环境线索暴露对酒精依赖者心理渴求及生理指标的影响
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摘要
目的:酒依赖者戒断后,会有60-80%的人因种种原因而复饮,戒断后的复饮率一直是戒酒治疗中的难题。了解与复饮和滥用的相关因素,对于制定有效的治疗康复措施至关重要。引起复饮的原因很多,大量研究证实,与酒精相关的环境线索可以导致对酒的心理渴求。近年来,国外运用多种实验模式,对环境诱发渴求做了很多动物及临床方面的研究,探索在环境刺激诱发状态下出现的各种生理、心理及行为反应,并寻求通过训练降低酒依赖者对环境诱发的敏感性,降低复饮的可能性。国内类似的研究较少,环境线索诱导酒依赖者心理渴求的研究尚未见报道。本课题拟通过研究建立环境线索诱发渴求感实验模式,测量暴露于相关环境线索前后,酒依赖者心理渴求以及心率、血压、皮质醇等生理指标的动态变化,从心理学、生物学、社会学三个角度分析环境线索对渴求感的影响及其相关因素,确定酒精依赖者主观心理渴求和心率、血压、皮质醇等客观指标的相互影响。
方法:选择2005年11月-2007年1月在河北医科大学第一医院精神卫生研究所住院的64例酒依赖患者,均为男性患者。入组标准:符合DSM-Ⅳ酒精依赖诊断标准,无戒断症状。排除标准:严重心、肝、肾脏疾病及非酒精所致重性精神疾病。知情同意,自愿参加。按测试情况,给予被试者提供相应的出院后的防复饮建议。正常对照组:32名健康体检者为自愿参加人员,其年龄、性别及文化程度与患者组相匹配;无严重心、肝、肾脏疾病及精神疾病。知情同意,自愿参加。按随机数字表法随机将64例酒依赖患者分为患者实验组和患者对照组,两组各32例患者。为排除生物节律对血压、激素等生理指标的影响,所有实验均在16:00进行。所有被试者放松训练15分钟后采用12导联心电图仪记录心率,按WHO高血压专家委员会推荐的方法,使用校正过的汞柱式血压计,测量暴露前的血压。测量前至少静坐15分钟,不吸烟。测3次坐位右上臂血压,取平均值。抽取左臂静脉血,采用全自动化学发光酶免疫分析仪及试剂检测皮质醇,上述作为基线生理指标;然后呈现Likert线段,询问对酒精的渴求程度,告知被试者最左端表示一点也不想,最右端表示十分想。被试者依据当时感受,选择线段上任意符合自己渴求程度的点,作为基线渴求分值。之后患者实验组暴露于摆放各种饮酒用具的场景下,让被试者拿起酒杯闻1分钟,完成操作后呈现另一Likert线段询问渴求程度,获取诱发后的渴求分值。同时按上述程序抽取静脉血,测量心率、血压、作为线索诱发后的生理指标。而患者对照组暴露于摆放牛奶的中性刺激场景下,拿起奶杯闻1分钟。完成操作后呈现Likert线段询问渴求程度,获取诱发后的渴求分值。同时按上述程序抽取静脉血,测量心率、血压、作为诱发后的生理指标。正常对照组暴露于摆放各种饮酒用具的场景下,让被试者拿起酒杯闻1分钟,完成操作后呈现Likert线段询问渴求程度,获取诱发后的渴求分值。同时按上述程序抽取静脉血,测量心率、血压、作为诱发后的生理指标。所有被试者于线索暴露后第1周、第4周再次按上述程序抽取静脉血,测量渴求分值及心率、血压,作为诱发后第1周、第4周的心理及生理指标。所有数据用用SPSS13. 0统计软件包进行统计,计量资料用均数±标准差表示,采用t检验比较环境线索暴露对酒依赖者心理渴求及各生理指标的影响和酒精依赖者主观心理渴求和心率、血压、皮质醇等客观指标的相互关系。
结果:
1与正常对照组和患者对照组相比,患者实验组暴露于相关的环境线索后第一天自我报告的渴求分值及心率、收缩压、舒张压及血皮质醇改变均较基线有所增加,与基线相比差异有显著性( P < 0. 05)。
2患者实验组暴露于相关的环境线索后第1天、第1周、第4周渴求分值、心率、收缩压、舒张压及血皮质醇有逐渐降低的趋势,第1天与第1周、第4周的各项指标相比,均有显著性差异( P < 0. 05),第1周、第4周的各项指标差异无显著性。
3戒断期酒依赖患者血浆皮质醇水平高于正常对照组,差异具有显著性的意义( P < 0. 05)
结论:环境线索可以使戒断期酒依赖者心理渴求及心率、血压、皮质醇明显增加,环境线索对酒依赖患者心理渴求及生理指标的影响随时间推移而减小,高皮质醇水平可能是预示戒断期酒依赖患者高复饮倾向的一种生物学标志。
Objective: In humans, relapse behaviour is a ubiquitous problem for individuals“recovering”from alcoholism, since at least 60 to 80% of abstinent alcoholics will relapse during their lifetime because of various reasons. To know about abuse related factor, for establishing effective treatment recover measure very important. Cue-reactivity studies in the clinic show that these alcohol-associated cues can elicit reports of craving in human addicts. Alcohol dependent patients report craving if asked to hold and sniff their favourite drink or imagine/recall a situation in which they had a strong desire for alcohol. In recent years, abroad with various experiment pattern found environmental clue increased craving for alcohol,along with physiological , psychological and behaviour changes. Domestic similar research is not much. Here we present preliminary results characterizing alcohol dependent patients with regard to subjective and psycho physiological aspects of in a cue reactivity paradigm. To know the relationship between psychological craving and heart rate, blood pressure and serum cortical level among alcohol dependence during rehabilitation period. We compared the difference of craving and physiological indexes before and after exposure. To analysis from psychology, biology and sociology how environments clue increased craving for alcohol. Explore the relevance in self-report score changes and biological and psychological responses, finally provide the evidence of theory and experiment for preventing relapse and methods of detoxification.
