编辑“精神藥理學”

{{Psychology}}
{{Portal|心理学}}
'''心理藥物學（[[英文]]：Psychopharmacology''' ）是指以科學方法研究預備、使用心理疾病藥物及這些藥物的效用。心理疾病相關藥物稱為psychotropic medications（'''psycho'''：心理的；'''tropic：'''作用於）。

== 主要概念<ref>{{Cite book|edition=15th ed|chapter=|url=https://www.worldcat.org/oclc/808107397|publisher=McGraw-Hill|date=2013|location=New York, NY|isbn=9780073529745|oclc=808107397|first=Hart, Carl|last=L.|title=Drugs, society & human behavior|year=|pages=}}</ref> ==

=== 基本概念 ===

*[[心物問題]]
*[[突触|突觸]]與[[动作电位|動作電位]]
*[[离子通道|離子通道]]<ref>{{Cite book|chapter=|url=http://worldcat.org/oclc/918899790|isbn=9780071390118|oclc=918899790|first=Kandel, Eric R. Mack, Sarah, art|last=editor.|title=Principles of neural science|publisher=|year=|location=|pages=|access-date=2019-03-21|archive-date=2021-03-23|archive-url=https://web.archive.org/web/20210323004245/https://www.worldcat.org/title/principles-of-neural-science/oclc/918899790}}</ref> 
**[[鈉離子通道]]打開會{{Tsl|en|Excitatory postsynaptic potential|刺激性後突觸勢能}}（EPSP）；[[鉀離子通道]]或{{Tsl|en|Chloride channel|氯離子通道}}打開會{{Tsl|en|Inhibitory postsynaptic potential|壓抑性後突觸勢能}}（IPSP）
**[[代谢型受体|代謝型受體]]比起 ionotropic receptor較慢但影響較廣<ref>{{Cite journal|title=The neurobiology of slow synaptic transmission|url=https://www.ncbi.nlm.nih.gov/pubmed/11691979|last=Greengard|first=P.|date=2001-11-02|journal=Science (New York, N.Y.)|issue=5544|doi=10.1126/science.294.5544.1024|volume=294|pages=1024–1030|issn=0036-8075|pmid=11691979|access-date=2019-03-21|archive-date=2019-03-22|archive-url=https://web.archive.org/web/20190322062418/https://www.ncbi.nlm.nih.gov/pubmed/11691979|dead-url=no}}</ref>
**[[血腦屏障]]，藥物因此屏障較難直接送入腦中。腦內以下這些地方沒有此屏障：
***{{Tsl|en|area postrema|腦極後區}}（area postrema），酒精可滲入此區來觸發嘔吐
***{{Tsl|en|median eminence of the hypothalamus|正中隆突}}（median eminence of the hypothalamus），用來改變身體[[激素|'''荷爾蒙''']]
**[[胎盤]]，嬰兒透過胎盤吸收母體[[乙醇|酒精]]，導致嬰兒[[畸形学|畸型]]<ref>{{Cite web|title=Disease of the Week - Alcohol and Pregnancy|url=http://www.cdc.gov/dotw/fasd/index.html|work=Centers for Disease Control and Prevention|date=2017-09-06|accessdate=2019-03-21|language=en-us|last=CDC|archive-date=2019-03-21|archive-url=https://web.archive.org/web/20190321132250/https://www.cdc.gov/dotw/fasd/index.html|dead-url=no}}</ref>。
*[[耐药性|耐藥性]]
*{{Tsl|en|compliance|服從醫生指示}}

{| class="wikitable"
|+常見不跟從服藥指示原因<ref>{{Cite book|chapter=4|title=Principles of Psychopharmacology for Mental Health Professionals|url=http://dx.doi.org/10.1002/0471794635.ch2|publisher=John Wiley & Sons, Inc.|date=2005-10-07|location=Hoboken, NJ, USA|isbn=9780471794639|pages=9–35|last=|first=|year=}}</ref>
|
*以為很快見效，但抗抑鬱藥要至少2星期才見效
*麻煩、工作上不便，或影響生計
*服藥等於軟弱
*以為會根治，但有的藥物只是爭取時間來讓病患有更多精力去處理問題
*享受藥物的舒緩效果，如服用巴比妥類後會很快就不緊張
*享受受人關注，病了有人去關心自己而[[孟喬森症候群|繼續去病]]（{{Tsl|en|Primary and secondary gain|附加的好處}}）
|}

