Sato M, Numachi Y, Hamamura T
Dept. of Psychiatry, Tohoku University School of Medicine, Miyagi, Japan.
Schizophr Bull. 1992;18(1):115-22. doi: 10.1093/schbul/18.1.115.
The study of the clinical course of methamphetamine (MAP) psychosis yields insights into the biological aspect of the relapse of the paranoid psychotic state with hallucination in schizophrenia. A series of MAP psychosis studies in Japan conducted over a period of more than four decades revealed three types of clinical courses of MAP psychosis after discontinuation of MAP: transient type, prolonged type, and persistent type. Identification of the latter two indicates a lasting change in the brain that produces and maintains a schizophrenia-like paranoid psychotic state without MAP. The characteristic course seen in the transient type is acute recurrence of the psychotic state after a long remission period, almost identical to the initial episode, due to reuse of MAP or to psychological stressors. Such lasting vulnerability of the brain to schizophrenia-like psychotic symptoms may be caused by a lasting sensitization of the brain to the psychotogenic action of MAP resulting from its chronic abuse. Experimental studies using animals sensitized to MAP-induced stereotypy suggest that lasting enhancement of MAP-induced dopamine release in the striatum and nucleus accumbens is related to the development and expression of brain vulnerability to schizophrenic symptoms.
对甲基苯丙胺（MAP）所致精神障碍临床病程的研究有助于深入了解精神分裂症中伴有幻觉的偏执性精神病状态复发的生物学方面。日本在四十多年时间里开展的一系列MAP所致精神障碍研究揭示了停用MAP后MAP所致精神障碍的三种临床病程类型：短暂型、迁延型和持续型。后两种类型的确定表明大脑发生了持久变化，在没有MAP的情况下产生并维持类似精神分裂症的偏执性精神病状态。短暂型的特征病程是在长时间缓解期后精神病状态急性复发，几乎与初次发作相同，这是由于再次使用MAP或心理应激源所致。大脑对类似精神分裂症的精神病症状的这种持久易损性可能是由于长期滥用MAP导致大脑对MAP的致幻作用产生持久的敏感性所致。使用对MAP诱导的刻板行为敏感的动物进行的实验研究表明，纹状体和伏隔核中MAP诱导的多巴胺释放的持久增强与大脑对精神分裂症症状的易损性的发展和表达有关。
