Rauchen ist wegen der hohen Prävalenz gerade bei psychiatrisch
Erkrankten von besonderer Bedeutung. Die Entwicklung einer
körperlichen und psychischen Abhängigkeit macht es oft
schwierig, den Konsum zu beenden. Die aktuelle S3-Leitlinie liefert
evidenzbasierte Strategien zur Behandlung dieser Suchterkrankung und zum
erfolgreichen Rauchstopp und gibt Empfehlungen für die
Besonderheiten psychiatrischer Patienten und deren Medikation.
Abstract
Smoking is a major health risk to the general public and especially to
psychiatric patients. Both mental and physical tobacco dependency makes quitting
challenging for many smokers. Evidence based cessation support as referred to in
the German AWMF-treatment guidelines can make quit approaches successful.
Basically, a structured assessment of smoking status combined with advice to
quit should be offered to all smokers with or without mental illness. Cessation
programs should combine stop-smoking counselling with medication to reduce
withdrawal symptoms. Self-help booklets, internet- and app-based programs can
support quit approaches easily and effectively. Nicotine replacement,
varenicline, bupropion, cytisine and the second line drugs nortriptyline and
clonidine help smokers effectively to quit, whereas e-cigarettes were not
recommended. Ongoing observations about their long-term use may help to clarify
their potential health risks. Nevertheless, e-cigarettes may have a potential
for harm reduction approaches in smokers. A stop smoking support for mentally
ill smokers should be offered in a period of stable illness, contain specialized
counselling to meet the patients’ coping needs and address the fact that
the plasma level of several psychiatric drugs could be affected when smoking is
stopped. Considering the tremendous health consequences of smoking, we see a
need for cost coverage of cessation programs by the health insurance companies
to facilitate an increase in the amount of quit approaches in smokers.
Schlüsselwörter
Rauchen - Tabakabhängigkeit - Raucherentwöhnung - psychiatrische Patienten - E-Zigarette
Key words
smoking - tobacco dependency - smoking cessation - mental illness - e-cigarette
