帕金森病患者的肢体暴力和攻击行为系统综述。

IF 2.7 4区 心理学 Q2 PSYCHIATRY Journal of the Academy of Consultation-Liaison Psychiatry Pub Date : 2024-07-01 DOI:10.1016/j.jaclp.2024.01.007
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引用次数: 0

摘要

背景:肢体暴力和攻击行为(PVA)是指可能造成身体伤害的行为,是治疗全因性神经退行性痴呆症的不幸风险。帕金森病(Parkinson's disease,PD)的痴呆症可能在临床发病多年后才显现出来,而神经精神障碍则发生在疾病的各个阶段。目前的问题是,帕金森病中的PVA是否与临床因素有关,而这些因素在没有普遍痴呆综合征的情况下是否可以作为预防和管理的目标:本系统综述研究了无痴呆症的 PD 患者的 PVA 在多大程度上具有临床意义,以及它是否与需要积极管理的因素有关:对 9 个电子数据库进行了系统性检索,使用了 MeSH 标题和与 PD、攻击性和暴力相关的术语。符合条件的稿件是发表在同行评议期刊上的原创文章,这些文章报道了在清醒状态下患有帕金森氏症的成人的情况,PVA是可能的结果。提取的数据包括研究设计、PD确定方法和特征、PVA评估方法、受试者人口统计学特征、精神和医疗合并症以及相关结果。从病例报告中提取了诱发因素和混杂因素。根据研究设计(如观察性、定性或病例报告)使用质量评估工具:搜索共发现 10 篇手稿:2 项观察性定量研究(PD=545)、1 项定性研究(PD=20)和 7 项病例报告(N=7)。观察性研究表明,与其他神经精神障碍相比,PVA 的发病率较低,但由于研究方法不尽相同和质量问题,无法得出进一步的结论。在病例报告中,所有患者均为男性,且大多数患者发病较早。在六份报告中,PVA发生在双侧丘脑下核深部脑刺激(STN-DBS)的情况下:PVA虽然在帕金森病中相对罕见,但可能是一个重要的管理问题,与特定的病前特征和抗帕金森病运动疗法有关。由于 PVA 的报告可能不足,对其频率、原因、风险因素和结果的进一步了解将得益于对其进行系统评估,最好使用自我报告和基于信息的问卷调查。
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Physical Violence and Aggression in Parkinson's Disease: A Systematic Review

Background

Physical violence and aggression (PVA), defined as behaviors with the potential to cause bodily injury, are unfortunate risks in the management of all-cause neurodegenerative dementias. While dementia in Parkinson's disease (PD) may not be evident for many years after clinical onset, neuropsychiatric disturbances occur at all stages of the disease. At issue is whether PVA in PD is associated with clinical factors that can be targets for prevention and management in the absence of a prevailing dementia syndrome.

Objective

This systematic review examined the extent to which PVA in PD without dementia is a clinically significant concern and whether it is associated with factors that could warrant proactive management.

Methods

A systematic search of 9 electronic databases used MeSH headings and equivalent terms for PD, aggression, and violence. Eligible manuscripts were original articles that were published in peer-reviewed journals and reported on adults with PD in the awake state with PVA as possible outcomes. Extracted data included study design, PD ascertainment methods and characteristics, PVA assessment methods, subject demographics, psychiatric and medical comorbidities, and pertinent results. Inciting and confounding factors were extracted from case reports. Quality assessment tools were applied in accordance with the study design (e.g., observational, qualitative, or case report).

Results

The search identified 10 manuscripts: 2 observational quantitative studies (total n with PD = 545), 1 qualitative study (n with PD = 20), and 7 case reports (n = 7). The observational studies suggested that PVA is less common than other neuropsychiatric disturbances, but heterogeneous methods and quality concerns prevented further conclusions. In the case reports, all patients were male, and most were early onset. In 6 of the reports, PVA occurred in the context of bilateral subthalamic nucleus deep brain stimulation.

Conclusions

PVA, while relatively rare in PD, can be a significant management issue that is associated with select premorbid characteristics and antiparkinsonian motor treatments. As PVA may be under-reported, further understanding of its frequency, causes, risk factors, and outcomes would benefit from its systematic assessment, ideally using self-report and informant-based questionnaires.

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来源期刊
CiteScore
5.80
自引率
13.00%
发文量
378
审稿时长
50 days
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