Method: Case-control study. 64 men who had entered the in-patient component of the Mental Health Institute at the First Hospital of Hebei Medical University were recruited for this study. They had to meet at least 5 criteria to be included according to DSM-IV criteria for dependence. All patients gave their written informed consent before participating in the study. The local Ethics Committee had approved the study protocol. Prior to inclusion in the study, all subjects underwent clinical detoxication according to routine procedures at the Mental Health Institute at the First Hospital of Hebei Medical University. Main exclusion criteria were the presence of a relevant axis I disorder such as major depression, bipolar disorder, any relevant anxiety disorder, psychotic disorders or other substance dependence. Also, patients with severe medical disorders or dementia of any etiology were excluded. According to random digital table 64 alcohol dependence patients divide into patient experiment group and patient compare group, two groups of each 32 patients. Control subjects (n=32) were recruited as healthy volunteers meeting criteria for neither harmful use nor dependence. The age, gender and cultural background matched with patient group .All subjects supplied demographic information and data on past history of medical and psychiatric problems, drinking and drug use patterns and any history of psychiatric disorders. To remove the biological section influence for the physiological indexes such as blood pressure and hormone, cue exposure was always performed at the same time of day 16:00. All subjects have been tried relax train 15 minutes. To record heart rate with 12 lead electrocardiogram instrument, according to the method that WHO hypertension expert committee recommends, use the type sphygmomanometer of mercury column that rectified, measure blood pressure. Before measuring at least sit quietly 15 minutes, do not smoke. To measure the three times seat right blood pressure of upper arm, take average. Take out to take the vein blood of left arm, with full automatic chemiluminescence’s enzyme immunity analyser detect cortisol. Above-mentioned is the physiological index of base line; Then, Subjects were asked to rate their desire for an alcoholic drink on a 100mm visual analogue scale (Like scale) reaching from“no desire”(extreme left) to“maximum desire”(extreme right). After a baseline session (no cue), patient experiment group were exposed by sight and smell to their favourite alcoholic beverage (alcoholic cue). Patient compare group were exposed by sight and smell to tea or milk (neutral cue). Control subjects were exposed by sight and smell to alcoholic beverage (alcoholic cue). Each cue exposure lasted exactly 1 minute. All subjects were asked to rate their desire for an alcoholic drink on Likert-scale measure and were recorded physiological index (blood pressure, heart rate, cortisol) after cue exposure and at the week of 1st and 4th.
Own data use SPSS13. 0 statistical software packages make statistics, initially the homogeneity of variance among all the groups was analysed. All the measurement data was expressed as mean standard deviation(mean±SD). with the t test compare environmental clue to expose for alcohol dependence on psychology craving and the influence of each physiological index (heart rate, blood pressure and cortisol). The related factors to cue-elicited alcohol craving have been screened by step-wise correlation.
