苯丙胺兴奋剂所致精神障碍的诊治问题.ppt

小结 有关ATS所致精神障碍的药物治疗，目前研究尚未形成一致的结论，有许多问题值得探讨。 兴奋激越等精神症状持续存在时，如何选择BZs和抗精神病药物？ 抗精神病药物应该对急性精神障碍治疗多长时间？精神病性症状消失后需要药物维持治疗吗？ 对慢性精神障碍及症状回闪如何治疗？ 以上问题有待于进一步研究。 推荐阅读 致谢 六病区朱子俊大夫提供部分统计资料 ★与精神分裂症的鉴别诊断 鉴别要点 苯丙胺性精神病 精神分裂症 ATS滥用史 肯定有 无 起病形式 多数较急 不定 病程 较短，大多数停用ATS后1月内缓解，部分患者病程较长 慢性 意识状态 可有意识模糊（谵妄） 清晰，定向、记忆完整 精神病性症状 被害妄想、幻听、思维广播较常见，幻视、夸大 幻觉、妄想、思维散漫 思维联想障碍不太明显， 可有Schneider一级症状 较少Schneider一级症状 情感反应 焦虑，易激惹多见；对周围环境兴趣正常 较淡漠，对周围环境不关心 抗精神病药物治疗 具有较好的治疗反应，疗效较好 不明确 引自赵敏，郝伟(上海精神医学，2011，vol.23,No.6),略有修改 amphetamine-induced psychosis（1） Use of amphetamine and methamphetamine is widespread in the general population and common among patients with psychiatric disorders. Amphetamines may induce symptoms of psychosis very similar to those of acute schizophrenia spectrum psychosis. This has been an argument for using amphetamine-induced psychosis as a model for primary psychotic disorders. amphetamine-induced psychosis（2） To distinguish the two types of psychosis on the basis of acute symptoms is difficult. However, acute psychosis induced by amphetamines seems to have a faster recovery and appears to resolve more completely compared to schizophrenic psychosis. amphetamine-induced psychosis（3） The increased vulnerability for acute amphetamine induced psychosis seen among those with schizophrenia, schizotypal personality and, to a certain degree other psychiatric disorders, is also shared by non-psychiatric individuals who previously have experienced amphetamine-induced psychosis. amphetamine-induced psycho