帕金森病冲动控制障碍的Scoping综述

doi:10.3969/j.issn.1006-9771.2021.07.006

摘要/Abstract

摘要：

目的探讨帕金森病冲动控制障碍的流行病学、发病机制、危险因素、筛查和评估方法、诊断策略和治疗方法。

方法采用主题检索方式,检索 PubMed、 Medline、Embase、Cochrane Library、CNKI、维普数据库和万方数据帕金森病并发冲动控制障碍的中英文相关文献,截至2020年12月,并辅以参考文献回溯和手工检索。提取相关数据进行Scoping综述。

结果共返回文献2355篇,最终纳入30篇,来自10个国家,主要来源于医学、神经病学、精神病学、睡眠医学运动障碍等相关的期刊,发表时间集中在2010年至2020年。研究主要涉及帕金森病并发冲动控制障碍的发病机制、危险因素、筛查和评估方法、诊断策略和治疗方法等。

结论帕金森病患者并发冲动控制障碍的危险因素众多,多巴胺能药物是其主要危险因素,特别是多巴胺受体激动剂。对冲动控制障碍的干预强调预防和早期识别。应在调整多巴胺受体激动剂的基础上,根据患者症状类型,制定个体化治疗方案。

关键词: 帕金森病, 冲动控制障碍, Scoping综述

Abstract:

Objective To explore the epidemiology, pathogenesis, risk factors, screening and evaluation, diagnostic strategies and treatment of impulse control disorder after Parkinson's disease (PD).

Methods Studies related to Parkinson's disease complicated with impulse control disorder were retrieved using subject search from PubMed, Medline, Embase, Cochrane Library, CNKI, VIP and Wanfang Data, until December, 2020, and supplemented by reference backtracking and manual retrieval.

Results A total of 2355 studies were returned first, and 30 were included, from ten countries, mainly published in journals about medicine, neurology, psychiatry, sleep medicine and movement disorders, etc., between 2010 and 2020. The researches mainly involved the pathogenesis, risk factors, screening and evaluation, diagnostic strategies and treatment.

Conclusion There are many risk factors for impulse control disorder in PD patients, mostly the dopaminergic drugs, especially dopamine receptor agonists. Interventions for impulse control disorders emphasize prevention and early identification. Individualized and symptomatic treatments based on adjustment of dopamine receptor agonists are needed.

Key words: Pakinson's disease, impulse control disorders, scoping review

中图分类号:

R742.5

肖琳娜,李晓红. 帕金森病冲动控制障碍的Scoping综述[J]. 《中国康复理论与实践》, 2021, 27(7): 774-779.

XIAO Lin-na,LI Xiao-hong. Impulse Control Disorder in Parkinson's Disease: A Scoping Review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(7): 774-779.

图/表 2

表1

帕金森病并发冲动控制障碍的定义、表现形式及危险因素"

分析构架		定义
冲动控制障碍		包括情绪和行为的自我控制问题且具有破坏性的冲动控制行为
病理性赌博		无法抵制冲动、欲望或诱惑去执行的一种典型的愉悦活动,由于过度进行这种活动最终会对个人或他人造成伤害。符合下列10条中至少5条可确诊：(1)终日思赌;(2)赌博进行性加重;(3)有过戒赌的想法或行动但未成功;(4)试图戒赌时出现生理不适感,如坐立不安、暴躁、心慌、出汗等;(5)利用赌博排解烦恼、逃离现实;(6)总相信输钱是暂时的,不能自拔;(7)对家人、朋友或医生隐瞒陷入赌博的程度;(8)因赌博出现犯罪行为;(9)丧失重要的人际关系,如家庭、工作,或失去受教育和就业的机会;(10)因赌博陷入债务危机
强迫性性行为		(1)性欲、性行为增多及异常的性行为。(2)上述症状持续存1个月以上。(3)至少存在以下一种情况：①已经对自身生活造成影响;②试图控制,但却无效;③消耗大量时间;④影响社会及职业功能。(4)此类性行为并非只发生在躁狂期。(5)如果除第(3)条外均满足,则称为亚临床表现。
强迫性进食		在短时间内周期性发作的大量进食,难以控制。诊断标准：(1)对饮食缺乏控制,反复多次、大量进食;(2)为防止超重而让自己呕吐、灌肠、滥用药物、运动或绝食;(3)每周至少发生1次,至少持续3个月;(4)对自己的体型及体质量作出不客观评价;(5)需排除发作时出现上述行为的神经性厌食者
强迫性购物		非正常的过度专注于购买,表现为不可抗拒冲动性购买行为,具有强迫性或无意识性,因购买过多不需要的物品而造成财务问题,且消耗时间过多,严重干扰社会和职业功能
危险因素	人口统计学特征	年纪较轻、社会文化因素(有赌博、上网的机会,有金融资源)、性别(女性暴饮暴食、强迫性购物居多,男性性欲亢进居多)
	发病前特征	吸烟史、冲动或寻求新奇人格、个人及家庭酗酒或赌博史、遗传学(多巴胺、血清素和谷氨酸系统)
	临床特征	使用多巴胺受体激动剂、DBS (STN)、左旋多巴当量日剂量高、金刚烷胺、雷沙吉兰、早发型帕金森病、长时间多巴胺受体激动剂治疗、抑郁、焦虑、RBD、妄想
	神经学特征	腹侧纹状体和中脑皮质系统影像学特征突出、认知扭曲(基于奖励的决策改变)

表1

表2

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研究	国家	研究对象	研究方法	干预方法	疗效	评估方法	用法	副作用
Ward等(2018)^[25]	英国	赌博患者	回顾性	纳曲酮	显著减少赌博欲望及行为	赌博欲望量表	起始25 mg,维持50 mg	食欲减退、胃肠疼痛、镇静状态、感觉异常
Vriend等(2018)^[26]	西班牙	帕金森病患者并发冲动控制障碍	前瞻性	唑尼沙胺	减轻症状严重程度	Barratt冲动量表/临床总体印象量表	起始25 mg,维持200 mg	注意力涣散、疲劳、感觉异常
Jeon等(2020)^[27]	美国	普拉克索/罗匹尼罗治疗的帕金森病患者	回顾性	谷氨酸能调节剂/选择性5-羟色胺再摄取抑制剂	无明显改善	–	–	增加发生冲动控制障碍的风险
Lapenta等(2018)^[28]	巴西	冲动控制障碍患者	回顾性	经颅直流电刺激	调节认知和运动功能	–	–	–
Kim等(2018)^[29]	韩国	帕金森病患者并发冲动控制障碍	前瞻性	STN-DBS	症状消失/减轻	明尼苏达冲动障碍访谈	–	出现新的短暂的冲动控制障碍
Okai等(2013)^[30]	英国	帕金森病患者并发冲动控制障碍	前瞻性	认知行为疗法	症状显著改善	冲动-强迫障碍问卷/临床总体印象量表/神经精神量表/冲动控制行为严重性量表	–	–