Results:
1 With compare group and patient normally compare group compare , the craving and the physiological index (blood pressure, heart rate, cortisol) of patient experiment group exposes in related environmental clue after first day change than base line , increased significantly (P<0.05).
2 The craving and the physiological index (blood pressure, heart rate, cortisol) of patient experiment group exposes in related environmental clue after the day of 1th, the week of 1th and the week of 4th have the tendency that reduces gradually. In the day of 1th, every index with the week of 1th and the week of 4th is compared with , has significance discrepancy ( P < 0.05 ) .In the week of 1th , every index discrepancy of the week of 4th do not have significance.
3 All the patients during rehabilitation period have more craving and their serum cortical levels were higher than those of normal control group(P<0.05).
Conclusions:Craving and the change of some physiolo -gical indexes can been elicited by alcohol-related cue. Psychological craving and heart rate, blood pressure and serum cortisol level among alcohol dependence have the tendency that reduces gradually after exposes in related environmental clue. most of alcohol dependence during rehabilitation period have strong psychological craving and high serum cortical levels. The serum cortical level maybe one of biological marks of relapse trend.
方法:选择2005年11月-2007年1月在河北医科大学第一医院精神卫生研究所住院的64例酒依赖患者,均为男性患者。入组标准:符合DSM-Ⅳ酒精依赖诊断标准,无戒断症状。排除标准:严重心、肝、肾脏疾病及非酒精所致重性精神疾病。知情同意,自愿参加。按测试情况,给予被试者提供相应的出院后的防复饮建议。正常对照组:32名健康体检者为自愿参加人员,其年龄、性别及文化程度与患者组相匹配;无严重心、肝、肾脏疾病及精神疾病。知情同意,自愿参加。按随机数字表法随机将64例酒依赖患者分为患者实验组和患者对照组,两组各32例患者。为排除生物节律对血压、激素等生理指标的影响,所有实验均在16:00进行。所有被试者放松训练15分钟后采用12导联心电图仪记录心率,按WHO高血压专家委员会推荐的方法,使用校正过的汞柱式血压计,测量暴露前的血压。测量前至少静坐15分钟,不吸烟。测3次坐位右上臂血压,取平均值。抽取左臂静脉血,采用全自动化学发光酶免疫分析仪及试剂检测皮质醇,上述作为基线生理指标;然后呈现Likert线段,询问对酒精的渴求程度,告知被试者最左端表示一点也不想,最右端表示十分想。被试者依据当时感受,选择线段上任意符合自己渴求程度的点,作为基线渴求分值。之后患者实验组暴露于摆放各种饮酒用具的场景下,让被试者拿起酒杯闻1分钟,完成操作后呈现另一Likert线段询问渴求程度,获取诱发后的渴求分值。同时按上述程序抽取静脉血,测量心率、血压、作为线索诱发后的生理指标。而患者对照组暴露于摆放牛奶的中性刺激场景下,拿起奶杯闻1分钟。完成操作后呈现Likert线段询问渴求程度,获取诱发后的渴求分值。同时按上述程序抽取静脉血,测量心率、血压、作为诱发后的生理指标。正常对照组暴露于摆放各种饮酒用具的场景下,让被试者拿起酒杯闻1分钟,完成操作后呈现Likert线段询问渴求程度,获取诱发后的渴求分值。同时按上述程序抽取静脉血,测量心率、血压、作为诱发后的生理指标。所有被试者于线索暴露后第1周、第4周再次按上述程序抽取静脉血,测量渴求分值及心率、血压,作为诱发后第1周、第4周的心理及生理指标。所有数据用用SPSS13. 0统计软件包进行统计,计量资料用均数±标准差表示,采用t检验比较环境线索暴露对酒依赖者心理渴求及各生理指标的影响和酒精依赖者主观心理渴求和心率、血压、皮质醇等客观指标的相互关系。
结果:
1与正常对照组和患者对照组相比,患者实验组暴露于相关的环境线索后第一天自我报告的渴求分值及心率、收缩压、舒张压及血皮质醇改变均较基线有所增加,与基线相比差异有显著性( P < 0. 05)。
2患者实验组暴露于相关的环境线索后第1天、第1周、第4周渴求分值、心率、收缩压、舒张压及血皮质醇有逐渐降低的趋势,第1天与第1周、第4周的各项指标相比,均有显著性差异( P < 0. 05),第1周、第4周的各项指标差异无显著性。
3戒断期酒依赖患者血浆皮质醇水平高于正常对照组,差异具有显著性的意义( P < 0. 05)
结论:环境线索可以使戒断期酒依赖者心理渴求及心率、血压、皮质醇明显增加,环境线索对酒依赖患者心理渴求及生理指标的影响随时间推移而减小,高皮质醇水平可能是预示戒断期酒依赖患者高复饮倾向的一种生物学标志。
Objective: In humans, relapse behaviour is a ubiquitous problem for individuals“recovering”from alcoholism, since at least 60 to 80% of abstinent alcoholics will relapse during their lifetime because of various reasons. To know about abuse related factor, for establishing effective treatment recover measure very important. Cue-reactivity studies in the clinic show that these alcohol-associated cues can elicit reports of craving in human addicts. Alcohol dependent patients report craving if asked to hold and sniff their favourite drink or imagine/recall a situation in which they had a strong desire for alcohol. In recent years, abroad with various experiment pattern found environmental clue increased craving for alcohol,along with physiological , psychological and behaviour changes. Domestic similar research is not much. Here we present preliminary results characterizing alcohol dependent patients with regard to subjective and psycho physiological aspects of in a cue reactivity paradigm. To know the relationship between psychological craving and heart rate, blood pressure and serum cortical level among alcohol dependence during rehabilitation period. We compared the difference of craving and physiological indexes before and after exposure. To analysis from psychology, biology and sociology how environments clue increased craving for alcohol. Explore the relevance in self-report score changes and biological and psychological responses, finally provide the evidence of theory and experiment for preventing relapse and methods of detoxification.
