JAMA Psychiatry：长期服用甲基苯丙胺与精神病性症状

　　日前，一项来自澳大利亚的前瞻性纵向调查研究提示，患者在服用甲基苯丙胺期间精神病性症状的发作增加，且这种增加具有较强的剂量依赖性。相关论文发表在《美国医学会杂志·精神病学》（JAMA Psychiatry）上。

　　甲基苯丙胺与精神病性症状有关，但尚不清楚用药人群发病前的精神病性症状在多大程度上与此药相关。该研究旨在确定在甲基苯丙胺用药期间可能的精神病性症状改变。

　　在该项纵向前瞻性队列研究中，研究人员对包含4个非连续性、观察期为1个月的纵向固定样本数据进行了固定效应分析，以便确定甲基苯丙胺用药改变与个体随着时间推移而发生精神病性症状风险的关系。

　　研究共纳入278名参与者，纳入标准为≥16岁，入组时符合DSM-IV中甲基苯丙胺依赖标准，但不符合DSM-IV中终生精神分裂症或躁狂标准。

　　在过去一个月的临床明显精神病性症状定义为，简明精神病评定量表中多疑、幻觉或奇异的想法中任意一项的得分≥4。应用阿片类治疗指数来评价过去一个月的甲基苯丙胺用药天数。

　　结果显示，与非用药期间相比，应用甲基苯丙胺期间，精神病性症状发作的可能性增加5倍（P < .001），这种增加表现为强烈的剂量依赖性，频繁应用大麻和/或酒精进一步增加精神病性症状发生的比值比。

与精神病相关的拓展阅读：

• JAMA Psychiatry：精神病患者发生转移癌风险高
• JAMA Psychiatry：青年认知减退或可预测成年精神病
• Am J Psychiatry：二甲双胍可治疗抗精神病药物所致不良反应
• JAMA Psychiatry:甲基安非他明治疗精神病呈强剂量依赖效应
• Addiction：吸食大麻青少年易发精神病
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Dose-Related Psychotic Symptoms in Chronic Methamphetamine Users

Evidence From a Prospective Longitudinal Study

Context  

Methamphetamine is associated with psychotic phenomena, but it is not clear to what extent this relationship is due to premorbid psychosis among people who use the drug.

Objective  

To determine the change in the probability of psychotic symptoms occurring during periods of methamphetamine use.

Design  

Longitudinal prospective cohort study. A fixed-effects analysis of longitudinal panel data, consisting of 4 noncontiguous 1-month observation periods, was used to examine the relationship between changes in methamphetamine use and the risk of experiencing psychotic symptoms within individuals over time.

Setting  

Sydney and Brisbane, Australia.

Participants  

A total of 278 participants 16 years of age or older who met DSM-IV criteria for methamphetamine dependence on entry to the study but who did not meet DSM-IV criteria for lifetime schizophrenia or mania.

Main Outcome Measures  

Clinically significant psychotic symptoms in the past month, defined as a score of 4 or more on any of the Brief Psychiatric Rating Scale items of suspiciousness, hallucinations, or unusual thought content. The number of days of methamphetamine use in the past month was assessed using the Opiate Treatment Index.

Results  

There was a 5-fold increase in the likelihood of psychotic symptoms during periods of methamphetamine use relative to periods of no use (odds ratio [OR], 5.3 [95% CI, 3.4-8.3]; P < .001), this increase being strongly dose-dependent (1-15 days of methamphetamine use vs abstinence in the past month: OR, 4.0 [95% CI, 2.5-6.5]; ≥16 days of methamphetamine use vs abstinence in the past month: OR, 11.2 [95% CI, 5.9-21.1]). Frequent cannabis and/or alcohol use (≥16 days of use in the past month) further increased the odds of psychotic symptoms (cannabis: OR, 2.0 [95% CI, 1.1-3.5]; alcohol: OR, 2.1 [95% CI, 1.1-4.2]).

Conclusions  

There was a large dose-dependent increase in the occurrence of psychotic symptoms during periods of methamphetamine use among users of the drug.