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Disfunción dopaminérgica en el alcoholismo y la esquizofrenia: correlatos psicopatológicos y conductuales
Published online by Cambridge University Press: 12 May 2020
Resumen
Se ha implicado a la disfunción de la neurotransmisión dopaminérgica central en la patogénesis de la esquizofrenia y además en la dependencia de drogas y alcohol. Diferentes drogas estimulan la liberación de la dopamina en el estriado ventral y refuerzan así el consumo. El aumento de la liberación subcortical de dopamina se ha asociado también con la patogénesis de los síntomas positivos en la esquizofrenia y puede estar conducido por una disfunción dopaminérgica prefrontal. Estos hallazgos aparentemente heterogéneos se pueden explicar por investigaciones recientes en primates no humanos. Según estos estudios, la anticipación de la recompensa pero no el consumo anticipado de la recompensa se acompaña de una liberación fásica de dopamina en el estriado y la corteza prefrontal. En el estriado, la liberación fásica de dopamina afecta ante todo a la motivación, la activación psicomotriz y el anhelo de la recompensa, mientras que en la corteza prefrontal, la estimulación dopaminérgica está implicada en la activación de la memoria operativa y la anticipación de la recompensa. En el alcoholismo, estímulos anteriormente neutrales que se han asociado con la ingesta de alcohol se pueden convertir en claves condicionadas que activen la liberación fásica de dopamina y el anhelo de la recompensa. En la esquizofrenia, la activación inducida por estrés o caótica de la liberación de dopamina puede atribuir saliencia de incentivo a estímulos por lo demás irrelevantes y, así, estar implicada en la patogénesis del estado de ánimo delirante y otros síntomas positivos. Los estudios en humanos y primates no humanos ponen de relieve el papel de la neurotransmisión dopaminérgica en la anticipación de la recompensa y su disfunción en diferentes enfermedades neuropsiquiátricas.
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