76例苯丙胺类兴奋剂所致精神病性障碍复吸患者临床分析

76 cases of amphetamines doping mental disorder caused by relapsed patients clinical analysis

目的:探讨苯丙胺类兴奋剂所致精神病性障碍复吸患者的临床特点。方法:对近一年半内单用苯丙胺类兴奋剂所致精神病性障碍复吸住院的76例患者的复吸原因、首次与复吸滥用毒品后出现精神病性障碍时间、首次住院及复吸住院精神症状及其变化、抗精神病药物使用情况及疗效等进行比较分析。结果:复吸原因中以朋友压力为主,其次为心瘾;症状中以易激惹为多见。自知力均有不同程度改变。对每例复吸患者住院病历记录精神症状与首次住院精神症状进行相符评定,高度相符者61例,基本相符者15例。对本组患者两次住院的所有精神症状进行比较,没有统计学差异。复吸后出现精神症状时间平均(1.26±3.08)月,明显短于开始使用毒品后出现精神症状时间(30.90±20.26)月。差异具有显著性(T=12.72,P<0.01)。在治疗中,抗精神病药物使用频率最高的是利培酮,其次是富马酸喹硫平、奥氮平,大多数常规加用情感稳定剂丙戊酸钠或碳酸锂。疗效都比较满意。结论:苯丙胺类兴奋剂致精神病性障碍复吸原因以朋友压力、心瘾为主,复吸后出现精神病性症状快,其症状与首次住院类同,治疗效果都比较理想。

Objective：Explore amphetamines doping mental disorder caused by the clinical characteristics of patients with relapsed. Methods：seventy six relapsed inpatients who only used amphetamines stimulants during past 18 months were interviewed to ifnd reasons for relapse. The time psychotic symptoms occurred after initial use of stimulants and after relapsed, the changes of psychotic symptom spectrum between ifrst hospitalization and relapsed hospitalization, thus age of anti-psychotics and treatment effects were compared. Results：The main reason for relapse was al ured by friends, fol owed by craving. Symptom spectrum mainly included irritability and impaired insight in different degrees. When comparing each patient’s psychotic symptoms between the relapsed hospitalization and the ifrst hospitalization, we found out that sixty-one cases were highly consistent while other iffteen cases were basical y consistent. After comparing al psychotic symptoms of the patients in this group between the two hospitalizations, there is no statistic difference. The symptom spectrum of relapse was similar to the ifrst hospitalization. Psychotic symptom occurred in 1.26±3.08 months after relapsed, shorter than psychotic symptoms began to appear after the onset of amphetamine used（30.90±20.26 months）, which has obvious statistical difference （T=12.72,p〈0.01）. Risperidone was the most often used in the treatment, fol owed by quetiapine fumarate and olanzapine, most conventional with emotional stabilizer valproate and lithium carbonate. The treatment effect is quite satisfactory. Conclusion：Being allured by friends and craving are main reasons for relapse in amphetamine type stimulants induced psychotic. Psychotic symptoms would appear quickly after relapse, and the symptom spectrum is similar to the ifrst hospitalization. The treatment effect is quite satisfactory.