Fiorentini Alessio, Cantù Filippo, Crisanti Camilla, Cereda Guido, Oldani Lucio, Brambilla Paolo
Department of Neurosciences and Mental Health, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Front Psychiatry. 2021 Dec 23;12:694863. doi: 10.3389/fpsyt.2021.694863. eCollection 2021.
On the current psychopharmacological panorama, the variety of substances able to provoke an episode of acute psychosis is rapidly increasing. Such psychotic episodes are classified according to the major category of symptoms: positive, negative, or cognitive psychotic episodes. On one hand, the abuse of methamphetamines, cannabis, and cocaine plays a big role in increasing the incidence of episodes resembling a psychotic disorder. On the other hand, the progress in terms of pharmacodynamics knowledge has led to the synthesis of new drugs, such as cannabinoids and cathinone's, which have rapidly entered into the common pool of abusers' habits. Regarding these newly synthesized substances of abuse, further clinical studies are needed to understand their psychogenic properties. The topic of this review is complicated due to the frequent abuse of psychotomimetic drugs by patients affected by psychotic disorders, a fact that makes it extremely difficult to distinguish between an induced psychosis and a re-exacerbation of a previously diagnosed disorder. The present narrative review summarizes results from clinical studies, thus investigating the psychotogenic properties of abused substances and the psychotic symptoms they can give rise to. It also discusses the association between substance abuse and psychosis, especially with regards to the differential diagnosis between a primary vs. a substance-induced psychotic disorder. Our findings support the theory that psychosis due to substance abuse is commonly observed in clinical practice. The propensity to develop psychosis seems to be a function of the severity of use and addiction. Of note, from a phenomenological point of view, it is possible to identify some elements that may help clinicians involved in differential diagnoses between primary and substance-induced psychoses. There remains a striking paucity of information on the outcomes, treatments, and best practices of substance-induced psychotic episodes.
在当前的精神药理学领域，能够引发急性精神病发作的物质种类正在迅速增加。此类精神病发作根据主要症状类别进行分类：阳性、阴性或认知性精神病发作。一方面，甲基苯丙胺、大麻和可卡因的滥用在增加类似精神病性障碍发作的发生率方面起了很大作用。另一方面，药效学知识的进步导致了新药物的合成，如大麻素和卡西酮类药物，这些药物迅速进入了滥用者的常见习惯范围。关于这些新合成的滥用物质，需要进一步的临床研究来了解它们的致心理疾病特性。由于患有精神病性障碍的患者经常滥用拟精神病药物，本综述的主题变得复杂，这一事实使得区分诱发的精神病和先前诊断疾病的再次发作极其困难。本叙述性综述总结了临床研究结果，从而研究滥用物质的致心理疾病特性以及它们可能引发的精神病症状。它还讨论了物质滥用与精神病之间的关联，特别是关于原发性与物质诱发的精神病性障碍之间的鉴别诊断。我们的研究结果支持这样一种理论，即物质滥用所致精神病在临床实践中很常见。发生精神病的倾向似乎是使用和成瘾严重程度的函数。值得注意的是，从现象学角度来看，有可能识别出一些有助于临床医生对原发性和物质诱发的精神病进行鉴别诊断的因素。关于物质诱发的精神病发作的结果、治疗和最佳实践，仍然缺乏大量信息。