Method: Case-control study. 64 men who had entered the in-patient component of the Mental Health Institute at the First Hospital of Hebei Medical University were recruited for this study. They had to meet at least 5 criteria to be included according to DSM-IV criteria for dependence. All patients gave their written informed consent before participating in the study. The local Ethics Committee had approved the study protocol. Prior to inclusion in the study, all subjects underwent clinical detoxication according to routine procedures at the Mental Health Institute at the First Hospital of Hebei Medical University. Main exclusion criteria were the presence of a relevant axis I disorder such as major depression, bipolar disorder, any relevant anxiety disorder, psychotic disorders or other substance dependence. Also, patients with severe medical disorders or dementia of any etiology were excluded. According to random digital table 64 alcohol dependence patients divide into patient experiment group and patient compare group, two groups of each 32 patients. Control subjects (n=32) were recruited as healthy volunteers meeting criteria for neither harmful use nor dependence. The age, gender and cultural background matched with patient group .All subjects supplied demographic information and data on past history of medical and psychiatric problems, drinking and drug use patterns and any history of psychiatric disorders. To remove the biological section influence for the physiological indexes such as blood pressure and hormone, cue exposure was always performed at the same time of day 16:00. All subjects have been tried relax train 15 minutes. To record heart rate with 12 lead electrocardiogram instrument, according to the method that WHO hypertension expert committee recommends, use the type sphygmomanometer of mercury column that rectified, measure blood pressure. Before measuring at least sit quietly 15 minutes, do not smoke. To measure the three times seat right blood pressure of upper arm, take average. Take out to take the vein blood of left arm, with full automatic chemiluminescence’s enzyme immunity analyser detect cortisol. Above-mentioned is the physiological index of base line; Then, Subjects were asked to rate their desire for an alcoholic drink on a 100mm visual analogue scale (Like scale) reaching from“no desire”(extreme left) to“maximum desire”(extreme right). After a baseline session (no cue), patient experiment group were exposed by sight and smell to their favourite alcoholic beverage (alcoholic cue). Patient compare group were exposed by sight and smell to tea or milk (neutral cue). Control subjects were exposed by sight and smell to alcoholic beverage (alcoholic cue). Each cue exposure lasted exactly 1 minute. All subjects were asked to rate their desire for an alcoholic drink on Likert-scale measure and were recorded physiological index (blood pressure, heart rate, cortisol) after cue exposure and at the week of 1st and 4th.
Own data use SPSS13. 0 statistical software packages make statistics, initially the homogeneity of variance among all the groups was analysed. All the measurement data was expressed as mean standard deviation(mean±SD). with the t test compare environmental clue to expose for alcohol dependence on psychology craving and the influence of each physiological index (heart rate, blood pressure and cortisol). The related factors to cue-elicited alcohol craving have been screened by step-wise correlation.
