Spezielle psychopharmakologische Therapie und Prophylaxe

Zusammenfassung

Suizidales Verhalten stellt ein häufiges Phänomen bei psychiatrischen Erkrankungen dar. Insbesondere Patienten mit affektiven Störungen haben ein erhöhtes Suizidrisiko. Die leitliniengerechte Versorgung affektiver Störungen ist für Ärzte, Pfleger, Psychologen und andere Berufsgruppen im Gesundheitswesen hochanspruchsvoll und bedarf pharmakotherapeutischer, psychotherapeutischer und pflegerischer Expertise sowie eines hohen Maßes an Empathie. Generell verfügen wir über pharmakologische Behandlungsmöglichkeiten, die effektiv in der Behandlung von psychiatrischen Erkrankungen eingesetzt werden können, mindestens genauso bedeutsam sind auch psychotherapeutische und soziotherapeutische Behandlungsansätze. In den letzten Jahren konnte eine andauernde Debatte über den potenziellen Einfluss antidepressiver Medikation auf Suizidalität verfolgt werden. Hierbei zeigte sich eine mangelnde Evidenz für die suizidprotektive Wirkung von Antidepressiva. Mögliche Gründe dafür liegen in methodischen Schwierigkeiten, dies zu untersuchen. Seit den frühen 1970er-Jahren haben eine große Anzahl von Studien einen suizidprotektiven Effekt von Lithium nachgewiesen. Für die Behandlung von schizophrenen Erkrankungen konnte ein solcher Effekt für Clozapin aufgezeigt werden. Der folgende Artikel gibt einen Überblick über den aktuellen Wissenstand bezüglich psychopharmakologischer Behandlungsmöglichkeiten von suizidalen Patienten.

Summary

Suicidal behavior represents a frequent phenomenon in patients with psychiatric disorders. Especially patients with affective disorders have an increased suicide risk. The management and treatment of those patients is one of the most challenging tasks for health care professionals. In general several pharmacological strategies are known to be effective in the treatment of psychiatric diseases, however psychotherapeutic and sociotherapeutic strategies play also an important role.

There is an ongoing debate whether or not antidepressant and neuroleptic drugs have a suicide-preventing effect. There is still a lack of evidence due to methodical study limitations and ethical concerns. Since the early 1970s, several national and international studies confirmed the anti-suicidal effect of lithium in the treatment of patients with affective disorders. Only clozapine has shown to have some anti-suicidal properties in the treatment of schizophrenic patients. The following article provides an overview about the current knowledge of psychopharmacological treatment options for patients with suicidal behavior.

