パーキンソン病の妄想に対するolanzapineの有用性

The Efficacy of Olanzapine for Delusion in Patients with Parkinson's Disease

要旨　目的：パーキンソン病（PD）の妄想に対するolanzapineの有用性を検討した。方法：妄想が認められたPD 9例に対し，quetiapine 5例（初回投与量25～50mg/日），olanzapine 4例（初回投与量0.625～5mg/日）を投与し，妄想の改善がみられるまで漸増した。Quetiapine 300mg/日まで増量しても改善が得られない場合，olanzapineに変更した。結果：Quetiapineは5例中2例で有効であった。Olanzapineは7例中6例で有効であり，quetiapine無効の3例中2例においても改善を認めた。結語：Olanzapineは既報告よりも極めて少量で改善を得られる症例が存在した。Quetiapineが無効の妄想に対し，olanzapineは試みるべき薬剤であると考えられた。

Abstract

　We investigated the usefulness of quetiapine and olanzapine for delusion in nine patients with Parkinson's disease （PD）. Two of five patients initially treated with quetiapine showed resolution of delusion on low dose （25mg and 50mg/day）, whereas three patients had no improvement in spite of increasing the dose to 300mg/day. Quetiapine non-responders had a tendency to more severe delusion and dementia compared with responders. Not only all four patients initially treated but also two of three quetiapine non-responders showed a remarkable resolution of delusion on olanzapine. In particular, three of seven patients responded to an extremely low dose of 0.625mg/day. However, severe motor debilitation was observed in one patient treated with 1.25mg/day. Olanzapine might be useful for delusion of PD in patients not responded to quetiapine, although it should be started at a very low dosage to ameliorate worsening parkinsonism.

（Received : October 18, 2004）