Schmitt A, May B, Müller B, Zink M, Braus D F, Henn F A
Zentralinstitut für Seelische Gesundheit, Universität Mannheim, Germany.
Nervenarzt. 2004 Jan;75(1):16-22. doi: 10.1007/s00115-003-1593-3.
Post-mortem investigations have confirmed that glutamatergic NMDA, AMPA, and kainate receptors are involved in the pathophysiology of schizophrenia. It is still unclear, however, whether the altered number of receptors is caused by the disease itself or the medication. Therefore, animal models were investigated for effects of antipsychotic medication after treatment periods of up to 6 months, the results of which are summarized here. Generally, NMDA receptor binding was found to be increased in striatum and nucleus accumbens after therapy with haloperidol, whereas clozapine only increased the number of receptors in nucleus accumbens. While haloperidol led to an increase in AMPA receptors in the posterior cingulate gyrus, striatum, insular cortex, and n. accumbens, clozapine was found to elevate ligand binding in the anterior cingulate gyrus and infralimbic cortex. Although kainate receptor binding was increased in hippocampus by both antipsychotics, clozapine was significantly more effective. In conclusion, data reveal different effects from the typical neuroleptic haloperidol and the atypical antipsychotic clozapine. The results suggest that post-mortem findings in patients with schizophrenia may at least partially be explained by drug effects and plasticity changes induced by long-term medication with antipsychotics.
尸检研究已证实,谷氨酸能N-甲基-D-天冬氨酸(NMDA)、α-氨基-3-羟基-5-甲基-4-异恶唑丙酸(AMPA)和红藻氨酸受体参与了精神分裂症的病理生理学过程。然而,受体数量的改变是由疾病本身还是药物引起的仍不清楚。因此,研究了动物模型在长达6个月的治疗期后抗精神病药物的作用,现将结果总结如下。一般来说,用氟哌啶醇治疗后,纹状体和伏隔核中的NMDA受体结合增加,而氯氮平仅增加伏隔核中的受体数量。氟哌啶醇导致后扣带回、纹状体、岛叶皮质和伏隔核中的AMPA受体增加,而氯氮平则使前扣带回和边缘下皮质中的配体结合增加。虽然两种抗精神病药物都使海马体中的红藻氨酸受体结合增加,但氯氮平的效果明显更好。总之,数据显示典型抗精神病药物氟哌啶醇和非典型抗精神病药物氯氮平有不同的作用。结果表明,精神分裂症患者的尸检结果可能至少部分是由抗精神病药物的长期用药引起的药物效应和可塑性变化所解释的。