(神经病学)9.GJC-PD-for-psychology.ppt

Hyperkinetic DisorderTardive Dyskinesia Occurs in 20-40% of individuals who are long time (at least 3 months) users of conventional antipsychotics Conventional or classic antipsychotics (e.g., haloperidol) block dopamine receptors Symptoms include: Chorea Tics Akathisia – compulsive, hyperactive, and fidgeting movements of the legs (静坐不能) Dystonia Possible causes are supersensitivity of dopamine neurons after prolonged suppression Atypical antipsychotics are good at suppressing psychoses and they have fewer motor side effects Clinical correlations of basal ganglia lesions Clinical syndromes Most common location Drugs that are beneficial Akinesia-rigid syndromes Parkinsonism SNc (less often striatum, GP) Dopamine agonist or replacement Dyskinesia Chorea Striatum, especially caudate N, less common subthalamic N GABAegic (benzodiazepines), anti-dopamine (tetrabenazine, heloperidol) Ballism Subthalamic N (less often striatum) anti-dopamine (tetrabenazine, heloperidol) GABAergic (baclofen,clonazepam) Dystonia Striatum, especially putamen (less often thalamus GP, extra-BG sites) Anticholinergic, GABA-B agonist (baclofen) Tremor Variable, often outside BG Anticholinergic (anti-? adrenergic or promidone for ET) Tics Unknown (ventral striatum?) Antipsychotics (typical or atypical) Further thinking What are the clinical features of Parkinson’s Disease? What is dopamine replacement therapy? How to identify and treat levodopa-induced motor complications? ANY QUESTIONS? Thank You * * Motor persistence. Milkmaid’s grip :Maintaining a continuous hand grip. Darting tongue: Difficulty holding there tongues out. Motor persistence. Milkmaid’s grip :Maintaining a continuous hand grip. Darting tongue: Difficulty holding there tongues out. Motor persistence. Milkmaid’s grip :Maintaining a continuous hand grip. Darting tongue: Difficulty holding there tongues out. Motor impersistence * * * Parkinson′s disease (PD) was first described by an English physician, James Parkinson, in 181