Javitt D C, Zukin S R
Department of Psychiatry, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, N.Y.
Am J Psychiatry. 1991 Oct;148(10):1301-8. doi: 10.1176/ajp.148.10.1301.
Phencyclidine (PCP, "angel dust") induces a psychotomimetic state that closely resembles schizophrenia. As opposed to amphetamine-induced psychosis, PCP-induced psychosis incorporates both positive (e.g., hallucinations, paranoia) and negative (e.g., emotional withdrawal, motor retardation) schizophrenic symptoms. PCP-induced psychosis also uniquely incorporates the formal thought disorder and neuropsychological deficits associated with schizophrenia. The purpose of the present paper is to review recent advances in the study of the molecular mechanisms of PCP action and to describe their implications for the understanding of schizophrenic pathophysiology.
Twenty-five papers were identified that described the clinical dose and serum and CSF levels at which PCP induces its psychotomimetic effects. The dose range of PCP-induced effects were compared to the dose range at which PCP interacts with specific molecular targets and affects neurotransmission.
It was found that PCP-induced psychotomimetic effects are associated with submicromolar serum concentrations of PCP. At these concentrations PCP interacts selectively with a specific binding site (PCP receptor) that is associated with the N-methyl-D-aspartate (NMDA)-type excitatory amino acid receptor. Occupation of its receptor by PCP induces noncompetitive inhibition of NMDA receptor-mediated neurotransmission. Other NMDA antagonists such as the dissociative anesthetic ketamine induce PCP-like neurobehavioral effects in proportion to their potency in binding to the PCP receptor and inducing NMDA receptor inhibition.
These findings suggest that endogenous dysfunction of NMDA receptor-mediated neurotransmission might contribute to the pathogenesis of schizophrenia. The relative implications of the PCP and amphetamine models of schizophrenia are discussed in relationship to the diagnosis and etiology of schizophrenia.
苯环己哌啶(PCP,“天使尘”)可诱发一种与精神分裂症极为相似的拟精神病状态。与苯丙胺所致精神病不同,PCP所致精神病兼具阳性(如幻觉、偏执)和阴性(如情感退缩、运动迟缓)精神分裂症症状。PCP所致精神病还独特地包含了与精神分裂症相关的形式思维障碍和神经心理学缺陷。本文旨在综述PCP作用分子机制研究的最新进展,并描述其对理解精神分裂症病理生理学的意义。
检索到25篇描述PCP诱发拟精神病作用的临床剂量以及血清和脑脊液水平的论文。将PCP诱发效应的剂量范围与PCP与特定分子靶点相互作用并影响神经传递的剂量范围进行比较。
发现PCP诱发的拟精神病作用与亚微摩尔浓度的血清PCP相关。在这些浓度下,PCP选择性地与一个与N-甲基-D-天冬氨酸(NMDA)型兴奋性氨基酸受体相关的特定结合位点(PCP受体)相互作用。PCP占据其受体可诱导NMDA受体介导的神经传递的非竞争性抑制。其他NMDA拮抗剂,如解离性麻醉剂氯胺酮,会根据其与PCP受体结合和诱导NMDA受体抑制的效力,诱发类似PCP的神经行为效应。
这些发现表明,NMDA受体介导的神经传递的内源性功能障碍可能有助于精神分裂症的发病机制。本文还讨论了PCP和苯丙胺精神分裂症模型与精神分裂症诊断和病因的相对意义。