Fiorentini Alessio, Volonteri Lucia Sara, Dragogna Filippo, Rovera Chiara, Maffini Michele, Mauri Massimo Carlo, Altamura Carlo A
Clinical Psychiatry, Clinical Neuropsychopharmacology Unit, IRCCS Foundation Ospedale Maggiore Policlinico, Milano MI, Italy.
Curr Drug Abuse Rev. 2011 Dec;4(4):228-40. doi: 10.2174/1874473711104040228.
Substances with psychotomimetic properties such as cocaine, amphetamines, hallucinogens and cannabis are widespread, and their use or abuse can provoke psychotic reactions resembling a primary psychotic disease. The recent escalating use of methamphetamine throughout the world and its association with psychotic symptoms in regular users has fuelled concerns. The use of cannabis and cocaine by young people has considerably increased over recent years, and age at first use has dramatically decreased. There is some evidence that cannabis is now on the market in a more potent form than in previous decades. Furthermore, a large number of studies have reported a link between adolescent cannabis use and the development of stable psychosis in early adulthood. The situation is further complicated by the high rates of concomitant substance use by subjects with a psychotic illness which, especially in young users with an early-phase psychotic disorder, can make diagnosis difficult. This paper reviews the literature concerning the properties of psychotogenic substances and the psychotic symptoms they can give rise to, and discusses the association between substance abuse and psychosis with particular emphasis on the differential diagnosis of a primary and substance-induced psychotic disorder. The findings of this review indicate that psychosis due to substance abuse is commonly observed in clinical practice. The propensity to develop psychosis seems to be a function of the severity of use and dependence. From a phenomenological point of view, it is possible to identify some elements that may help clinicians involved in differential diagnoses between primary and substance-induced psychoses. There remains a striking paucity of information on the outcomes, treatments, and best practices of substance-induced psychotic episodes.
具有拟精神病特性的物质，如可卡因、苯丙胺、致幻剂和大麻广泛存在，其使用或滥用可引发类似原发性精神病性疾病的精神病性反应。近年来，甲基苯丙胺在全球的使用不断增加，且与经常使用者的精神病性症状相关，这引发了人们的担忧。近年来，年轻人使用大麻和可卡因的情况大幅增加，首次使用的年龄显著降低。有证据表明，现在市面上的大麻效力比前几十年更强。此外，大量研究报告了青少年使用大麻与成年早期发展为稳定型精神病之间的联系。患有精神病性疾病的患者同时使用物质的比例很高，这使情况更加复杂，尤其是在患有早期精神病性障碍的年轻使用者中，这可能会导致诊断困难。本文回顾了有关致精神病物质的特性及其可能引发的精神病性症状的文献，并讨论了物质滥用与精神病之间的关联，特别强调原发性和物质所致精神病性障碍的鉴别诊断。本综述的结果表明，物质滥用所致精神病在临床实践中很常见。发展为精神病的倾向似乎是使用严重程度和依赖程度的函数。从现象学角度来看，有可能识别出一些有助于临床医生对原发性和物质所致精神病进行鉴别诊断的因素。关于物质所致精神病性发作的结局、治疗和最佳实践，仍然缺乏大量信息。
