Devinsky O, Kernan J, Bear D M
Department of Neurology, New York University School of Medicine, Hospital for Joint Diseases, NY 10003.
J Neuropsychiatry Clin Neurosci. 1992 Spring;4(2):189-94. doi: 10.1176/jnp.4.2.189.
The authors report four instances of significant, essentially unprovoked aggressive behavior, including two homicides, following exposure to cholinesterase inhibitors. No subject had a history of violent behavior, antisocial personality, or major psychiatric or neurologic disorder. After anticholinesterase exposure ceased, all showed sincere remorse for their actions, and none has since engaged in aggressive or psychopathologic behavior. Well-controlled experimentation in animals suggests that enhanced activation of hypothalamic cholinergic receptors may underlie aggressive behavior in humans exposed to cholinesterase inhibitors. A relationship between cholinesterase inhibitors and aggression has important implications for public health, raising the possibility of unappreciated neurotoxic influences on behavior.
作者报告了4例在接触胆碱酯酶抑制剂后出现显著的、基本无明显诱因的攻击行为的病例，其中包括2起杀人事件。所有病例均无暴力行为史、反社会人格，也没有严重的精神或神经疾病史。在停止接触抗胆碱酯酶药物后，所有患者都对自己的行为表现出真诚的悔恨，此后也没有人再出现攻击或精神病理行为。在动物身上进行的严格对照实验表明，下丘脑胆碱能受体的激活增强可能是接触胆碱酯酶抑制剂的人类出现攻击行为的基础。胆碱酯酶抑制剂与攻击行为之间的关系对公共卫生具有重要意义，这增加了行为受到未被认识到的神经毒性影响的可能性。
