Medikamentöse Behandlung von psychiatrischen Störungen bei Alkoholabhängigen

Zusammenfassung

Epidemiologische Studien zeigen, dass bei Alkoholabhängigen eine hohe Lebenszeitprävalenz für psychiatrische Störungen, insbesondere für Angst-, phobische, depressive und schizophrene Störungen besteht. Aufgrund der komplexen Zusammenhänge von erhöhtem Alkoholkonsum und psychischem Befinden kommt es häufig zu diagnostischen Problemen und Schwierigkeiten bei der Therapieplanung, insbesondere der Indikation zu einer medikamentösen Therapie. In dieser Übersicht werden die Ergebnisse der Studien über eine medikamentöse Behandlung von psychiatrischen Störungen bei Alkoholkranken referiert und anhand dieser Daten Indikationen für eine medikamentöse Therapie erarbeitet. Nur in wenigen Studien konnte auch ein Effekt auf das Trinkverhalten nachgewiesen werden. Zusammenfassend muss festgestellt werden, dass die medikamentösen Behandlungsmöglichkeiten für Alkoholkranke mit einer psychiatrischen Störung bisher nur unzureichend untersucht worden sind. Insbesondere fehlen Studien über die Behandlungsmöglichkeiten von Schizophrenen mit Alkoholproblemen.

Medical Treatment of Psychiatric Comorbidity in Alcoholics

Purpose: Epidemiological studies show that alcoholics have a high life-time prevalence of psychiatric illnesses, particularly of anxiety, depressive and schizophrenic disorders. But the complex relationships between elevated alcohol consumption and psychiatric symptomatology frequently Iead to problems in finding diagnosis and thereafter in planning therapeutic strategies. Methods: In this article the results of the studies concerning the medical treatment of psychiatric comorbidity of alcoholics are critically reviewed. Results: According to the available results a therapy with antidepressive drugs indicated in alcoholics with depression lasting over 14 days. Anxiety disorders seem to have little influence on the course of alcoholism. Thus, an anxiolytic medication has to be considered carefully in view of the addiction potency of tranquilizers. There is a paucity of data concerning drug treatment of schizophrenics with alcohol abuse. Thus far only a few studies have shown an effect of a drug treatment of the psychiatric comorbidity on the drinking behavior. Conclusion: There is a lack of studies on specific treatment strategies of psychiatric comorbid alcoholics, particularly of schizophrenics with alcohol abuse.