Results:
1 With compare group and patient normally compare group compare , the craving and the physiological index (blood pressure, heart rate, cortisol) of patient experiment group exposes in related environmental clue after first day change than base line , increased significantly (P<0.05).
2 The craving and the physiological index (blood pressure, heart rate, cortisol) of patient experiment group exposes in related environmental clue after the day of 1th, the week of 1th and the week of 4th have the tendency that reduces gradually. In the day of 1th, every index with the week of 1th and the week of 4th is compared with , has significance discrepancy ( P < 0.05 ) .In the week of 1th , every index discrepancy of the week of 4th do not have significance.
3 All the patients during rehabilitation period have more craving and their serum cortical levels were higher than those of normal control group(P<0.05).
Conclusions:Craving and the change of some physiolo -gical indexes can been elicited by alcohol-related cue. Psychological craving and heart rate, blood pressure and serum cortisol level among alcohol dependence have the tendency that reduces gradually after exposes in related environmental clue. most of alcohol dependence during rehabilitation period have strong psychological craving and high serum cortical levels. The serum cortical level maybe one of biological marks of relapse trend.
引文
1 郝伟,杨德森,何鸣.我国饮酒现状、预测及对策.中国临床心理学杂志,1995,3:243-248
2 郝伟.精神活性物质所致精神障碍.见:徐韬园,主编.现代精神医学.上海:上海医科大学出版社,2000.247-248
3 HamalainenM,Hari R,Llmoniemi RJ,etal. Magnetoence -phalography theory,instrumentation,and applications to noninvasive studies of the working human brain[J].Rev Mod Phys,1993,65(2):413-497
4 Mucha RF,Geier A,Stuhlinger M,Mundle G (2000) Appetitive effects of drug cues modelled by pictures of the intake ritual: generality of cue-modulated startle examined with inpatient alcoholics. Psychopharmacology 151: 428-432
5 Wrase J, Gr sser SM,Klein S,Diener C,Hermann D,Flor H, Mann K,Braus DF,Heinz A (2002)Development of alcohol- associated cues and cue-induced brain activation in alcoholics. Eur Psychiatry17:287-291
6 Braus DF, Wrase J,Grusser S,Hermann D,Ruf M,Flor H, Mann K,Heinz A (2001) Alcohol-associated stimuli activate the ventral striatum in abstinent alcoholics. J Neural Transm 108:887-894
7 Lee CH, Seok JH, Lee MH,Lee BO,Namkoong K (2002) Development of the alcohol-related visual stimuli inducing alcohol craving. J Korean Neuropsychiatr Assoc 41:442-453
8 George MS, Anton RF, Bloomer C,Teneback C, Drobes DJ,Lorberbaum JP, Nahas Z, Vincent DJ (2001) Activation of prefrontal cortex and anterior thalamus in alcoholic subjects on exposure to alcohol-specific cues. Arch Gen Psychiatry 58:345-352. Bibliographic Links
9 Robins LN,Regier DA.Psychatric disorders in America.New York:Free Press.1991
10 郝伟,杨德森,肖水源.中国临床心理学杂志,1998,2:65-70
11 沈渔村.近年来国内有关酒依赖和慢性酒中毒的流行学调查资料.中国心理卫生杂志,1987,1:251-256
12 成自强,张子饮,张中兴,等.河南省酒精依赖流行学调查.中国心理卫生杂志,1992,6:120
13 亢明,陆滨,谢健,等.名酒产地江苏淮阴市酒精依赖及有关问题流行学调查.中国心理卫生杂志,1992,6:118-119
14 HaoWei.Women and substance use in China. Country Reports.WHO PSA 93.13
15 郝伟,杨德森,何鸣.我国饮酒现状、预测及对策.中国临床心理学杂志,1995,3:243-248
16 邵春红,江开达,徐一峰.物质成瘾中渴求的神经生物学机制研究进展.中华精神科杂志,2003,36:190-192
17 Drummond DC. Theories of drug craving,ancient and modern.Addiction, 2001,96:33-46
18 Wikler A. Recent progress in research on the neurophysiologic basis of morphine addiction. Am J Psychiatry,1948,105:329-338
19 Robinson TE, Berridge KC. The neural basis of drug craving:an incentive-sensitization theory of addiction. Brain Research Reviews,1993,18:247-291
