解离剂(英语:Dissociative)是致幻剂的亚类之一,能扭曲视觉和听觉感知,并能产生脱离环境与自我的解离效果。虽然许多种类药物都能产生解离,但解离剂的独特之处,在于其产生解离效果的方式,而其中可能包括解离、感官体验淡漠、幻觉、梦境与麻醉。[1]

虽说大多数解离剂的主要作用机制与NMDA受体的拮抗作用有关,但解离剂中的一些物质,也会非选择性的作用影响于多巴胺[2] 或阿片[3]系统,因而可能会产生更直接与可重复的兴奋感与症状,此类典型的“硬性毒品”,或常见滥用药物的效果更为相似。这或许为解离性药物被认为有一定成瘾性之因,并且使其与迷幻药形成区别。尽管某些解离性药物,如苯环己哌啶具有刺激性,但多数解离药,具有抑制作用,可产生镇静、呼吸抑制、恶心、迷失方向、镇痛、麻醉、共济失调、认知和记忆障碍以及失忆等的症状。

效果

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解离剂的作用包括感觉解离、幻觉、躁狂、催眠、镇痛与失忆。[4][5][6]据彭德(Pender,1972)所说“因为病人似乎真的与周遭环境分离了,因而这种(解离的)状态被称为解离性麻醉。”[7]彭德(Pender,1970)和约翰斯顿(Johnstone,1959)等人都曾报告,使用氯胺酮苯环己哌啶麻醉的患者,在麻醉期间与麻醉后容易出现无目的的运动和幻觉(或“梦”),一些患者认为幻觉令人兴奋,而另一些患者对幻觉表示不安。[8]在亚麻醉剂量下,解离剂与其他致幻剂(如麦司卡林LSD赛洛西宾)类似,会改变许多相同的认知和感知过程,因此,这两类经常被用作对比,前者亦被认为具有致幻性。[9][10][11]解离剂与传统迷幻药物(如LSD麦司卡林),在主观体验上最大区别或许在于解离效应,包括:人格解体,即感到自我一部分或全部不真实、与自我脱节或无法控制自己的行为;去人格化,即感觉外部世界不真实或认为自我处于梦境。[12]

用途

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医用

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在医院等医疗环境中,氯胺酮等许多解离剂,被用作手术或止痛的麻醉剂。不过,由于可能产生致幻作用,因此仅有迫不得已时使用。[13][14]某些吗啡喃解离剂,如右美沙芬,也被以亚精神活性剂量用于抑制咳嗽。[15]

作为一种可能的速效抗抑郁剂的氯胺酮,目前也正在接受研究,并显示出良好的效果。[16][17]它还可作为C-PTSD慢性疼痛的可能的缓和治疗方法之一。[18][19]

娱乐用途

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一些解离药物被用于娱乐。如,氯胺酮氧化亚氮俱乐部毒品英语Club drug苯环己哌啶(俗称天使尘)是街头毒品的一种。右美沙芬止咳糖浆也具有解离作用,一些使用者过量使用,以用于娱乐[20]氯仿二乙醚历来也都被用于娱乐。

扩展阅读

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参考文献

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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 . 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 . 
  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 . 
  7. ^ Pender, John W. Dissociative Anesthesia. California Medicine. October 1972, 117 (4): 46–7. PMC 1518731 . 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. (原始内容存档于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 (德语). 
  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 (编). Australian Medicines Handbook. Adelaide: The Australian Medicines Handbook Unit Trust. 2013. ISBN 978-0-9805790-9-3. [页码请求]
  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. (编). 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]. (原始内容存档于2023-08-17) (美国英语). 
  20. ^ Dextromethorphan (DXM) | CESAR. web.archive.org. 2018-01-06 [2023-08-08]. (原始内容存档于2018-01-06).