Literatur

• 1 Kessler R C, Crum R M, Warner L A, Nelson C B, Schulenberg J, Anthony J C. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey.  Arch Gen Psychiatry. 1997;  54 313-321
• 2 Regier D A, Farmer M E, Rae D S, Locke B Z, Keith S J, Judd L L, Goodwin F K. Comorbidity of mental disorders with alcohol and other drug abuse.  JAMA. 1990;  264 2511-2518
• 3 Weiss R D, Mirin S M, Griffin M L. Methodological considerations in the diagnosis of coexistence psychiatric disorders in substance abusers.  Br J Addict. 1992;  87 179-187
• 4 Keeler M H, Taylor I, Miller M C. Are all recently detoxified alcoholics depressed.  Am J Psychiatry. 1979;  136 586-588
• 5 Brown S A, Irwin M, Schuckit M A. Changes in anxiety among abstinent male alcoholics.  J Stud Alcohol. 1991;  52 55-61
• 6 Brown S A, lnaba R K, Gillin J C, Schuckit M A, Stewart M A, Irwin M R. Alcoholism and affective disorder: clinical course of depressive symptoms.  Am J Psychiatry. 1995;  152 45-52
• 7 Dackis C A, Gold M S, Pottash A LC, Sweeney D R. Evaluating depression in alcoholics.  Psychiatric Res. 1986;  17 105-109
• 8 Dorus W, Kennedy J, Gibbons R D, Ravi S D. Symptoms and diagnosis of depression in alcoholics.  Alcohol Clin Exp Res. 1987;  11 150-154
• 9 West A P, Gocka E F. Self-ratings of typical mood and behavior during recovery from alcohol abuse. A multivariate study of alcoholic men.  Psychopathology. 1986;  19 303-308
• 10 Helzer J E, Pryzbeck T R. The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment.  J Stud Alcohol. 1988;  49 219-224
• 11 McLellan A T, Luborsky L, Woody G E, O'Brien C P, Druley K A. Predicting response to alcohol and drug abuse treatments. Role of psychiatric severity.  Arch Gen Psychiatry. 1983;  40 620-625
• 12 Powell B J, Penick E C, Liskow B I, Riesenmy K D, Campion S L, Brown E F. Outcomes of co-morbid alcoholic men: A 1-year follow-up.  Alcohol Clin Exp Res. 1992;  16 131-138
• 13 Rounsaville B J, Dolinsky Z S, Babor T F, Meyer R E. Psychopathology as a predictor of treatment outcome in alcoholics.  Arch Gen Psychiatry. 1987;  44 505-513
• 14 Alling C, Balldin J, Bökström K, Gottfries C G, Karlsson I, Langstrom G. Studies on duration of a late recovery period after chronic abuse of ethanol. A cross-sectional study of biochemical and psychiatric indicators.  Acta Psychiatr Scand. 1982;  66 384-397
• 15 Scholz H. Die Rehabilitation bei chronischem Alkoholismus. Stuttgart; Enke 1986
• 16 Dilling H, Mombour M, Schmidt M H. Internationale Klassifikation psychischer Störungen. ICD-10. 3. Aufl. Huber 2000
• 17 Saß H, Wittchen H-U, Zaudig M. (Hrsg) .Diagnostisches und statistisches Manual psychischer Störungen DSM-IV. Göttingen; Hogrefe 1996
• 18 Greenfield S F, Weiss R D, Muenz L R, Vagge L M, Kelly J F, BeIb L R, Michael J. The effect of depression on return to drinking: a prospective study.  Arch Gen Psychiatry. 1998;  55 259-265
• 19 Mason B J, Kocsis J H, Ritvo E C, Cutler R B. A double-blind, placebo-controlled trial of desipramine for primary alcohol dependence stratified on the presence or absence of major depression.  JAMA. 1996;  275 761-767
• 20 McGrath P J, Nunes E V, Stewart J W, Goldman D, Agosti V, Ocepek-Welikson K, Quitkin F M. Imipramine treatment of alcoholics with primary depression.  Arch Gen Psychiatry. 1996;  53 232-240
• 21 Wetterling T. Diagnostik und Behandlungsansätze depressiver Störungen bei Alkoholabhängigen.  Fortschr Neurol Psychiat. 1999;  67 131-141
• 22 Cornelius J R, Salbum I M, Ehler J G, Jarrett P J, Cornelius M D, Perel M J, Thase M E, Black A. Fluoxetine in depressed alcoholics. A double-blind, placebo-controlled trial.  Arch Gen Psychiatry. 1997;  54 700-705
• 23 Janiri L, Gobbi G, Mannelli P, Pozzi G, Serretti A, Tempesta E. Effects of fluoxetine at antidepressant doses on short-term outcome of detoxified alcoholics.  Int Clin Psychopharmacol. 1996;  11 109-117
• 24 Kranzler H R, Burleson J A, Korner P, Del Boca F K, Bohn M J, Brown J, Liebowitz N. Placebo-controlled trial of fluoxetine as an adjunct to relapse prevention.  Am J Psychiatry. 1995;  151 391-397
• 25 Nunes E V, McGrath P J, Quitkin F M, Stewart J P, Harrison W, Tricamo E, Ocepek-Welikson K. Imipramine treatment of alcoholism with comorbid depression.  Am J Psychiatry. 1993;  150 963-965
• 26 Powell B J, Campbell J L, Landon J F, Liskow B I, Thomas H M, Nickel E J, Dale T M, Penick E C, Samuelson S D, Lacoursiere R. A double-blind, placebo-controlled study of nortriptyline and bromocriptine in male alcoholics subtyped by comorbid psychiatric disorders.  Alcohol Clin Exp Res. 1995;  19 462-468
