Satel S L, Price L H, Palumbo J M, McDougle C J, Krystal J H, Gawin F, Charney D S, Heninger G R, Kleber H D
Clinical Neuroscience Research Unit, Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, West Haven.
Am J Psychiatry. 1991 Dec;148(12):1712-6. doi: 10.1176/ajp.148.12.1712.
This study was undertaken to document symptoms and changes in dopaminergic function emerging after abrupt cessation of cocaine use.
After admission, 22 patients with DSM-III-R cocaine dependence were observed drug free for 3 weeks. The patient-rated Ribicoff Abstinence Rating Scale, Symptom Rating Scale, Physical Symptom Scale, Patient Rated Anxiety Scale, Beck Depression Inventory, and visual analogue scales for 16 subjective states were completed daily, and nurses rated 13 patients with the global anxiety and depression items of the Short Clinical Rating Scale. Serial blood samples were obtained three times weekly, and the patients' levels of prolactin, growth hormone (GH), and homovanillic acid (HVA) were measured. Their prolactin and GH values were compared with those of matched normal subjects.
A total of 62 subjective symptom variables were evaluated. At baseline, the symptom ratings were mildly elevated. At 3 weeks there were significant decreases from baseline in 28 variables and nearly significant decreases in six additional variables. Nurse-rated anxiety and depression also changed, but in a more variable pattern. There was a small but significant increase from baseline over time in plasma prolactin, but there were no significant changes in GH or HVA. The patients' prolactin and GH values did not differ from those of the normal subjects.
These findings suggest that symptoms after inpatient cessation of uncomplicated cocaine addiction are relatively mild and decrease linearly over the first month. Evidence of dysregulated central dopamine function was limited. The findings do not support routine use of pharmacological agents in the inpatient management of such patients.
本研究旨在记录可卡因使用突然停止后出现的症状及多巴胺能功能的变化。
入院后，对22例符合DSM-III-R可卡因依赖标准的患者进行3周的无药观察。每日完成患者自评的里比科夫戒断评定量表、症状评定量表、躯体症状量表、患者自评焦虑量表、贝克抑郁量表以及16种主观状态的视觉模拟量表，护士使用简短临床评定量表的整体焦虑和抑郁项目对13例患者进行评定。每周三次采集系列血样，检测患者的催乳素、生长激素（GH）和高香草酸（HVA）水平。将他们的催乳素和GH值与匹配的正常受试者进行比较。
共评估了62个主观症状变量。基线时，症状评分轻度升高。3周时，28个变量较基线有显著下降，另外6个变量接近显著下降。护士评定的焦虑和抑郁也有变化，但模式更具变异性。血浆催乳素随时间推移较基线有小幅但显著的升高，而GH或HVA无显著变化。患者的催乳素和GH值与正常受试者无差异。
这些发现表明，住院戒除单纯性可卡因成瘾后的症状相对较轻，且在第一个月呈线性下降。中枢多巴胺功能失调的证据有限。这些发现不支持对此类患者住院管理中常规使用药物制剂。
