Rosse R B, Collins J P, Fay-McCarthy M, Alim T N, Wyatt R J, Deutsch S I
Psychiatry Service, Department of Veterans Affairs, Medical Center, Washington, D.C. 20422, USA.
Clin Neuropharmacol. 1994 Aug;17(4):359-69. doi: 10.1097/00002826-199408000-00008.
Both stimulant-induced and phencyclidine (PCP)-induced psychoses have been proposed as models of the idiopathic psychosis of schizopherenia. In this two-part study, the phenomenology of the psychosis associated with a period of cocaine intoxication was evaluated retrospectively in 34 male crack cocaine-dependent patients without concomitant psychiatric disorder and then was compared with the psychosis of 16 actively psychotic schizophrenic men (without a history of drug or alcohol abuse in the past year). Certain First Rank Schneiderian Symptoms (FRSS) were more commonly observed in the schizophrenic patients (e.g., thought broadcasting, thought withdrawal) than in the cocaine addicts. In the second part of this study, we retrospectively examined the cocaine and PCP experiences of an additional 22 cocaine addicts who had a past history of separate periods of cocaine and PCP use. Overall, the frequency of FRSS recalled during periods of cocaine and PCP intoxication was similar. However, the psychosis related to cocaine intoxication was more associated with an intense suspiciousness and paranoia related to a fear of being discovered or harmed while using cocaine. PCP-induced psychosis was less associated with suspiciousness and more associated with delusions of physical power, altered sensations, and unusual experiences [e.g., out of body experiences, experiencing religious figures or events directly (e.g., being with Noah at the time of the Arc)]. As elements of both cocaine and PCP psychosis can be found in schizophrenia, a model integrating the mechanisms of several psychotogenic drugs may be more informative. Such an integrative model might better capture the heterogeneity of psychotic symptoms that can be seen in schizophrenia. Furthermore, different pharmacologic interventions (e.g., "anti-stimulant" versus "anti-PCP") might address different aspects of the positive symptom picture in schizophrenia.
兴奋剂所致和苯环己哌啶（PCP）所致精神病均被提议作为精神分裂症特发性精神病的模型。在这项分为两部分的研究中，对34名无并发精神障碍的男性快克可卡因依赖患者在一段可卡因中毒期间相关精神病的现象学进行了回顾性评估，然后将其与16名处于活动期精神病性发作的精神分裂症男性患者（过去一年无药物或酒精滥用史）的精神病进行比较。某些一级施奈德症状（FRSS）在精神分裂症患者中（如思维播散、思维被夺）比在可卡因成瘾者中更常见。在本研究的第二部分，我们回顾性检查了另外22名有可卡因和PCP单独使用史的可卡因成瘾者的可卡因和PCP使用经历。总体而言，在可卡因和PCP中毒期间回忆起的FRSS频率相似。然而，与可卡因中毒相关的精神病更多与强烈的猜疑和偏执有关，这种猜疑和偏执与使用可卡因时害怕被发现或伤害有关。PCP所致精神病与猜疑的关联较小，更多与身体力量的妄想、感觉改变和异常体验有关[如体外体验、直接体验宗教人物或事件（如在方舟时代与诺亚在一起）]。由于可卡因和PCP所致精神病的要素均可在精神分裂症中发现，整合几种致幻药物机制的模型可能更具信息量。这样一个综合模型可能能更好地捕捉精神分裂症中可见的精神病性症状的异质性。此外，不同的药物干预（如“抗兴奋剂”与“抗PCP”）可能针对精神分裂症阳性症状表现的不同方面。
