Serper M R, Alpert M, Richardson N A, Dickson S, Allen M H, Werner A
New York University School of Medicine, NY, USA.
Am J Psychiatry. 1995 Oct;152(10):1464-9. doi: 10.1176/ajp.152.10.1464.
Dopamine function has been hypothesized to be involved in both producing schizophrenic symptoms and mediating cocaine's reinforcing properties. As a result, cocaine abuse in schizophrenic patients may be seen as a natural experiment that may alter the phenomenology and neurobiology of schizophrenia. This report concerns the clinical effects of cocaine abuse and cessation in schizophrenic patients at two times: when patients presented to the psychiatric emergency service and again after 4 weeks of hospitalization.
The subjects were 15 cocaine-abusing and 22 cocaine-abstaining schizophrenic patients. Diagnostic assessments were performed with the Structured Clinical Interview for DSM-III-R--Patient Version, which uses DSM-III-R criteria. All of the patients were assessed at both times with the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms.
Cocaine-abusing schizophrenic patients showed fewer negative signs and more anxiety/depression at the hospital-admission assessment than their nonabusing counterparts. At retest, no group differences were detected in patients' negative signs or mood symptoms. Severity of positive symptoms was equal at both testing sessions.
The significant difference in negative signs and mood symptoms at admission assessment was attributed to the neurobiological impact of cocaine. The role of psychostimulants in schizophrenic patients is discussed.
有假说认为多巴胺功能既参与产生精神分裂症症状，又介导可卡因的强化特性。因此，精神分裂症患者滥用可卡因可被视为一项可能改变精神分裂症现象学和神经生物学的自然实验。本报告关注精神分裂症患者滥用可卡因及戒断在两个时间点的临床效应：一是患者就诊于精神科急诊时，二是住院4周后。
研究对象为15名滥用可卡因的精神分裂症患者和22名未滥用可卡因的精神分裂症患者。采用基于《精神疾病诊断与统计手册第三版修订版》（DSM - III - R）标准的《DSM - III - R结构化临床访谈——患者版》进行诊断评估。所有患者在两个时间点均接受简明精神病评定量表、阳性症状评定量表和阴性症状评定量表评估。
滥用可卡因的精神分裂症患者在入院评估时，与未滥用者相比，阴性体征较少，焦虑/抑郁较多。在复测时，两组患者在阴性体征或情绪症状方面未检测到差异。两个测试阶段的阳性症状严重程度相同。
入院评估时阴性体征和情绪症状的显著差异归因于可卡因的神经生物学影响。文中讨论了精神兴奋剂在精神分裂症患者中的作用。
