Thirthalli Jagadisha, Benegal Vivek
Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.
Curr Opin Psychiatry. 2006 May;19(3):239-45. doi: 10.1097/01.yco.0000218593.08313.fd.
This work reviews the evidence that substances of abuse can cause psychosis in nonpsychotic persons. The review is based on the concept that psychosis exists in continuum. Studies examining substance use in, or its effect on, already psychotic individuals were not reviewed.
A substantial proportion of substance users experience psychosis. Use of cocaine, amphetamines, cannabis and alcohol seems to be associated with greater risk for psychosis. Severity and duration of use, age at the time of first use and vulnerability to develop psychosis by virtue of familial, possibly genetic and personality factors seem to be the determinants for the development of psychosis. Epidemiological and preliminary biological studies suggest that cannabis is a component cause in the development of schizophrenia. Evidence for the causative role of other substances is less systematic.
There exists strong evidence that abuse of substances is associated with greater risk for psychosis and preliminary evidence for their causative role in the development of psychosis. More systematic examination of this issue is likely to throw light on the neurobiology of psychosis and possibly help the vulnerable population in primary prevention.
本文综述了滥用物质可导致非精神病患者出现精神病的证据。本综述基于精神病存在连续谱的概念。未对研究已患精神病个体的物质使用情况或其对这些个体的影响进行综述。
相当一部分物质使用者会出现精神病。使用可卡因、苯丙胺、大麻和酒精似乎与患精神病的风险更高有关。使用的严重程度和持续时间、首次使用时的年龄以及因家族因素（可能是遗传和人格因素）而发展为精神病的易感性似乎是精神病发生的决定因素。流行病学和初步生物学研究表明，大麻是精神分裂症发病的一个成因。其他物质致病作用的证据则缺乏系统性。
有强有力的证据表明物质滥用与患精神病的风险更高有关，且有初步证据表明它们在精神病发病中具有致病作用。对此问题进行更系统的研究可能会揭示精神病的神经生物学机制，并可能有助于在一级预防中保护易感人群。