20 RobinsonTE,BerridgeKC.Mechanisms of action of addictive stimuli.Incentive sensitization and addiction. Addiction,2001,96:103-114
21 Franken IH, Kroon LY, W iers RW, et al. Selective cognitive processing of drug cues in heroin dependence. Psychophar -macology,2000,14:395-400
22 George MS,Anton RF,B loomer C,et al.Activation of prefrontal cortex and anterior thalamus in alcoholic subjects on exposure to alcohol2specific cues. Arch Gen Psychiatry,2001,58:345-352
23 Schneider F , Habel U , Wagner M , et al.Subcortisal correlates of craving in recently abstinent alcoholic patients. Am J Psychiatry,2001,158: 1075-1083
24 张镜如,乔健天. 生理学. 第四版. 北京: 人民卫生出版社,1995. 403-404
25 陆林,黄明生,李保明.糖皮质激素在奖赏行为中的作用机制研究进展.中国药物依赖性杂志,1999,8(4):245-249
1 FEINSTEIN C , ELIEZ S , BLASEY C , et al. Psychiatric disorders and behavioral problems in children with velocardiofacial syndrome :usefulness as phenotypic indicators of schizophrenia risk [J].Biol Psychiatry ,2002 ,51 (4) :312 - 318
2 WINOKUR A , DEMARTINIS N A , MCNALL YD P ,et al. Comparative effects of mirtazapine and fluoxetine on sleep physiology measures in patients with major depression and insomnia[J ] . J Clin Psychiatry ,2003 ,64 (10) :1 224-1 229
3 Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990;264:2511-8
4 Bruns L , TeessonM : Alcohol use disorders co morbid with anxiety, depression and drug use disorders. Drug Alcohol Depend. 2002; 68 (3) : 299-307
5 Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51: 8-19
6 Winokur G. Alcoholism in bipolar disorder. In: Goldberg JF, Harrow M, eds. Bipolar disorders: Clinical course and outcome. Washington, DC: American Psychiatric Press; 1999:185-98
7 Frye M, Altshuler LL, Denicoff KD, et al. Gender differences in bipolar disorder alcohol abuse comorbidity. Acta Neuropsychiatrica 2000;12:159
8 SchuckitMA.TippJE.BucholzKK. etal. The lifetime rates of three major mood disorders and four major anxiety disorders in alcoholics and controls.Addiction1997,92(10):1289
9 Tohen M, Zarate CA Jr. Bipolar disorder and comorbid substance abuse. In: Goldberg JF, Harrow M, eds. Bipolar disorders: Clinical course and outcome. Washington, DC: American Psychiatric Press;1999:171-84
10 Keck PE Jr, McElroy SL, Strakowski SM, et al. Outcome and comorbidity in first- compared with multiple-episode mania. J Nerv Ment Dis 1995;183:320-4
11 Strakowski SM, Sax KW, McElroy SL, et al. The effects of antecedent substance abuse on the development of first-episode psychotic mania. J Psychiatr Res 1996;30:59-68
12 BradyKT. Sonne. The relationship between substance abuse and bipolar disorder. Jclin psychiatry1995,56(suppl.3):19
13 Bebbington P . Rammana R . The epidemiology of bipolar affective disorder Soc psychiatry psyciatry Epidemid, 1995,30:279
14 WinkourG. CoryellW. AksikalHS. EndicottJ. kellerM. MuellerT. Manic-depressive(bipolar) disorder : the course in light of a prospective ten year follow up of 131 patients . Actapsychiatr Scand1994,89:102
15 SchuckitMA .TippJE .BucholzKK .etal. The lifetime rates of three major mood disorders and four major anxiety disorders in alcoholics and controls.Addiction1997,92(10):1289
16 Brady KT . Sonne. The relationship between substance abuse and bipolar disorder. Jclinpsychiatry 1995,56 (suppl.3):19
17 BebbingtonP .Rammana R. The epidemiology of bipolar affective disorder Soc psychiatry psyciatr Epidemid, 1995,30:279
18 WinkourG.CoryellW.AksikalHS.EndicottJ.kellerM.MuellerT.Manic-depressive(bipolar)disorder:the course in light of a prospective ten-year follow up of 131 patients. Act a psychiatr Scand1994,89:102
