) motor subscale were obtained. There were no differences in baseline characteristics between the treatment arms except that the placebo group had more sleep in stage REM (74.7 min vs. 40.1 min; p < .001). Data were imputed for all patients who prematurely discontinued (four quetiapine and one placebo) in an intention-to-treat analysis. The average quetiapine dose was 58.3 mg/day. While there was no significant difference in the change in REM duration pre- vs. post-treatment in either arm, patients randomized to quetiapine improved on the CGIS (p = .03) and the hallucination item of the BPRS (p = .02). No difference was noted in the UPDRS motor scores. Despite the small sample, this is the first double-blind trial to show quetiapine's efficacy over placebo in controlling VH in the PD population. However, normalization of sleep architecture was not supported as the mechanism.
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