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解離劑

維基百科,自由的百科全書

解離劑(英語:Dissociative)是致幻劑的亞類之一,能扭曲視覺和聽覺感知,並能產生脫離環境與自我的解離效果。雖然許多種類藥物都能產生解離,但解離劑的獨特之處,在於其產生解離效果的方式,而其中可能包括解離、感官體驗淡漠、幻覺、夢境與麻醉。[1]

雖說大多數解離劑的主要作用機制與NMDA受體的拮抗作用有關,但解離劑中的一些物質,也會非選擇性的作用影響於多巴胺[2] 或阿片[3]系統,因而可能會產生更直接與可重複的興奮感與症狀,此類典型的「硬性毒品」,或常見濫用藥物的效果更為相似。這或許為解離性藥物被認為有一定成癮性之因,並且使其與迷幻藥形成區別。儘管某些解離性藥物,如苯環己哌啶具有刺激性,但多數解離藥,具有抑制作用,可產生鎮靜、呼吸抑制、噁心、迷失方向、鎮痛、麻醉、共濟失調、認知和記憶障礙以及失憶等的症狀。

效果

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解離劑的作用包括感覺解離、幻覺、躁狂、催眠、鎮痛與失憶。[4][5][6]據彭德(Pender,1972)所說「因為病人似乎真的與周遭環境分離了,因而這種(解離的)狀態被稱為解離性麻醉。」[7]彭德(Pender,1970)和約翰斯頓(Johnstone,1959)等人都曾報告,使用氯胺酮苯環己哌啶麻醉的患者,在麻醉期間與麻醉後容易出現無目的的運動和幻覺(或「夢」),一些患者認為幻覺令人興奮,而另一些患者對幻覺表示不安。[8]在亞麻醉劑量下,解離劑與其他致幻劑(如麥司卡林LSD賽洛西賓)類似,會改變許多相同的認知和感知過程,因此,這兩類經常被用作對比,前者亦被認為具有致幻性。[9][10][11]解離劑與傳統迷幻藥物(如LSD麥司卡林),在主觀體驗上最大區別或許在於解離效應,包括:人格解體,即感到自我一部分或全部不真實、與自我脫節或無法控制自己的行為;去人格化,即感覺外部世界不真實或認為自我處於夢境。[12]

用途

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醫用

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在醫院等醫療環境中,氯胺酮等許多解離劑,被用作手術或止痛的麻醉劑。不過,由於可能產生致幻作用,因此僅有迫不得已時使用。[13][14]某些嗎啡喃解離劑,如右美沙芬,也被以亞精神活性劑量用於抑制咳嗽。[15]

作為一種可能的速效抗抑鬱劑的氯胺酮,目前也正在接受研究,並顯示出良好的效果。[16][17]它還可作為C-PTSD慢性疼痛的可能的緩和治療方法之一。[18][19]

娛樂用途

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一些解離藥物被用於娛樂。如,氯胺酮氧化亞氮俱樂部毒品英語Club drug苯環己哌啶(俗稱天使塵)是街頭毒品的一種。右美沙芬止咳糖漿也具有解離作用,一些使用者過量使用,以用於娛樂[20]氯仿二乙醚歷來也都被用於娛樂。

