酒精使用障碍的药物治疗医学

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1、酒精使用障碍的药物治疗进展MedicationforAlcoholUseDisorders交流提纲概述酒精使用障碍（alcoholusedisorder，AUD）酒精依赖酒精戒断反应酒精所致精神病酒精所致人格改变酒精所致智能障碍Theassociationbetweenalcoholuseandpsychosiswasdocumentedasearlyas1847byMarcel.Hewascreditedfordifferentiatingthedisorderfromdeliriumtremens(Johansson1961).Kraepel

2、in(1913)andotherauthorsalsoreportedadistinctpsychoticsyndromeassociatedwithalcoholismthatdifferedfromdeliriumtremens(alcoholwithdrawalwithdelirium),Wernicke’sencephalopathy,Korsakoff’spsychosisandalcohol-induceddementia(Glass1989a).Psychoticmanifestationsmayalsooccurinotherge

3、neralmedicalorneurologicaldisordersassociatedwithalcoholdependence(GreenbergandLee2001).Earlydescriptionsofadistinctpsychoticsyndromeassociatedwithexcessivealcoholusewerebasedoncase-studiesandclinicalobservation.Bleuler(1916)termedtheconditionalcoholichallucinosis.Follow-upst

4、udiesonpatientgroupsappearedfromaroundthe1950’sanddescribedthefeaturesofwhatiscurrentlyknownas:Alcohol-inducedPsychoticDisorder(AIPD)(APA,DSM-IV-TR2000;DSM-5,2013),orPsychoticDisorderduetotheuseofAlcohol(WHOICD-101993).EssentiallytheDSMcriteriarequire:(A)thepresenceofprominen

5、thallucinationsordelusions,(B)evidencefromthehistory,physicalexaminationorlaboratoryfindingsthatthesymptomsdevelopedwithinorduringamonthofalcoholintoxicationorwithdrawal.Thesymptomsare(C)notbetteraccountedforbyapsychoticdisorderthatisnotsubstance-induced(e.g.symptomsprecedesu

6、bstanceuse)and(D)donotexclusivelyoccurduringthecourseofadelirium.DSM5stipulatesthattheperiodofonsetshouldbe“duringorsoon”afterintoxicationorwithdrawalofalcoholandthatthedisturbanceshouldcauseclinicalsignificantdistressorimpairment.Initialstudiesongroupsofpatientsdidnotcompare

7、patientswithotherdiagnosticgroups(Benedetti1952;Burton-Bradley1958;VictorandHope1958).Conclusionswerebasedonclinicalobservationsandfollow-upstudiesovervariableperiodsoftime.Fromthe1960’sstudiesadoptedamoresystematicresearchapproach(Glass1989a).EpidemiologyWhereasthelifetimeri

8、skforalcoholdependenceis10–15%(males)and3–5%(females)(Schuckit2005),