Schlüsselwörter

Suizidalität - affektive Störungen - Lithium - Prävention

Keywords

Suicidality - lithium - prevention - affective disorders

• Literatur

• 1 WHO. http://www.who.int/mental_health/suicide-prevention/en/
• 2 Lee Bh, Kim YK. Potential peripheral biological predictors of suicidal behaviour in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35: 842-847.
• 3 WHO (2014) Preventing suicide: A global imperative. www.who.int/mental_health/suicide- prevention/world_report_2014/en/
• 4 http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4272b1-01-FDA.pdf
• 5 Haussmann R. et al. Psychopharmaceuticals for treatment of suicidal patients and for suicide prevention. Nervenarzt 2016; 87 (05) 483-487.
• 6 www.leitlinien.de/mdb/downloads/nvl/de pression/depression-2aufl-vers3-lang.pdf
• 7 Khan A. et al. Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: a replication analysis of the Food and Drug Administration Database. Int J Neuropsychopharmacol 2001; 04 (02) 113-8.
• 8 Khan A, Warner H, Brown W. Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: an analysis of the Food and Drug Administration database. Arch Gen Psychiatry 2000; 57 (04) 311-7.
• 9 Khan A. et al. Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports. Am J Psychiatry 2003; 160 (04) 790-2.
• 10 Fergusson D. et al. Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. BMJ 2005; 330 (7488): 396.
• 11 Gunnell D, Saperia J, Ashby D. Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials submitted to the MHRA’s safety review. BMJ 2005; 330 (7488): 385-638.
• 12 Hammad TA, Laughren T, Racoosin JA. Suicide rates in short-term randomized controlled trials of newer antidepressants. J Clin Psychopharmacol 2006; 26 (02) 203-7.
• 13 Gibbons RD. et al. Relationship between antidepressants and suicide attempts: an analysis of the Veterans Health Administration data sets. Am J Psychiatry 2007; 164 (07) 1044-9.
• 14 Barbui CE, Esposito E, Cipriani A. Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies. CMAJ 2009; 180 (03) 291-7.
• 15 Gibbons RD. et al. Benefits from antidepressants: synthesis of 6-week patient-level outcomes from double-blind placebo-controlled randomized trials of fluoxetine and venlafaxine. Arch Gen Psychiatry 2012; 69 (06) 572-9.
• 16 Stone M. et al. Risk of suicidality in clinical trials of antidepressatns in adults: analysis of proprietary data submitted to US Food and Drug Administration. BMJ 2009; 339: b2880.
• 17 Donovan S. et al. The occurrence of suicide following the prescription of antidepressant drugs. Arch Suicide Res 1999; 05 (03) 181-92.
• 18 Gunnell D, Ashby D. Antidepressants and suicide: what is the balance of benefit and harm. BMJ 2004; 329 (7456) 34-8.
• 19 Braun C, Bschor T, Franklin J, Baethge C. Suicides and suicide attempts during long-term treatment with antidepressants: A meta-analysis of 29 placebo-controlled studies including 6934 patients with major depressive disorder. Psychother Psychosom 2016; 85: 171-179.
• 20 Hegerl U. Antidepressiva und Suizidalität – Nutzen-Risiko-Abschätzung. Nervenarzt 2007; 78: 7-14.
• 21 Wassermann D. et al. The European Psychiatric Association (EPA) guidance on suicide treatment and prevention. European Psychiatry 2012; 27: 129-41.
• 22 Stübner S. et al. Suicidality as rare adverse event of antidepressant medication: report from the AMSP multicenter drug safety surveillance project. J Clin Psychiatry 2010; 71 (10) 1293-1307.
• 23 Mavrogiorgou PM, Bründe P, Juckel G. The management of psychiatric emergencies. Dtsch Arztebl Int 2011; 108: 222-30.
• 24 Lewitzka U, Severus E, Bauer R, Ritter P, Müller-Oerlinghausen B, Bauer M. The suicide prevention effect of lithium: more than 20 years of evidence – a narrative review. Int J Bipolar Disord 2015; 03: 32.
• 25 Baldessarini R, Tondo L, Hennen J. Lithium treatment and suicide risk in major affective disorders: update and new findings. J Clin Psychiatry 2003; 64 (Suppl. 05) 44-52.
• 26 Cipriani A. et al. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry 2005; 162 (10) 1805-19.