*[[成瘾|成癮]]與[[物質濫用|濫藥]]
*心理治療方案<ref>{{Cite web|title=保安局禁毒處 - 戒毒治療和康復服務戒毒治療和康復服務|url=https://www.nd.gov.hk/tc/treatment.htm|work=www.nd.gov.hk|accessdate=2019-03-21|archive-date=2018-11-18|archive-url=https://web.archive.org/web/20181118055307/https://www.nd.gov.hk/tc/treatment.htm|dead-url=no}}</ref>
**{{Tsl|en|Motivational enhancement therapy|動機增益治療法}} （MET），階段性管理戒毒過程
**{{Tsl|en|Contingency management|後果管理}} （CM），例如獎勵病患提供無藥尿液樣本
**[[认知行为疗法|認知行為療法]] （CBT），讓病患認知問題及學習管理預防{{Tsl|en|Relapse|復發}}
**[[藥品|藥物治療]]

=== [[药物代谢动力学|藥物代謝動力學]]<ref name=":0">{{Cite book|edition=Second edition|chapter=2,3|url=https://www.worldcat.org/oclc/819641635|location=Sunderland, Massachusetts|isbn=087893510X|oclc=819641635|first=Meyer, Jerrold S.,|last=1947-|first2=Rice, Susan|last2=A.,|first3=Yates, Jennifer|last3=R.,|title=Psychopharmacology : drugs, the brain, and behavior|publisher=|year=|pages=}}</ref>===

*[[生物利用度]] ：（bioavailability）真正身體最終吸收了所用的藥
*[[给药途径|給藥途徑]]：決定藥物進入血管的速度及完整度
**[[首过效应|首過效應]]
*[[电离|電離]] (ionisation)：非游離形式的藥物因不帶[[電荷]]而易滲入[[膜|細胞膜]]<ref>{{Citation|title=Fluid Mosaic Model of the Cell Membrane|url=https://www.youtube.com/watch?v=LKN5sq5dtW4|date=2009-07-19|accessdate=2019-03-21|last=Wesley McCammon|archive-date=2020-02-24|archive-url=https://web.archive.org/web/20200224075358/https://www.youtube.com/watch?v=LKN5sq5dtW4&gl=US&hl=en|dead-url=no}}</ref>，受住血管或消化系統等體內[[pH值]]，及藥物自己的[[酸度系数|酸度係數]]（pKa值）影響<ref>{{Cite journal|title=Longer and safer gastric residence|url=http://dx.doi.org/10.1038/nmat4432|last=Khutoryanskiy|first=Vitaliy V.|date=2015-10|journal=Nature Materials|issue=10|doi=10.1038/nmat4432|volume=14|pages=963–964|issn=1476-1122}}</ref>
*[[血浆蛋白结合|血漿蛋白結合]] （binding）：藥物困住在血漿、肌肉或脂肪中而變動不活躍，令到藥物在目標位置濃度降低而效用減少。或者多種藥物同時服用時，藥物甲導致藥物乙濃度太高而[[藥物過量]]。
*[[生物轉化作用]]
**[[药物代谢|藥物代謝]]
*** 階段一/階段二：只是一個名稱，不一定代表代謝次序<ref>{{Cite web|title=Carbon Oxidation|url=https://learn.genetics.utah.edu/content/metabolism/carbon/|work=learn.genetics.utah.edu|accessdate=2019-03-21|archive-date=2019-03-21|archive-url=https://web.archive.org/web/20190321132249/https://learn.genetics.utah.edu/content/metabolism/carbon/|dead-url=no}}</ref>。
*** 常見肝酶：[[细胞色素P450|細胞色素P450]]，在[[内质网|光滑內質網]]（ sER）<ref>{{Citation|title=Biology: Cell Structure I Nucleus Medical Media|url=https://www.youtube.com/watch?v=URUJD5NEXC8|date=2015-03-18|accessdate=2019-03-21|last=Nucleus Medical Media|archive-date=2019-06-02|archive-url=https://web.archive.org/web/20190602210744/https://www.youtube.com/watch?v=URUJD5NEXC8|dead-url=no}}</ref>
*[[速率方程]]：例如酒精是zero-order kinetics，即不論飲用多少酒，身體每個小時只能處理最多15毫升的酒精<ref>{{Cite web|title=What Is A Standard Drink? {{!}} National Institute on Alcohol Abuse and Alcoholism (NIAAA)|url=https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink|work=www.niaaa.nih.gov|accessdate=2019-03-19|archive-date=2019-03-26|archive-url=https://web.archive.org/web/20190326181758/https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink|dead-url=no}}</ref>。對應first-order kinetics，藥物濃度越高則消化速度越快。
*[[排泄作用]]，透過不同方法將藥物離開身體，如[[母乳|製造母乳]]、[[呼吸]]、[[汗液|出汗]]、[[尿|排尿]]等。

