Veerman S R T, Schulte P F J, de Haan L
Mental Health Service Organisation North Holland North, Community Mental Health Division, Flexible Assertive -Community Treatment, Alkmaar, The Netherlands.
Mental Health Service Organisation North Holland North, Division for Specialised Treatment, Treatment Centre for Bipolar Disorders, Alkmaar, The Netherlands.
Pharmacopsychiatry. 2014 Jul;47(4-5):121-30. doi: 10.1055/s-0034-1383657. Epub 2014 Jul 7.
We discuss the relevance of the glutamate hypothesis in explaining cognitive disturbances and negative symptoms in schizophrenia. 4 lines of evidence support the hypothesis that glutamate deregulation, mainly through dysfunction of the N-methyl-D-aspartate (NMDA) receptor, is an important underlying mechanism of schizophrenia. Glutamate pathways are promising sites for intervention. Glutamate agonists combined with non-clozapine antipsychotics and glutamate antagonists augmented to clozapine show interesting clinical benefits in refractory schizophrenia. We illustrate how unique properties of the NMDA receptor antagonist memantine in addition to clozapine, may cause improvement of positive, negative and cognitive symptoms of schizophrenia.
我们讨论了谷氨酸假说在解释精神分裂症的认知障碍和阴性症状方面的相关性。有4条证据支持这样的假说：谷氨酸调节异常，主要通过N-甲基-D-天冬氨酸（NMDA）受体功能障碍，是精神分裂症的一个重要潜在机制。谷氨酸通路是有前景的干预位点。谷氨酸激动剂与非氯氮平抗精神病药物联合使用，以及谷氨酸拮抗剂与氯氮平联合使用，在难治性精神分裂症中显示出有趣的临床益处。我们阐述了除氯氮平外，NMDA受体拮抗剂美金刚的独特性质如何可能改善精神分裂症的阳性、阴性和认知症状。
