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Nervenheilkunde 2009; 28(08): 509-513
DOI: 10.1055/s-0038-1628677
Suchterkrankungen
Schattauer GmbH

Sucht, psychiatrische Komorbidität und das serotonerge System

Substance addiction, comorbidity, and central nervous transmitter systems
D. Wedekind
1   Klinik für Psychiatrie und Psychotherapie der Universitätsmedizin Göttingen
,
U. Havemann-Reinecke
1   Klinik für Psychiatrie und Psychotherapie der Universitätsmedizin Göttingen
› Author Affiliations
Further Information

Publication History

Eingegangen am: 10 November 2008

angenommen am: 27 November 2008

Publication Date:
24 January 2018 (online)

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Zusammenfassung

Komorbide psychiatrische Störungen sind bei Suchtmittelerkrankten eher die Regel als die Ausnahme. Der Einfluss auf Behandlungskosten, Verlauf und Einschränkung der Lebensqualität ist nicht zu unterschätzen. Anhand von Untersuchungen unserer Forschungsgruppe werden Daten präsentiert, die im Einklang mit der wissenschaftlichen Literatur, hohe Prävalenzzahlen von psychiatrischen komorbiden Störungen bei Alkohol- Opioid- und Nikotinabhängigen aufzeigen, vor allem Angst- und affektive Störungen. Von der anderen Seite her gesehen wird auch eine hohe Prävalenz von schädlichem Suchtmittelgebrauch bei Patienten mit einer Angststörung oder einer Persönlichkeitsstörung beobachtet. Hierbei handelt es sich zumeist um GABAerge Substanzen wie Alkohol und Benzodiazepine. Diese Befunde könnten auf Dysfunktionen bestimmter zentralnervöser Neurotransmittersysteme hinweisen.

Summary

Comorbid psychiatric disorders are a common finding in substance addicted subjects. They have an enormous impact on treatment costs, course and restriction in quality of life. Data from our research group are presented which, according to recent scientific literature, demonstrate a high prevalence of psychiatric morbidity in alcohol-, opioid-, and nicotine-addicted individuals, before all of anxiety- and affective disorders. Seen from a different point of view a high prevalence of harmful substance use can be observed in patients with anxiety disorders or with borderline personality disorder. Substances abused are mostly alcohol and benzodiazepines. These findings may be related to possible dysfunctions of distinct central nervous transmitter systems.