19 Lejoyeux M , Ades J . Evaluation of lithium treatment in alcoholism. Alcohol Alcoholism ,1993 ,28 (3):273
20 Johnson BA.Roleof the serotonergic system in the neurobiology of alcoholism:implications for treatment[J]. CNS Drugs,2004,18(15):1105-1118
21 Finley PR.Selective serotonin reuptake in hibitors: pharmacologic profiles and potential the rapeutic distinctions [Review] [J].Annalsof Pharmacotherapy,1994, 28(12):1359-1369
22 CorneliusJR. Salloum IM.Ehler JG .etc. Fluoxetine in depressed alcoholics [J].Arch Gene Psychiatry,1997,54(8): 700-705
23 Lhuintre J P , Moore N , Tran G, et al . Acamprosate appearsto decrease alcohol intake in weaned alcoholics. Alcohol Alcoholism ,1990 ,25:613
2 郝伟.精神活性物质所致精神障碍.见:徐韬园,主编.现代精神医学.上海:上海医科大学出版社,2000.247-248
3 HamalainenM,Hari R,Llmoniemi RJ,etal. Magnetoence -phalography theory,instrumentation,and applications to noninvasive studies of the working human brain[J].Rev Mod Phys,1993,65(2):413-497
4 Mucha RF,Geier A,Stuhlinger M,Mundle G (2000) Appetitive effects of drug cues modelled by pictures of the intake ritual: generality of cue-modulated startle examined with inpatient alcoholics. Psychopharmacology 151: 428-432
5 Wrase J, Gr sser SM,Klein S,Diener C,Hermann D,Flor H, Mann K,Braus DF,Heinz A (2002)Development of alcohol- associated cues and cue-induced brain activation in alcoholics. Eur Psychiatry17:287-291
6 Braus DF, Wrase J,Grusser S,Hermann D,Ruf M,Flor H, Mann K,Heinz A (2001) Alcohol-associated stimuli activate the ventral striatum in abstinent alcoholics. J Neural Transm 108:887-894
7 Lee CH, Seok JH, Lee MH,Lee BO,Namkoong K (2002) Development of the alcohol-related visual stimuli inducing alcohol craving. J Korean Neuropsychiatr Assoc 41:442-453
8 George MS, Anton RF, Bloomer C,Teneback C, Drobes DJ,Lorberbaum JP, Nahas Z, Vincent DJ (2001) Activation of prefrontal cortex and anterior thalamus in alcoholic subjects on exposure to alcohol-specific cues. Arch Gen Psychiatry 58:345-352. Bibliographic Links
9 Robins LN,Regier DA.Psychatric disorders in America.New York:Free Press.1991
10 郝伟,杨德森,肖水源.中国临床心理学杂志,1998,2:65-70
11 沈渔村.近年来国内有关酒依赖和慢性酒中毒的流行学调查资料.中国心理卫生杂志,1987,1:251-256
12 成自强,张子饮,张中兴,等.河南省酒精依赖流行学调查.中国心理卫生杂志,1992,6:120
13 亢明,陆滨,谢健,等.名酒产地江苏淮阴市酒精依赖及有关问题流行学调查.中国心理卫生杂志,1992,6:118-119
14 HaoWei.Women and substance use in China. Country Reports.WHO PSA 93.13
15 郝伟,杨德森,何鸣.我国饮酒现状、预测及对策.中国临床心理学杂志,1995,3:243-248
16 邵春红,江开达,徐一峰.物质成瘾中渴求的神经生物学机制研究进展.中华精神科杂志,2003,36:190-192
17 Drummond DC. Theories of drug craving,ancient and modern.Addiction, 2001,96:33-46
18 Wikler A. Recent progress in research on the neurophysiologic basis of morphine addiction. Am J Psychiatry,1948,105:329-338
19 Robinson TE, Berridge KC. The neural basis of drug craving:an incentive-sensitization theory of addiction. Brain Research Reviews,1993,18:247-291
20 RobinsonTE,BerridgeKC.Mechanisms of action of addictive stimuli.Incentive sensitization and addiction. Addiction,2001,96:103-114
21 Franken IH, Kroon LY, W iers RW, et al. Selective cognitive processing of drug cues in heroin dependence. Psychophar -macology,2000,14:395-400
22 George MS,Anton RF,B loomer C,et al.Activation of prefrontal cortex and anterior thalamus in alcoholic subjects on exposure to alcohol2specific cues. Arch Gen Psychiatry,2001,58:345-352
23 Schneider F , Habel U , Wagner M , et al.Subcortisal correlates of craving in recently abstinent alcoholic patients. Am J Psychiatry,2001,158: 1075-1083
24 张镜如,乔健天. 生理学. 第四版. 北京: 人民卫生出版社,1995. 403-404
25 陆林,黄明生,李保明.糖皮质激素在奖赏行为中的作用机制研究进展.中国药物依赖性杂志,1999,8(4):245-249