擴展閱讀

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參考文獻

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  1. ^ Snyder, Solomon H. Phencyclidine. Nature. 1980, 285 (5764): 355–6. Bibcode:1980Natur.285..355S. PMID 7189825. doi:10.1038/285355a0. 
  2. ^ Giannini, AJ; Eighan, MS; Loiselle, RH; Giannini, MC. Comparison of haloperidol and chlorpromazine in the treatment of phencyclidine psychosis. Journal of Clinical Pharmacology. 1984, 24 (4): 202–4. PMID 6725621. S2CID 42278510. doi:10.1002/j.1552-4604.1984.tb01831.x. 
  3. ^ Giannini, A. James; Nageotte, Catherine; Loiselle, Robert H.; Malone, Donald A.; Price, William A. Comparison of Chlorpromazine, Haloperidol and Pimozide in the Treatment of Phencyclidine Psychosis: Da-2 Receptor Specificity. Clinical Toxicology. 1984, 22 (6): 573–9. PMID 6535849. doi:10.3109/15563658408992586. 
  4. ^ Pender, John W. Dissociative Anesthesia. California Medicine. 1970, 113 (5): 73. PMC 1501800可免費查閱. PMID 18730444. 
  5. ^ Johnstone, M.; Evans, V.; Baigel, S. Sernyl (C1-395) in Clinical Anaesthesia. British Journal of Anaesthesia. 1959, 31 (10): 433–9. PMID 14407580. doi:10.1093/bja/31.10.433可免費查閱. 
  6. ^ Oduntan, S. A.; Gool, R. Y. Clinical trial of ketamine (ci-581): A preliminary report. Canadian Anaesthetists' Society Journal. 1970, 17 (4): 411–6. PMID 5429682. doi:10.1007/BF03004705可免費查閱. 
  7. ^ Pender, John W. Dissociative Anesthesia. California Medicine. October 1972, 117 (4): 46–7. PMC 1518731可免費查閱. PMID 18730832. 
  8. ^ Virtue, RW; Alanis, JM; Mori, M; Lafargue, RT; Vogel, JH; Metcalf, DR. An anaesthetic agent: 2-orthochlorophenyl, 2-methylamino cyclohexanone HCl (CI-581).. Anesthesiology. 1967, 28 (5): 823–33. PMID 6035012. S2CID 34414786. doi:10.1097/00000542-196709000-00008. 
  9. ^ Mason, Oliver J.; Morgan, Celia J.M.; Stefanovic, Ana; Curran, H Valerie. The Psychotomimetic States Inventory (PSI): Measuring psychotic-type experiences from ketamine and cannabis. Schizophrenia Research. 2008, 103 (1–3): 138–42. PMID 18387788. S2CID 807162. doi:10.1016/j.schres.2008.02.020. 
  10. ^ Gouzoulis-Mayfrank, E.; Heekeren, K.; Neukirch, A.; Stoll, M.; Stock, C.; Obradovic, M.; Kovar, K.-A. Psychological Effects of (S)-Ketamine and N,N-Dimethyltryptamine (DMT): A Double-Blind, Cross-Over Study in Healthy Volunteers. Pharmacopsychiatry. 2005, 38 (6): 301–11. PMID 16342002. doi:10.1055/s-2005-916185. 
  11. ^ Krupitsky, EM; Grinenko, AY. Ketamine psychedelic therapy (KPT): a review of the results of ten years of research.. Journal of Psychoactive Drugs. 1997, 29 (2): 165–83 [2010-10-25]. PMID 9250944. doi:10.1080/02791072.1997.10400185. (原始內容存檔於2010-08-19). 
  12. ^ Vollenweider, F; Geyer, MA. A systems model of altered consciousness: integrating natural and drug-induced psychoses. Brain Research Bulletin. 2001, 56 (5): 495–507. PMID 11750795. S2CID 230298. doi:10.1016/S0361-9230(01)00646-3. 
  13. ^ Adams HA. [S-(+)-ketamine. Circulatory interactions during total intravenous anesthesia and analgesia-sedation] [S-(+)-ketamine. Circulatory interactions during total intravenous anesthesia and analgesia-sedation]. Der Anaesthesist. December 1997, 46 (12): 1081–7. PMID 9451493. doi:10.1007/s001010050510 (德語). 
  14. ^ Barrett W, Buxhoeveden M, Dhillon S. Ketamine: a versatile tool for anesthesia and analgesia. Current Opinion in Anesthesiology. October 2020, 33 (5): 633–638. PMID 32826629. S2CID 221236545. doi:10.1097/ACO.0000000000000916. 
  15. ^ Rossi, S (編). Australian Medicines Handbook. Adelaide: The Australian Medicines Handbook Unit Trust. 2013. ISBN 978-0-9805790-9-3. [頁碼請求]
  16. ^ Sanacora G, Frye MA, McDonald W, Mathew SJ, Turner MS, Schatzberg AF, et al. A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders. JAMA Psychiatry. April 2017, 74 (4): 399–405. PMID 28249076. S2CID 28320520. doi:10.1001/jamapsychiatry.2017.0080. 
  17. ^ Marcantoni WS, Akoumba BS, Wassef M, Mayrand J, Lai H, Richard-Devantoy S, Beauchamp S. A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 - January 2019. J Affect Disord. December 2020, 277: 831–841. PMID 33065824. S2CID 223557698. doi:10.1016/j.jad.2020.09.007. 
  18. ^ Feder, Adriana; Rutter, Sarah B.; Schiller, Daniela; Charney, Dennis S. Chapter Nine - The emergence of ketamine as a novel treatment for posttraumatic stress disorder. Duman, Ronald S. (編). Advances in Pharmacology. Rapid Acting Antidepressants 89. Academic Press. 2020-01-01: 261–286. 
  19. ^ lucca-jaeckel. MIND Blog | Ketamine in Contextual Trauma Therapy: The Paradox of Dissociation. MIND Foundation. 2021-03-12 [2023-08-17]. (原始內容存檔於2023-08-17) (美國英語). 
  20. ^ Dextromethorphan (DXM) | CESAR. web.archive.org. 2018-01-06 [2023-08-08]. (原始內容存檔於2018-01-06).