• 27 Guzzetta F. et al. Lithium treatment reduces suicide risk in recurrent major depressive disorder. J Clin Psychiatry 2007; 68 (03) 380-3.
• 28 Kessing LV. et al. Suicide risk in patients treated with lithium. Arch Gen Psychiatry 2005; 62 (08) 860-6.
• 29 Guzzetta F. et al. Lithium treatment reduces suicide risk in recurrent major depressive disorder. J Clin Psychiatry 2007; 68 (03) 380-3.
• 30 Goodwin FK. et al. Suicide risk in bipolar disorder during treatment with lithium and divalproex. JAMA 2003; 290 (11) 1467-73.
• 31 Lauterbach E. et al. Adjunctive lithium treatment in the prevention of suicidal behaviour in depressive disorders: a randomised, placebo-controlled, 1-year trial. Acta sychiatr Scand 2008; 118: 469-79.
• 32 Ahrens B, Müller-Oerlinghausen B. Does lithium exert an independent antisuicidal effect?. Pharmacopsychiatry 2001; 34: 132-6.
• 33 Giotakos O, Nisianakis P, Tsouvelas G, Giakalou VV. Lithium in the public water supply and suicide mortality in Greece. Biol Trace Elem Res 2013; 156: 376-9.
• 34 Kabacs N, Memon A, Obinwa T, Stochl J, Perez J. Lithium in drinking water and suicide rates across the East of England. Br J Psychiatry 2011; 198: 406-7.
• 35 Kapusta ND, Mossaheb N, Etzersdorfer E, Hlavin G, Thau K, Willeit M, Praschak-Rieder N, Sonneck G, Leithner-Dziubas K. Lithium in drinking water and suicide mortality. Br J Psychiatry 2011; 198: 346-50.
• 36 Ohgami H, Terao T, Shiotsuki I, Ishii N, Iwata N. Lithium levels in drinking water and risk of suicide. Br J Psychiatry 2009; 194: 464-5.
• 37 Brodersen A, Licht RW, Vestergaard P. et al. Sixteen-year mortality in patients with affective disorder commenced on lithium. Br J Psychiatry 2000; 176: 429-33.
• 38 Coryell W. et al. Lithium and suicidal behaviour in major affective disorder: a case-control study. Act Psychiatr Scand 2001; 104: 193-7.
• 39 Oquendo MA. et al. Treatment of suicide attempters with bipolar disorders: A randomized clinical trial comparing lithium and valproate in the prevention of suicidal behavior. Am J Psychiatry 2011; 168 (10) 1050-6.
• 40 Lewitzka U, Bauer M. What role does (should) lithium play in suicide treatment/prevention?. Psychiatric Times 2014; 10-15.
• 41 Müller-Oerlinghausen B, Lewitzka U. The contributions of lithium and clozapine for the prophylaxis and treatment of suicidal behavior. In: Biological aspects of suicidal behavior. Kaschka W, Rujescu D. (eds.) Basel: Karger; 2016
• 42 Lohse M, Müller-Oerlinghausen B. Psychopharmaka, in Arzneiverordnungsreport 2015. In: Schwabe U, Paffrath D. (Hrsg.) Berlin: Springer; 2015
• 43 Baldessarini R, Tondo L, Hennen J. Effects of lithium treatment and its discontinuation on suicidal behaviour in bipolar manic-depressive disorders. J Clin Psychiatry 1999; 60 (Suppl. 02) 77-84.
• 44 Meltzer H. Treatment of suicidality in schizophrenia. Ann N Y Acad Sci 2001; 932: 44-58.
• 45 Meltzer H. Suicidality in schizophrenia: a review of the evidence for risk factors and treatment options. Curr Psychiatry Rep 2002; 04: 279-83.
• 46 Drake R, Ehrlich J. Suicide attempts associated with akathisia. Am J Psychiatry 1985; 142: 499-501.
• 47 Meltzer H, Okayli G. Reduction of suicidality during clozapine treatment of neuroleptic-resistant schizophrenia: impact on risk-benefit assessment. Am J Psychiatry 1995; 152: 183-90.
• 48 Meltzer H. et al. Clozapine tratment for suicidality in schizophrenia. Arch Gen Psychiatry 2003; 60: 82-91.
• 49 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN); Bundesärztekammer (BÄK); Kassenärztliche Bundesvereinigung (KBV); Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (AWM)F. (Hrsg.) Nationale Versorgungsleitlinie Unipolare Depression. Reihe: Interdisziplinäre S3-Praxisleitlinien 2010.;
• 50 Lam RW, Kennedy SH, Grigoriadis S. et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacopsychiatry. J Affect Disord 2009; 117: 26-43.
• 51 Bschor T, Lewitzka U, Pfennig A. et al. Twenty-five years of lithium augmentation. Nervenarzt 2007; 78: 1237-47.