Systematische Übersichtsarbeit Antipsychotische Behandlung des Alkoholentzugssyndroms: Fokus Delirium Tremens

Zusammenfassung

Hintergrund Das Delirium tremens (DT) ist eine weit verbreitete und potentiell vital bedrohliche Komplikation des Alkoholentzugs. Die medikamentöse Behandlung eines DT spielt sowohl eine wichtige Rolle in der stationären suchtmedizinischen Versorgung als auch in anderen medizinischen Fachbereichen, in denen ein Alkoholentzugsdelir sekundär durch die Hospitalisierung auftreten kann. Patienten im DT müssen hochdosiert mit Benzodiazepinen (bei geriatrischen Patienten kurzwirksame Benzodiazepine zur Vermeidung einer Akkumulierung) oder Clomethiazol sowie bei produktiv-psychotischen Symptomen zusätzlich antipsychotisch behandelt werden. Eine differenzierte Empfehlung zur konkreten Behandlung mit Antipsychotika im DT fehlt bisher. Die hier vorliegende Übersicht diskutiert die Empfehlungen der Fachgesellschaften mit anderen in der Literatur zugänglichen Ergebnissen bezüglich der Wahl eines Antipsychotikums zur Behandlung des DT. Ziel: Systematische Darstellung relevanter Antipsychotika zur Behandlung des DT.

Methode Es erfolgte eine systematische Literaturrecherche in Pubmed und Scopus nach Original- und Übersichtsarbeiten zu Antipsychotika im Alkoholentzug und DT. Letztmalig erfolgte eine Suche am 22. Mai 2022. Weiter wurden internationale Leitlinien berücksichtigt. Die Übersichtsarbeit wurde mittels PROSPERO registriert (https://www.crd.york.ac.uk/prospero/); CRD42021264611.

Ergebnisse Haloperidol wird besonders auf der Intensivstation empfohlen. Die Datenlage zur differentiellen Verwendung von atypischen Antipsychotika im DT ist weiter insuffizient. Insgesamt gilt es, die Medikation immer in Kombination mit Benzodiazepinen durchzuführen und potentielle Komplikationen wie das maligne neuroleptische Syndrom, QTc-Verlängerungen und extrapyramidal-motorische Störungen sowie komplikative Entzugskrampfanfälle durch Senkung der Krampfschwelle, unter der Verwendung von Antipsychotika, zu beachten.

Schlussfolgerung Die Behandlung mit Antipsychotika im DT sollte nach der Erfahrung des Behandlers erfolgen. Eine klare Empfehlung außer die Gabe von Haloperidol existiert nicht.

Abstract

Background Delirium tremens (DT) is a common complication of alcohol withdrawal. Pharmacological treatment of hospitalized patients with DT is important in addiction medicine but also in other medical disciplines where DT can occur as a complication of hospitalization. Patients suffering from DT require treatment with benzodiazepines (short-acting benzodiazepines for elderly patients to reduce accumulation), and in cases of psychotic symptoms, treatment with antipsychotics. Benzodiazepines are a first-line treatment for DT. A specific guideline for the use of antipsychotics has yet to be developed. This review discusses the current guidelines and literature on the antipsychotic treatment options in DT. Aim: Systematic presentation of relevant antipsychotics for the treatment of DT.

Methods A systematic literature search was conducted using Scopus and PubMed. The last search was conducted on May 22nd 2022. Original articles and reviews on antipsychotic treatment in alcohol withdrawal and DT were included in this review. Further, international guidelines were also considered. The review was registered using the PROSPERO database (https://www.crd.york.ac.uk/prospero/); CRD42021264611.

Results Haloperidol is mainly recommended for use in the intensive care unit. There is little literature on the use of atypical antipsychotics to treat DT. Treatment with antipsychotics always should be combined with benzodiazepines, and physicians should watch out for complications like neuroleptic malignant syndrome, QTc interval prolongation, extrapyramidal symptoms and withdrawal seizures resulting from lowering the threshold for seizures.

Conclusion Antipsychotic treatment should depend on the experience of the physician. Beside haloperidol, no other clear recommendations are available.

Schlüsselwörter

Antipsychotika - Alkoholentzugssyndrom - Delirium Tremens

Key words

antipsychotics - alcohol withdrawal syndrome - delirium tremens

Publication History

Received: 10 September 2022

Accepted: 29 January 2023

Article published online:
23 March 2023

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