Vincent P, Dole Dual Diagnosis Unit, Santa Chiara University Hospital, Department of Neurosciences, University of Pisa, Pisa, EU, Italy.
Ann Gen Psychiatry. 2012 Sep 3;11(1):23. doi: 10.1186/1744-859X-11-23.
Studies on the 'self-medication hypothesis' have focused on substance abuse as an attempt to alleviate emotional suffering.
We have investigated concomitant substances of abuse in 150 bipolar heroin addicts clustered according to their clinical presentation at treatment entry (depressive episode, hypomanic episode, manic episode and mixed episode). Bipolar heroin addicted patients were chosen because they tend to have a concomitant poly-substance abuse and because, as compared with patients suffering for other mental illnesses, they more clearly reveal a variety of identifiable affective states.
Patients with a depressive episode more frequently used non-prescribed anxiolytic-hypnotics. They were found to use cocaine-amphetamines more frequently during a hypomanic episode, whereas the use of cannabis and cocaine-amphetamines occurred more frequently during a manic episode. The associated use of alcohol, cocaine-amphetamines and cannabinoids was more frequently encountered during a mixed episode.
apart from the difficulty in determining whether the substance use modifies the mood or the mood state determines the substance used, this is a report on a retrospective analysis, rather than a study specifically designed to elucidate the issue; in addition, no information was available on the temperament of our subjects. Assessments of the same subject in various clinical presentations would have provided a better level of information.
Besides one expected result - the prominent use of CNS stimulants during a depressive phase of bipolar patients - this study supports the hypothesis that mood elation is a pleasurable, rewarding experience that, in bipolar patients, can be started or prolonged by means of CNS stimulant drugs. Stimulant use was, therefore, more prevalent during the 'up' rather than the 'down' phase of the illness.
关于“自我药疗假说”的研究集中在物质滥用上，试图以此来缓解情绪痛苦。
我们根据 150 名双相情感障碍海洛因成瘾者在治疗开始时的临床表现（抑郁发作、轻躁狂发作、躁狂发作和混合发作）对同时存在的物质滥用进行了调查。选择双相情感障碍海洛因成瘾患者是因为他们往往同时存在多种物质滥用，并且与患有其他精神疾病的患者相比，他们更能清楚地表现出各种可识别的情绪状态。
患有抑郁发作的患者更频繁地使用未经处方的镇静催眠药。在轻躁狂发作期间，他们被发现更频繁地使用可卡因-苯丙胺，而在躁狂发作期间，更频繁地使用大麻和可卡因-苯丙胺。在混合发作期间，更频繁地出现酒精、可卡因-苯丙胺和大麻素的联合使用。
除了难以确定物质使用是否会改变情绪，或者情绪状态是否决定所使用的物质之外，这是一份回顾性分析报告，而不是专门设计来阐明该问题的研究；此外，我们的研究对象的气质信息不可用。对同一患者在不同临床表现中的评估将提供更好的信息水平。
除了一个预期的结果——双相情感障碍患者抑郁期明显使用中枢神经系统兴奋剂——这项研究支持了这样一种假设，即情绪振奋是一种愉快的、有益的体验，在双相情感障碍患者中，可以通过中枢神经系统兴奋剂药物来启动或延长这种体验。因此，兴奋剂的使用在疾病的“上升”阶段比“下降”阶段更为普遍。
