McKetin Rebecca, Voce Alexandra, Burns Richard, Ali Robert, Lubman Dan I, Baker Amanda L, Castle David J
Faculty of Health Sciences, National Drug Research Institute, Curtin University, Perth, WA, Australia.
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
Front Psychiatry. 2018 Nov 19;9:578. doi: 10.3389/fpsyt.2018.00578. eCollection 2018.
The inability to distinguish clearly between methamphetamine-related psychosis and schizophrenia has led to the suggestion that "methamphetamine psychosis" does not represent a distinct diagnostic entity but rather that the drug has triggered a vulnerability to schizophrenia. We tested this possibility by exploring the latent class structure of psychotic symptoms amongst people who use the drug and examining how these latent symptom profiles correspond to a diagnosis of schizophrenia. Latent class analysis was carried out on the lifetime psychotic symptoms of 554 current methamphetamine users, of whom 40 met the DSM-IV criteria for schizophrenia. Lifetime diagnoses of schizophrenia and individual psychotic symptoms were assessed using the Composite International Diagnostic Interview. The chosen model found 22% of participants had a high propensity to experience a wide range of psychotic symptoms (schizophrenia-like), whereas the majority (56%) more specifically experienced persecutory delusions and hallucinations (paranoid psychosis) and had a lower probability of these symptoms than the schizophrenia-like class. A third class (22%) had a low probability of all symptoms, with the exception of 34% reporting persecutory delusions. Participants in the schizophrenia-like class were more likely to meet diagnostic criteria for schizophrenia (26 vs. 3 and 1% for each of the other classes, < 0.001) but the diagnosis failed to encompass 74% of this group. These results are consistent with there being a distinction between schizophrenia and methamphetamine-related psychotic symptoms, both in terms of the propensity to experience psychotic symptoms, as well as the symptom profile; however, this distinction may not be captured well by existing diagnostic classifications.
无法清晰区分甲基苯丙胺所致精神病和精神分裂症，这引发了一种观点，即“甲基苯丙胺精神病”并非一个独特的诊断实体，而是这种药物引发了对精神分裂症的易感性。我们通过探究吸毒者中精神病症状的潜在类别结构，并检查这些潜在症状概况如何与精神分裂症诊断相对应，来检验这种可能性。对554名当前甲基苯丙胺使用者的终生精神病症状进行了潜在类别分析，其中40人符合精神分裂症的DSM-IV标准。使用综合国际诊断访谈评估精神分裂症的终生诊断和个体精神病症状。所选模型发现，22%的参与者有体验广泛精神病症状（类精神分裂症）的高倾向，而大多数（56%）更具体地体验到被害妄想和幻觉（偏执型精神病），且这些症状出现的概率低于类精神分裂症类别。第三类（22%）除34%报告有被害妄想外，所有症状出现的概率都低。类精神分裂症类别的参与者更有可能符合精神分裂症的诊断标准（分别为26%，而其他类别为3%和1%，P<0.001），但该诊断未能涵盖该组中的74%。这些结果与精神分裂症和甲基苯丙胺相关精神病症状之间存在区别是一致的，这在体验精神病症状的倾向以及症状概况方面都是如此；然而，现有诊断分类可能无法很好地体现这种区别。
