Stress Disorder Research Project Team, Tokyo Metropolitan Institute of Medical Science (the former Tokyo Institute of Psychiatry), Tokyo, Japan.
Psychiatry Clin Neurosci. 2014 Jan;68(1):1-20. doi: 10.1111/pcn.12126. Epub 2013 Dec 29.
What psychiatric symptoms are caused by central noradrenergic dysfunction? The hypothesis considered in this review is that noradrenergic dysfunction causes the abnormalities in arousal level observed in functional psychoses. In this review, the psychiatric symptoms of noradrenergic dysfunction were inferred pathophysiologically from the neuroscience literature. This inference was examined based on the literature on the biology of psychiatric disorders and psychotropics. Additionally, hypotheses were generated as to the cause of the noradrenergic dysfunction. The central noradrenaline system, like the peripheral system, mediates the alarm reaction during stress. Overactivity of the system increases the arousal level and amplifies the emotional reaction to stress, which could manifest as a cluster of symptoms, such as insomnia, anxiety, irritability, emotional instability and exaggerated fear or aggressiveness (hyperarousal symptoms). Underactivity of the system lowers the arousal level and attenuates the alarm reaction, which could result in hypersomnia and insensitivity to stress (hypoarousal symptoms). Clinical data support the hypothesis that, in functional psychoses, the noradrenergic dysfunction is in fact associated with the arousal symptoms described above. The anti-noradrenergic action of anxiolytics and antipsychotics can explain their sedative effects on the hyperarousal symptoms of these disorders. The results of animal experiments suggest that excessive stress can be a cause of long-term noradrenergic dysfunction.
中枢去甲肾上腺素能功能障碍会引起哪些精神症状？本篇综述中考虑的假设是，去甲肾上腺素能功能障碍导致功能性精神病中观察到的觉醒水平异常。在本篇综述中，根据神经科学文献，从病理生理学角度推断出去甲肾上腺素能功能障碍的精神症状。这一推断基于精神疾病和精神药物的生物学文献进行了检验。此外，还提出了去甲肾上腺素能功能障碍的原因假设。中枢去甲肾上腺素系统与外周系统一样，在应激期间介导报警反应。该系统的过度活跃会增加觉醒水平，并放大对压力的情绪反应，这可能表现为一组症状，如失眠、焦虑、易怒、情绪不稳定和过度恐惧或攻击性（过度觉醒症状）。该系统的不活跃会降低觉醒水平，并减弱报警反应，这可能导致过度嗜睡和对压力不敏感（低觉醒症状）。临床数据支持这样一种假设，即功能性精神病中的去甲肾上腺素能功能障碍实际上与上述觉醒症状有关。抗焦虑药和抗精神病药的抗去甲肾上腺素能作用可以解释它们对这些疾病的过度觉醒症状的镇静作用。动物实验的结果表明，过度的压力可能是长期去甲肾上腺素能功能障碍的一个原因。