=== [[药物效应动力学|藥物效應動力學]]<ref name=":0" />===

*{{Tsl|en|Drug nomenclature|藥物命名法}}
*[[受体 (生物化学)|受體]]與[[配體]]（就像鎖與匙<ref>{{Cite web|title=Sinauer Associates, Inc., Publishers|url=https://www.sinauer.com/|work=www.sinauer.com|accessdate=2019-03-19|archive-date=2019-03-20|archive-url=https://web.archive.org/web/20190320114254/https://www.sinauer.com/|dead-url=no}}</ref>）每種[[神经递质|神經遞質]]可以有多個[[受体 (生物化学)|受體]]（如[[多巴胺]]有超過5種[[受体 (生物化学)|受體]]<ref>{{Cite web|title=Purple Haze of Parkinson’s: How Dopamine Works|url=https://journeywithparkinsons.com/2015/08/05/purple-haze-of-parkinsons-how-dopamine-works/|work=Journey with Parkinson's|date=2015-08-05|accessdate=2019-03-19|language=en|archive-date=2019-09-29|archive-url=https://web.archive.org/web/20190929010704/https://journeywithparkinsons.com/2015/08/05/purple-haze-of-parkinsons-how-dopamine-works/|dead-url=no}}</ref>）

{| class="wikitable"
!
![[配體 (生物化學)#受體與配體間的結合親和性|親和性]] (Affinity）
![[效能 (药理学)|效能]]（Efficacy）
|-
|[[激动剂|活化劑]]（agonist）
|高
|高
|-
|[[受体拮抗剂|阻斷劑]]（antagonist）
|中至高 
|低
|}

*[[構象改變]]，當受體和配體結合就會令蛋白發生結構上改變，從而影響[[效能 (药理学)|效能]]
*{{Tsl|en|Downregulation and upregulation|調升與調降}}：指因為[[配體]]的數量影響（太多或太少），[[受体 (生物化学)|受體]]的數量或敏感程度改變<ref>{{Cite web|title=2. General Mechanisms of the Endocrine Regulation • Functions of Cells and Human Body|url=http://fblt.cz/en/skripta/xi-regulacni-mechanismy-1-endokrinni-regulace/2-obecne-principy-endokrinni-regulace/|accessdate=2019-03-21|language=en-US|archive-date=2019-03-21|archive-url=https://web.archive.org/web/20190321131038/http://fblt.cz/en/skripta/xi-regulacni-mechanismy-1-endokrinni-regulace/2-obecne-principy-endokrinni-regulace/|dead-url=no}}</ref><ref>{{Cite web|title=About Huntington's Disease and Serotonin|url=https://hopes.stanford.edu/about-huntingtons-disease-and-serotonin/|work=HOPES Huntington's Disease Information|date=2011-06-30|accessdate=2019-03-21|language=en-US|archive-date=2019-03-14|archive-url=https://web.archive.org/web/20190314161305/https://hopes.stanford.edu/about-huntingtons-disease-and-serotonin/|dead-url=no}}</ref>
*{{Tsl|en|Dose response curve|劑量反應曲線}}<ref>{{Citation|title=Agonist Dose Response Curves|url=https://www.youtube.com/watch?v=9WRy53g6sPE|date=2015-06-11|accessdate=2019-03-21|last=Pharmapedia|archive-date=2021-05-21|archive-url=https://web.archive.org/web/20210521052850/https://www.youtube.com/watch?v=9WRy53g6sPE}}</ref>：[[File:Potency_Figure16.png|缩略图|若要0.25單位反應, 藥B有更高的potent。但若要0.75單位反應藥A反而更potent。]]指不同劑量下的反應。低劑量亦可代表只有少量[[配體]]佔用了<ref>{{Cite web|title=basic_principles_of_pharm    [TUSOM {{!}} Pharmwiki]|url=http://tmedweb.tulane.edu/pharmwiki/doku.php/basic_principles_of_pharm|work=tmedweb.tulane.edu|accessdate=2019-03-21|language=en|archive-date=2019-03-21|archive-url=https://web.archive.org/web/20190321131040/http://tmedweb.tulane.edu/pharmwiki/doku.php/basic_principles_of_pharm|dead-url=no}}</ref>。
**<math>ED_{50}</math>指一半測試人口都都可以有特定有用藥物反應
**<math>TD_{50}</math>指一半測試人口都都可以有特定有害藥物反應
**[[治療指數]] 是 <math>TD_{50} / ED_{50}</math>，越大數量該藥物越安全<ref>{{Cite web|title=ToxTutor - Determining the Safety of a Drug|url=https://toxtutor.nlm.nih.gov/02-005.html|work=toxtutor.nlm.nih.gov|accessdate=2019-03-21|archive-date=2019-03-21|archive-url=https://web.archive.org/web/20190321131039/https://toxtutor.nlm.nih.gov/02-005.html|dead-url=no}}</ref>
**[[效价强度|效價強度]]<ref>{{Citation|title=Efficacy vs Potency|url=https://www.youtube.com/watch?v=t0OEm-cJs40|date=2015-06-15|accessdate=2019-03-19|last=Pharmapedia|archive-date=2022-02-25|archive-url=https://web.archive.org/web/20220225091010/https://www.youtube.com/watch?v=t0OEm-cJs40}}</ref>：指達到一定效果所需的劑量。如[[阿司匹林|阿士匹靈]]的[[效价强度|效價強度]]（potency）雖然較[[嗎啡]]、[[可待因]]等藥的[[效能 (药理学)|效能]]（Efficacy）低，但只需要增加劑量也可達到相同<math>ED_{50}</math>的止痛作用。

