Halluzinationen und Psychose bei der Parkinson-Erkrankung

Zusammenfassung

Psychotische Symptome sind eine häufige Komplikation der Parkinson-Erkrankung und treten oft im Zusammenhang mit der Parkinson-Demenz und der Demenz mit Lewy- Körperchen auf. Da Halluzinationen bei Parkinson-Syndromen ohne Lewy-Körperchen wie der Multisystematrophie oder der progressiven Blickparese selten vorkommen, hat das Auftreten von Halluzination auch eine Wertigkeit für die Differenzialdiagnose.

Präsenzgefühle, illusionäre Verkennungen und visuelle Pseudohalluzinationen mit erhaltener Einsicht werden zunächst von vielen Betroffenen als wenig belastend erlebt. Da derartige „benigne“ Wahrnehmungsstörungen bei der Parkinson-Erkrankung allerdings mit einer hohen Inzidenz schwerer psychotischer Störungen im weiteren Krankheitsverlauf assoziiert sind, sollte frühzeitig eine medikamentöse Therapie in Betracht gezogen werden. Neben Clozapin können in Abhängigkeit von den Begleitumständen auch Quetiapin, Benzodiazepine und Cholinesterase-Inhibitoren zur Behandlung von Halluzinationen in Frage kommen.

Summary

Psychotic symptoms are a frequent complication of Parkinson’s disease. Parkinson’s disease dementia and dementia with Lewy bodies are conditions with increased incidence of psychosis. Occurrence of hallucinations has certain diagnostic implications since hallucinations are only rarely reported in parkinsonian syndromes without Lewy bodies such as multi-system atrophy or progressive supranuclear palsy. Feelings of presence or passage, visual illusions and pseudo-hallucinations with retained insight are often experienced without causing major distress to the patient. Yet, since these “benign” hallucinations bear a high-risk of transition to severe psychosis medical treatment should also be considered in early stages. In addition to clozapine quetiapine, benzodiazepines and central inhibitors of cholinesterase can be of value in some circumstances.

Schlüsselwörter

Parkinson-Syndrom - Clozapin - Psychose - Halluzinationen - Dopaminergika

Keywords

Parkinson’s disease - clozapine - psychosis - hallucinations - dopaminergics

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