University Hospital of Clinical Psychiatry, Bern, Switzerland.
CNS Spectr. 2000 Sep;5(9):47-51. doi: 10.1017/s1092852900021647.
Psychotic anxiety has not been systematically included in standard psychopathologic and diagnostic literature, presumably because anxiety is implicitly perceived to be an emphatically comprehensible consequence of the cognitive symptoms of psychosis. This review gives an overview of neurophysiologic studies that indicate different pathogenic mechanisms for different types of psychosis. Convergent and complementary structural and functional imaging findings, biochemical and neuropsychological data allow conjecture as to neurophysiologic-psychopathologic links in cycloid psychosis. Intriguing results suggest that in cycloid psychosis, a generalized hyperasousal related to the tonus of the noradrenergic system may be the basic disturbance causing the delusionary and perceptual psychotic distortions. The findings are specific for cycloid psychoses, which are diagnosed as polymorphous psychosis in the International Classification of Diseases and Related Health Problems, 10th Edition. Furthermore, these findings are consistent with the author's hypothesis that the emotional derailment is the primary disturbance in cycloid psychosis (anxiety-elation). In contrast, cognitive disturbances are secondary and remit after the exceptional emotional state is rebalanced.
精神病性焦虑并未被系统纳入标准的精神病理学和诊断文献中，这可能是因为焦虑被认为是精神病认知症状的一种可理解的必然结果。本文综述了神经生理学研究，这些研究表明不同类型的精神病可能有不同的发病机制。趋同和互补的结构和功能成像发现、生化和神经心理学数据，使得人们可以推测周期性精神病中神经生理学-精神病理学的联系。有趣的结果表明，在周期性精神病中，与去甲肾上腺素能系统张力相关的广泛过度唤醒可能是导致妄想和知觉精神病性扭曲的基本障碍。这些发现是周期性精神病特有的，在《疾病和有关健康问题的国际统计分类》第 10 版中被诊断为多形性精神病。此外，这些发现与作者的假设一致，即情绪脱轨是周期性精神病（焦虑-兴奋）的主要障碍。相比之下，认知障碍是次要的，在异常的情绪状态重新平衡后会缓解。