== 化學訊號 ==

=== [[神经递质|神經遞質]]<ref>{{Cite book|edition=12 e|chapter=|url=https://www.worldcat.org/oclc/898154491|location=Australia|isbn=9781305105409|oclc=898154491|first=Kalat, James|last=W,|title=Biological psychology|publisher=|year=|pages=49-57}}</ref>===


精神作用藥物通常用[[神经递质|神經遞質]]來影響{{Tsl|en|Neurotransmission|神經傳導}}。[[神经递质|神經遞質]]主要一種化學物質來讓[[神經元]]互相溝通，而精神作用藥物則影響這個溝通過程。這些藥物可以

# 作為[[神经递质|神經遞質]]的[[前体|前體]]（precursor）（作為製造[[神经递质|神經遞質]]的原材料）
# 壓抑[[神经递质|神經遞質]]的生成
# 避免[[突触小泡]]（presynaptic vesicle）儲存[[神经递质|神經遞質]]
# 刺激或抑制[[神经递质|神經遞質]]釋出
# 刺激或抑制後突觸（post-synaptic）的[[受体 (生物化学)|受體]]運作（Receptor）
# 刺激再攝取泵（autoreceptor），減少[[神经递质|神經遞質]]釋出
# 阻礙再攝取泵（autoreceptor），增加[[神经递质|神經遞質]]釋出
# 壓抑{{Tsl|en|Neurotransmission|神經傳導}} breakdown
# 阻礙前突觸（presynaptic）被{{Tsl|en|reuptake|再吸收}}（reuptake）

=== [[激素]] ===
{{TransH}}
The other central method through which drugs act is by affecting communications between cells through hormones. Neurotransmitters can usually only travel a microscopic distance before reaching their target at the other side of the synaptic cleft, while hormones can travel long distances before reaching target cells anywhere in the body. Thus, the endocrine system is a critical focus of psychopharmacology because 1) drugs can alter the secretion of many hormones; 2) hormones may alter the behavioral responses to drugs; 3) hormones themselves sometimes have psychoactive properties; and 4) the secretion of some hormones, especially those dependent on the pituitary gland, is controlled by neurotransmitter systems in the brain.
{{TransF}}

== 常見心理藥物 ==
{{Main|精神药物}}
== 相關期刊 ==

* ''[http://www.apa.org/journals/pha/ Experimental and Clinical Psychopharmacology] {{Wayback|url=http://www.apa.org/journals/pha/ |date=20130602002911 }}'', [[American Psychological Association]]
* ''[[Journal of Clinical Psychopharmacology]]'', Lippincott Williams & Wilkins
* ''[[Journal of Psychopharmacology]]'', British Association for Psychopharmacology, SAGE Publications
* ''[[Psychopharmacology (journal)|Psychopharmacology]]'', Springer Berlin/Heidelberg
* ''[[Neuropsychopharmacology]]'', Nature Publishing Group

== 參考來源 ==
<references responsive="" />{{心理学}}
[[Category:心理学| ]]
[[Category:生物心理学| ]]
[[Category:心理學分支]]
[[Category:神经心理学]]
[[Category:行为神经科学]]