van Os Jim, Kapur Shitij
Universitair Medisch Centrum Maastricht, afd. Psychiatrie en Psychologie, Maastricht, The Netherlands.
Ned Tijdschr Geneeskd. 2010;154:A1874.
Psychotic disorders such as schizophrenia are associated with severe psychological suffering for the patient and high healthcare costs. The initial symptoms typically emerge in adolescence and early adulthood. The incidence varies considerably from place to place and among different groups of immigrants. The symptoms, clinical course, and treatment response differs per individual. Genetic vulnerability for psychotic disorders is shared in part with bipolar disorder, and recent molecular genetic findings also indicate an overlap with developmental disorders such as autism. The diagnosis of schizophrenia is associated with demonstrable alterations in brain structure and changes in dopamine neurotransmission, the latter being directly related to hallucinations and delusions. Antipsychotics, which block the dopamine system, are effective for delusions and hallucinations but less so for disabling cognitive and motivational impairments. A better understanding of the biological mechanisms and the psychosocial factors underlying psychotic disorders may contribute to new treatments.
精神分裂症等精神障碍会给患者带来严重的心理痛苦，并产生高昂的医疗费用。最初症状通常出现在青春期和成年早期。发病率在不同地区以及不同移民群体之间差异很大。症状、临床病程和治疗反应因人而异。精神障碍的遗传易感性部分与双相情感障碍相同，最近的分子遗传学研究结果还表明与自闭症等发育障碍存在重叠。精神分裂症的诊断与大脑结构的明显改变以及多巴胺神经传递的变化有关，后者与幻觉和妄想直接相关。阻断多巴胺系统的抗精神病药物对妄想和幻觉有效，但对导致功能障碍的认知和动机损害效果较差。更好地理解精神障碍背后的生物学机制和社会心理因素可能有助于开发新的治疗方法。