Schlüsselwörter

Substanzabhängigkeit - Komorbidität - Angst- und affektive Störungen - Prävalenz

Keywords

Substance addiction - comorbidity - anxiety and affective disorders - prevalence
 

  • Literatur

  • 1 Andrade L, Eaton WW. Lifetime co-morbidity of panic attacks and major depression in a population-based study: age of onset. Psychol Med 1996; 26 (05) 991-6.
    CrossrefPubMedSearch in Google Scholar
  • 2 Batelaan N. et al. Economic costs of full-blown and subthreshold panic disorder. J Affect Disord 2007; 104 1-3 127-36.
    CrossrefPubMedSearch in Google Scholar
  • 3 Bleich S. et al. Association of the long allele of the 5-HTTLPR polymorphism with compulsive craving in alcohol dependence. Alcohol Alcohol 2007; 42 (06) 509-12.
    CrossrefPubMedSearch in Google Scholar
  • 4 Buckner JD. et al. Social anxiety and problematic cannabis use: evaluating the moderating role of stress reactivity and perceived coping. Behav Res Ther 2006; 44 (07) 1007-15.
    CrossrefPubMedSearch in Google Scholar
  • 5 Cloninger CR. A systematic method for clinical description and classification of personality variants. A proposal. Arch Gen Psychiatry 1987; 44 (06) 573-88.
    CrossrefPubMedSearch in Google Scholar
  • 6 Compton WM. et al. Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2005; 66 (06) 677-85.
    CrossrefPubMedSearch in Google Scholar
  • 7 Compton WM. et al. Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 2007; 64 (05) 566-76.
    CrossrefPubMedSearch in Google Scholar
  • 8 Conway KP. et al. Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2006; 67 (02) 247-257.
    CrossrefPubMedSearch in Google Scholar
  • 9 Driessen M. et al. Trauma and PTSD in patients with alcohol, drug or dual dependence: A Multi-Center study. Alcohol Clin Exp Res 2008; 32 (03) 1-8.
    CrossrefPubMedSearch in Google Scholar
  • 10 Havemann-Reinecke U. et al. Postakutbehandlung bei Störungen durch Opioide. In: LG Schmidt et al. (Hrgs.) Evidenzbasierte Suchtmedizin. Behandlungsleitlinie Suchtbezogene Störungen. Köln: Dt. Ärzte-Verlag; 2006
    Search in Google Scholar
  • 11 Havemann-Reinecke U. et al. Psychiaric comorbidity of dependent tobacco smokers. Europ Psych 2007; 22 (Suppl. 01) 42.
    Search in Google Scholar
  • 12 Havemann-Reinecke U. Aetiology of gender effects and dependence. Europ Psych 2008; 23 (Suppl. 01) 47.
    Search in Google Scholar
  • 13 Kendler KS. et al. The familial aggregation of common psychiatric and substance use disorders in the National Comorbidity Survey: a family history study. Br J Psychiatry 1997; 170: 541-8.
    CrossrefPubMedSearch in Google Scholar
  • 14 Kessler RC. et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 1994; 51: 8-19.
    CrossrefPubMedSearch in Google Scholar
  • 15 Kessler RC. et al. Lifetime co-occurrence of DSMIII-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 1997; 54 (04) 313-321.
    CrossrefPubMedSearch in Google Scholar
  • 16 Linnoila M, Virkkunen M. Biologic correlates of suicidal risk and aggressive behavioral traits. J Clin Psychopharmacol 1992; 12 (Suppl. 02) 19S-20S.
    CrossrefPubMedSearch in Google Scholar
  • 17 Magee WJ. et al. Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry 1996; 53: 159-168.
    CrossrefPubMedSearch in Google Scholar
  • 18 Manuzza S. et al. Generalized social phobia: reliability and validity. Arch Gen Psychiatry 1995; 52: 230-237.
    CrossrefPubMedSearch in Google Scholar
  • 19 Marshall JR. Comorbidity and its effects on panic disorder. Bull Menig Clin 1996; 60 (02) 39-53.
    Search in Google Scholar
  • 20 Merikangas KR, Angst J. Comorbidity and social phobia: evidence from clinical, epidemiologic, and genetic studies. Eur Arch Psychiatry Clin Neurosci 1995; 244 (06) 297-303.
    CrossrefPubMedSearch in Google Scholar
  • 21 Noyes Jr R. et al. Relationship between panic disorder and agoraphobia. A family study. Arch Gen Psychiatry 1986; 43 (03) 227-32.
    CrossrefPubMedSearch in Google Scholar
  • 22 Regier DA. et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990; 264: 2511-18.
    CrossrefPubMedSearch in Google Scholar
  • 23 Schneider U. et al. Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment: the first Multicentre Study in Germany. Alcohol Alcohol 2001; 36 (03) 219-23.
    CrossrefPubMedSearch in Google Scholar
  • 24 Schneier FR, Johnson J, Horning CD. Social phobia: Comorbidity and morbidity an an epidemiologic sample. Arch Gen Psychiatry 1992; 49: 282-288.
    CrossrefPubMedSearch in Google Scholar
  • 25 Sinha R. et al. Stress response dampening: effects of gender and family history of alcoholism and anxiety disorders. Psychopharmacology (Berl) 1998; 137 (04) 311-20.
    CrossrefPubMedSearch in Google Scholar
  • 26 Wedekind D. et al. Psychiatric comorbidity and additional abuse of drugs in maintenance treatment with l-and d,l-methadone. World J Biol Psychiatry 2008; 29: 1-10.
    Search in Google Scholar
  • 27 Wedekind D. et al. Serotonergic function, substance craving, and psychopathology in detoxified alcohol addicted males undergoing tryptophan depletion. Eur Arch Psychiatry Clin Neurosci 2008; 258 (04) 35.
    CrossrefPubMedSearch in Google Scholar
  • 28 Bakken K, Vaglum P. Predictors of suicide attempters in substance-dependent patients: a sixyear prospective follow-up. Clin Pract Epidermol Ment Health 2007; 10: 3-20.
    Search in Google Scholar
  • 29 Wedekind D. et al. Psychiatric comorbidity and gender effects in heroin and cocaine-addicted patients in specified long-term treatment and acute inpatient detoxification treatment. German J Psychiatry. 2009 E-pub ahead of print
    PubMedSearch in Google Scholar