Francesca Manzella, George T Taylor, Behavioral Neuroscience Program, Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO 63121, United States.
World J Psychiatry. 2015 Mar 22;5(1):35-46. doi: 10.5498/wjp.v5.i1.35.
A common remark among laypeople, and notably also among mental health workers, is that individuals with mental illnesses use drugs as self-medication to allay clinical symptoms and the side effects of drug treatments. Roots of the self-medication concept in psychiatry date back at least to the 1980s. Observations that rates of smokers in schizophrenic patients are multiple times the rates for regular smoking in the general population, as well as those with other disorders, proved particularly tempting for a self-medication explanation. Additional evidence came from experiments with animal models exposed to nicotine and the identification of neurobiological mechanisms suggesting self-medication with smoking is a plausible idea. More recently, results from studies comparing smoking and non-smoking schizophrenic patients have led to the questioning of the self-medication hypothesis. Closer examination of the literature points to the possibility that smoking is less beneficial on schizophrenic symptomology than generally assumed while clearly increasing the risk of cancer and other smoking-related diseases responsible for early mortality. It is a good time to examine the evidence for the self-medication concept as it relates to smoking. Our approach is to focus on data addressing direct or implied predictions of the hypothesis in schizophrenic smokers.
一种常见的说法，不仅在普通民众中，而且在精神健康工作者中也很普遍，即患有精神疾病的人会使用药物进行自我治疗，以缓解临床症状和药物治疗的副作用。自我治疗概念在精神病学中的根源至少可以追溯到 20 世纪 80 年代。观察到精神分裂症患者中的吸烟者比例是普通人群中常规吸烟者的多倍，以及其他疾病患者中的吸烟者比例，这尤其诱人地解释为自我治疗。来自动物模型暴露于尼古丁的实验以及识别出的神经生物学机制的额外证据表明，吸烟自我治疗是一个合理的想法。最近，比较吸烟和不吸烟的精神分裂症患者的研究结果导致对自我治疗假说提出了质疑。对文献的更仔细检查表明，吸烟对精神分裂症症状的益处可能不如普遍认为的那么大，而吸烟显然会增加患癌症和其他与吸烟有关的疾病的风险，这些疾病会导致早期死亡。现在是时候检查与吸烟有关的自我治疗概念的证据了。我们的方法是专注于处理与精神分裂症吸烟者的假设直接或隐含预测相关的数据。