• 27 Gorelick D A, Paredes A. Effect of fluoxetine on alcohol comsumption in male alcoholics.  Alcohol Clin Exp Res. 1992;  16 261-265
• 28 Roy-Byrne P P, Pages K P, Russo J E, Jaffe C, Blume A W, Kingsley E, Cowley D S, Ries R K. Nefazodone treatment of major depression in alcohol-dependent patients: a double-blind, placebo-controlled trial.  J Clin Psychopharmacol. 2000;  20 129-136
• 29 Kranzler H R, Modesto-Lowe V, van Kirk J. Naltrexone vs. nefazodone for treatment of alcohol dependence. A placebo-controlled trial.  Neuropsychopharmacology. 2000;  22 493-503
• 30 Winokur G, Coreyll W, Akiskal H S, Maser J D, Keller M B, Endicott J, Mueller T. Alcoholism in manic-depressive (bipolar) illness. Familial illness, course of illness, and the primary-secondary distinction.  Am J Psychiatry. 1995;  152 365-372
• 31 Lejoyeux M, Ades J. Evaluation of lithium treatment in alcoholism.  Alcohol Alcohol. 1993;  28 273-279
• 32 Schuckit M A, Hesselbrock V. Alcohol dependency and anxiety disorders: what is the relationship?.  Am J Psychiatry. 1994;  151 1723-1734
• 33 LaBounty L P, Hatsukami D, Morgan S F, Nelson L. Relapse among alcoholics with phobic and panic symptoms.  Addict Behav. 1992;  17 9-15
• 34 Tomasson K, Vaglum P. The 2-year course following detoxification treatment of substance abuse: the possible influence of psychiatric comorbidity.  Eur Arch Psychiatry Clin Neurosci. 1997;  247 320-327
• 35 Ciraulo D A, Sands B F, Shader R I. Critical review of liability for benzodiazepine abuse among alcoholics.  Am J Psychiatry. 1988;  145 1501-1506
• 36 Addington J, Duchak V. Reasons for substance use in schizophrenia.  Acta Psychiat Scand. 1997;  96 329-333
• 37 Brunette M F, Mueser K T, Xie H, Drake R E. Relationships between symptoms of schizophrenia and substance abuse.  J Nerv Ment Dis. 1997;  185 13-20
• 38 Lambert M, Haasen C, Mass R, Krausz M. Konsummuster und Konsummotivation des Suchtmittelgebrauchs bei schizophrenen Patienten.  Psychiat Prax. 1997;  24 185-189
• 39 Pristach C A, Smith C M. Self-reported effects of alcohol use on symptoms of schizophrenia.  Psychiatric Serv. 1996;  47 421-423
• 40 Kozaric-Kovacic D, Folnegovic-Smalc V, Folnegovic Z, Maruic A. lnfluence of alcoholism on the prognosis of schizophrenic patients.  J Stud Alcohol. 1995;  56 622-627
• 41 Buckley P F. Substance abuse in schizophrenia: a review.  J Clin Psychiatry. 1998;  59, Suppl 3 26-30
• 42 Wilkins J N. Pharmacotherapy of schizophrenia patients with comorbid substance abuse.  Schizophrenia Bull. 1997;  23 215-228
• 43 Verheul R, Hartgers C, van den Brink W, Koeter M W. The effect of sampling, diagnostic criteria and assessment procedures on the observed prevalence of DSM-III-R personality disorders among treated alcoholics.  J Stud Alcohol. 1998;  59 227-236
• 44 Schuckit M A, Tipp J E, Anthenelli R M. et al . Anorexia nervosa and bulimia nervosa in alcohol-dependent men and women and their relatives.  Am J Psychiatry. 1996;  153 74-82
• 45 Sinha R, O'Malley S S. Alcohol and eating disorders: implications for alcohol treatment and health services research.  Alcohol Clin Exp Res. 2000;  24 1312-1319
• 46 Vitiello M V. Sleep, alcohol and alcohol abuse.  Addict Biol. 1997;  2 151-158
• 47 Drummond S P, Gillin J C, Smith T L, DeModena A. The sleep of abstinent pure primary alcoholic patients: natural course and relationship to relapse.  Alcohol Clin Exp Res. 1998;  22 1796-802
• 48 Pelissolo A, Lepine J P. Les traitements pharmacologiques des troubles de la personnalite. Aspects methodologiques et revue des resultats obtenus.  Encephale. 1999;  25 496-507
• 49 Krausz M, Watermann U. Behandlungsmöglichkeiten bei Doppeldiagnosen. In: Uchtenhagen A, Zieglgänsberger W (Hrsg) Suchtmedizin. München; Urban & Fischer 2000 5: 376-383
• 50 Veltrup C. Abstinenzgefährdung und Abstinenzbeendigung bei Alkoholabhängigen nach einer umfassenden stationären Entzugsbehandlung. Münster; Waxmann 1995
• 51 Schuckit M A, Tipp J E, Bucholz K K, Nurnberger J I, Hesselbrock V M, Crowe R R, Kramer J. The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls.  Addiction. 1997;  92 1289-1304
• 52 Humphreys K, Weisner C. Use of exclusion criteria in selecting research subjects and its effect on the generalizability of alcohol treatment outcome studies.  Am J Psychiatry. 2000;  157 588-594