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Fortschr Neurol Psychiatr 2010; 78(2): 81-89
DOI: 10.1055/s-0028-1109978
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Psychose und Sucht bei Jugendlichen und Jungerwachsenen
Teil 1: Prävalenz und Erklärungsmodelle

Dual Diagnosis Psychosis and Substance Use Disorders in Adolescents – Part 1K. Meister1 , M. Burlon1 , L. Rietschel1 , E. Gouzoulis-Mayfrank2 , T. Bock1 , M. Lambert1
  • 1Psychosen-Ersterkennungs- und Behandlungsprojekt (PEB), Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätskrankenhaus Hamburg-Eppendorf (Direktor: Prof. Dr. D. Naber)
  • 2LVR-Klinik Köln und Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln (Direktor: Prof. Dr. J. Klosterkötter)
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Publikationsverlauf

Publikationsdatum:
09. Februar 2010 (online)

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Zusammenfassung

Epidemiologische Studien bei schizophrenen Patienten zeigen ein Lebenszeitrisiko von 20 – 50 % für eine komorbide Suchtstörung. Bei Patienten mit einer ersten Episode liegt die Prävalenz für eine komorbide Suchterkrankung zwischen 25 – 75 %, vor allem Cannabisgebrauch. Diese schwierig zu behandelnde Patientengruppe hat meist einen schlechteren Verlauf als schizophrene Patienten, die keine komorbide Suchtstörung aufweisen. Trotz zahlreicher Erklärungsmodelle, wie der Selbstmedikationshypothese, allgemeinen oder bidirektionalen Faktorenmodellen oder genetischer Vulnerabilität, kann keines umfassend die hohe Suchtkomorbidität bei schizophrenen Patienten erklären, wobei dies wichtig wäre, um diese Gruppe besser behandeln zu können. Da die Gruppe der Doppeldiagnosepatienten sehr heterogen ist, ist es möglich, dass verschiedene Erklärungsmodelle die Komorbidität in verschiedenen Subgruppen erklären könnten. Der vorliegende erste Teil der Übersichtsarbeit „Doppeldiagnose Psychose und Sucht mit Schwerpunkt bei Jungerwachsenen” befasst sich mit der Prävalenz und Erklärungsmodellen. Der zweite Teil gibt dann eine Übersicht zu Verlauf und psychosozialen Behandlungsmöglichkeiten.

Abstract

Epidemiological studies suggest that 20 % to 50 % of patients with schizophrenia have a lifetime comorbid substance use disorder (SUD). In first-episode psychosis this prevalence is even higher and varies between 20 % and 75 % with cannabis being the most widely used illicit drug. These difficult to treat patients usually have a worse prognosis as compared with non-substance abusing schizophrenic patients. Despite multiple theories proposed such as the self medication hypothesis, common or bidirectional factor models or genetic vulnerability, there is no consensus on the aetiology of increased rates of substance use in people with psychosis which is important to treat these patients. The dually diagnosed population is a heterogeneous group and it is likely that different models may explain comorbidity in different subgroups. The present review part one gives an overview on prevalence and explanation models for dual diagnosis psychosis and substance use with focus in adolescent and young adult populations, the second part reviews the clinical course for both disorders and current psychosocial treatment options.

Schlüsselwörter

Doppeldiagnose - Psychose - Sucht - Epidemiologie - Erklärungsmodelle

Key words

dual diagnosis - psychosis - substance abuse disorder - epidemiology - etiological theories

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PD Dr. Martin Lambert

Psychosen-Ersterkennungs- und Behandlungsprojekt (PEB)
Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin
Universitätsklinikum Hamburg-Eppendorf

Martinistr. 52

20246 Hamburg

eMail: lambert@uke.de