Department of Psychiatry, University of Minnesota School of Medicine, Tardive Dyskinesia Assessment Clinic, Minneapolis Veterans Administration Medical Center, One Veterans Drive, Minneapolis, MN 55417, United States.
Prog Neuropsychopharmacol Biol Psychiatry. 2011 Jan 15;35(1):1-10. doi: 10.1016/j.pnpbp.2010.08.028. Epub 2010 Sep 7.
Psychopharmacology and psychiatry during the past 50 years have focused on the specificity model in which it is assumed that psychiatric disorders are specific entities which should respond to drugs with specific mechanisms of action. However, the validity of this model has been challenged by the approval of multiple drugs for the same disorder, as well as the approval of single agents for a variety of disorders which have little in common. As an example of this unacknowledged paradigm shift, I will examine the foundation for using antipsychotics in the treatment of depression.
An extensive literature search of studies investigating various mechanisms of actions of antipsychotics and antidepressants with the goal of identifying neurochemical processes common to both.
The neurochemical differences in these classes of drugs appear to be profound, although several processes are common in both, including some degree of neuroprotection and changes in the epigenome. Whether these common features have any effect on clinical outcome remains in doubt.
While psychopharmacology and psychiatry remain largely committed to the specificity model, it appears that clinicians are prescribing on a dimensional model wherein symptoms are being treated with a variety of drugs, regardless of the diagnosis.
在过去的 50 年中，精神药理学和精神病学一直专注于特异性模型，该模型假设精神障碍是特定的实体，应该对具有特定作用机制的药物有反应。然而，这种模型的有效性受到了多种药物治疗同一种疾病的批准以及单一药物治疗具有很少共同点的多种疾病的批准的挑战。作为这种未被承认的范式转变的一个例子，我将研究使用抗精神病药治疗抑郁症的基础。
广泛搜索研究各种抗精神病药和抗抑郁药作用机制的文献，旨在确定两者共有的神经化学过程。
这些类药物的神经化学差异似乎非常明显，尽管两者有一些共同的过程，包括一定程度的神经保护和表观基因组的改变。这些共同特征是否对临床结果有任何影响仍有疑问。
虽然精神药理学和精神病学在很大程度上仍然致力于特异性模型，但似乎临床医生正在根据维度模型进行处方，无论诊断如何，他们都在使用各种药物治疗症状。
