Anton R F
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA.
Alcohol Alcohol. 1996 Mar;31 Suppl 1:43-53.
Results from studies of pharmacotherapies for primary alcoholism are reviewed, including selective serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibitors (e.g. fluoxetine), opiate antagonists (e.g. naltrexone) and dopamine agonists (e.g. bromocriptine). Because there is considerable comorbidity between alcohol dependence, anxiety, and affective disorders, results from studies of medications used to treat these psychiatric disorders are also reviewed, including the 5-HT agonist buspirone and the noradrenergic agent desipramine. The neurobehavioural model of alcohol dependence implies that combinations of medications may lead to more effective treatment; thus, identifying subtypes of alcoholic patients will be important in determining which therapies or combinations of therapy will be most effective in treating alcohol dependence. For example, in an ongoing study, we are attempting to subtype an alcoholic population for treatment selection by measuring endogenous opioid activity. Because endogenous opioids are involved in analgesia, we exposed male and female subjects with alcoholism [some of whom had post-traumatic stress disorder (PTSD)] to cold-induced pain and measured their response before and after administration of naloxone or placebo. The naloxone injection reduced pain response. In addition, women who have PTSD are much more sensitive to stress, which may be related to levels of brain opioid activity.
本文综述了针对原发性酒精中毒的药物治疗研究结果，包括选择性5-羟色胺（5-HT）再摄取抑制剂（如氟西汀）、阿片拮抗剂（如纳曲酮）和多巴胺激动剂（如溴隐亭）。由于酒精依赖、焦虑症和情感障碍之间存在相当高的共病率，本文还综述了用于治疗这些精神疾病的药物研究结果，包括5-HT激动剂丁螺环酮和去甲肾上腺素能药物地昔帕明。酒精依赖的神经行为模型表明，联合用药可能会带来更有效的治疗效果；因此，识别酒精中毒患者的亚型对于确定哪种治疗方法或联合治疗方法对治疗酒精依赖最有效至关重要。例如，在一项正在进行的研究中，我们试图通过测量内源性阿片活性对酒精中毒人群进行亚型分类，以选择治疗方案。由于内源性阿片参与镇痛作用，我们让患有酒精中毒的男性和女性受试者（其中一些人患有创伤后应激障碍（PTSD））接受冷刺激疼痛测试，并在注射纳洛酮或安慰剂前后测量他们的反应。注射纳洛酮后疼痛反应降低。此外，患有PTSD的女性对压力更为敏感，这可能与大脑阿片活性水平有关。