1 FEINSTEIN C , ELIEZ S , BLASEY C , et al. Psychiatric disorders and behavioral problems in children with velocardiofacial syndrome :usefulness as phenotypic indicators of schizophrenia risk [J].Biol Psychiatry ,2002 ,51 (4) :312 - 318
2 WINOKUR A , DEMARTINIS N A , MCNALL YD P ,et al. Comparative effects of mirtazapine and fluoxetine on sleep physiology measures in patients with major depression and insomnia[J ] . J Clin Psychiatry ,2003 ,64 (10) :1 224-1 229
3 Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990;264:2511-8
4 Bruns L , TeessonM : Alcohol use disorders co morbid with anxiety, depression and drug use disorders. Drug Alcohol Depend. 2002; 68 (3) : 299-307
5 Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51: 8-19
6 Winokur G. Alcoholism in bipolar disorder. In: Goldberg JF, Harrow M, eds. Bipolar disorders: Clinical course and outcome. Washington, DC: American Psychiatric Press; 1999:185-98
7 Frye M, Altshuler LL, Denicoff KD, et al. Gender differences in bipolar disorder alcohol abuse comorbidity. Acta Neuropsychiatrica 2000;12:159
8 SchuckitMA.TippJE.BucholzKK. etal. The lifetime rates of three major mood disorders and four major anxiety disorders in alcoholics and controls.Addiction1997,92(10):1289
9 Tohen M, Zarate CA Jr. Bipolar disorder and comorbid substance abuse. In: Goldberg JF, Harrow M, eds. Bipolar disorders: Clinical course and outcome. Washington, DC: American Psychiatric Press;1999:171-84
10 Keck PE Jr, McElroy SL, Strakowski SM, et al. Outcome and comorbidity in first- compared with multiple-episode mania. J Nerv Ment Dis 1995;183:320-4
11 Strakowski SM, Sax KW, McElroy SL, et al. The effects of antecedent substance abuse on the development of first-episode psychotic mania. J Psychiatr Res 1996;30:59-68
12 BradyKT. Sonne. The relationship between substance abuse and bipolar disorder. Jclin psychiatry1995,56(suppl.3):19
13 Bebbington P . Rammana R . The epidemiology of bipolar affective disorder Soc psychiatry psyciatry Epidemid, 1995,30:279
14 WinkourG. CoryellW. AksikalHS. EndicottJ. kellerM. MuellerT. Manic-depressive(bipolar) disorder : the course in light of a prospective ten year follow up of 131 patients . Actapsychiatr Scand1994,89:102
15 SchuckitMA .TippJE .BucholzKK .etal. The lifetime rates of three major mood disorders and four major anxiety disorders in alcoholics and controls.Addiction1997,92(10):1289
16 Brady KT . Sonne. The relationship between substance abuse and bipolar disorder. Jclinpsychiatry 1995,56 (suppl.3):19
17 BebbingtonP .Rammana R. The epidemiology of bipolar affective disorder Soc psychiatry psyciatr Epidemid, 1995,30:279
18 WinkourG.CoryellW.AksikalHS.EndicottJ.kellerM.MuellerT.Manic-depressive(bipolar)disorder:the course in light of a prospective ten-year follow up of 131 patients. Act a psychiatr Scand1994,89:102
19 Lejoyeux M , Ades J . Evaluation of lithium treatment in alcoholism. Alcohol Alcoholism ,1993 ,28 (3):273
20 Johnson BA.Roleof the serotonergic system in the neurobiology of alcoholism:implications for treatment[J]. CNS Drugs,2004,18(15):1105-1118
21 Finley PR.Selective serotonin reuptake in hibitors: pharmacologic profiles and potential the rapeutic distinctions [Review] [J].Annalsof Pharmacotherapy,1994, 28(12):1359-1369
22 CorneliusJR. Salloum IM.Ehler JG .etc. Fluoxetine in depressed alcoholics [J].Arch Gene Psychiatry,1997,54(8): 700-705
23 Lhuintre J P , Moore N , Tran G, et al . Acamprosate appearsto decrease alcohol intake in weaned alcoholics. Alcohol Alcoholism ,1990 ,25:613
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