Download PDF
Psychiatr Prax 2001; 28(6): 257-261
DOI: 10.1055/s-2001-16876
ÜBERSICHT
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Medikamentöse Behandlung von psychiatrischen Störungen bei Alkoholabhängigen

Medical Treatment of Psychiatric Comorbidity in AlcoholicsTilman Wetterling
  • Klinik für Psychiatrie und Psychotherapie I der Johann-Wolfgang-Goethe-Universität, Frankfurt
Further Information

Publication History

Publication Date:
31 August 2001 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Epidemiologische Studien zeigen, dass bei Alkoholabhängigen eine hohe Lebenszeitprävalenz für psychiatrische Störungen, insbesondere für Angst-, phobische, depressive und schizophrene Störungen besteht. Aufgrund der komplexen Zusammenhänge von erhöhtem Alkoholkonsum und psychischem Befinden kommt es häufig zu diagnostischen Problemen und Schwierigkeiten bei der Therapieplanung, insbesondere der Indikation zu einer medikamentösen Therapie. In dieser Übersicht werden die Ergebnisse der Studien über eine medikamentöse Behandlung von psychiatrischen Störungen bei Alkoholkranken referiert und anhand dieser Daten Indikationen für eine medikamentöse Therapie erarbeitet. Nur in wenigen Studien konnte auch ein Effekt auf das Trinkverhalten nachgewiesen werden. Zusammenfassend muss festgestellt werden, dass die medikamentösen Behandlungsmöglichkeiten für Alkoholkranke mit einer psychiatrischen Störung bisher nur unzureichend untersucht worden sind. Insbesondere fehlen Studien über die Behandlungsmöglichkeiten von Schizophrenen mit Alkoholproblemen.

Medical Treatment of Psychiatric Comorbidity in Alcoholics

Purpose: Epidemiological studies show that alcoholics have a high life-time prevalence of psychiatric illnesses, particularly of anxiety, depressive and schizophrenic disorders. But the complex relationships between elevated alcohol consumption and psychiatric symptomatology frequently Iead to problems in finding diagnosis and thereafter in planning therapeutic strategies. Methods: In this article the results of the studies concerning the medical treatment of psychiatric comorbidity of alcoholics are critically reviewed. Results: According to the available results a therapy with antidepressive drugs indicated in alcoholics with depression lasting over 14 days. Anxiety disorders seem to have little influence on the course of alcoholism. Thus, an anxiolytic medication has to be considered carefully in view of the addiction potency of tranquilizers. There is a paucity of data concerning drug treatment of schizophrenics with alcohol abuse. Thus far only a few studies have shown an effect of a drug treatment of the psychiatric comorbidity on the drinking behavior. Conclusion: There is a lack of studies on specific treatment strategies of psychiatric comorbid alcoholics, particularly of schizophrenics with alcohol abuse.

Literatur

  • 1 Kessler R C, Crum R M, Warner L A, Nelson C B, Schulenberg J, Anthony J C. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey.  Arch Gen Psychiatry. 1997;  54 313-321
    PubMedGoogle Scholar
  • 2 Regier D A, Farmer M E, Rae D S, Locke B Z, Keith S J, Judd L L, Goodwin F K. Comorbidity of mental disorders with alcohol and other drug abuse.  JAMA. 1990;  264 2511-2518
    Google Scholar
  • 3 Weiss R D, Mirin S M, Griffin M L. Methodological considerations in the diagnosis of coexistence psychiatric disorders in substance abusers.  Br J Addict. 1992;  87 179-187
    CrossrefPubMedGoogle Scholar
  • 4 Keeler M H, Taylor I, Miller M C. Are all recently detoxified alcoholics depressed.  Am J Psychiatry. 1979;  136 586-588
    PubMedGoogle Scholar
  • 5 Brown S A, Irwin M, Schuckit M A. Changes in anxiety among abstinent male alcoholics.  J Stud Alcohol. 1991;  52 55-61
    PubMedGoogle Scholar
  • 6 Brown S A, lnaba R K, Gillin J C, Schuckit M A, Stewart M A, Irwin M R. Alcoholism and affective disorder: clinical course of depressive symptoms.  Am J Psychiatry. 1995;  152 45-52
    PubMedGoogle Scholar
  • 7 Dackis C A, Gold M S, Pottash A LC, Sweeney D R. Evaluating depression in alcoholics.  Psychiatric Res. 1986;  17 105-109
    PubMedGoogle Scholar
  • 8 Dorus W, Kennedy J, Gibbons R D, Ravi S D. Symptoms and diagnosis of depression in alcoholics.  Alcohol Clin Exp Res. 1987;  11 150-154
    PubMedGoogle Scholar
  • 9 West A P, Gocka E F. Self-ratings of typical mood and behavior during recovery from alcohol abuse. A multivariate study of alcoholic men.  Psychopathology. 1986;  19 303-308
    PubMedGoogle Scholar
  • 10 Helzer J E, Pryzbeck T R. The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment.  J Stud Alcohol. 1988;  49 219-224
    PubMedGoogle Scholar
  • 11 McLellan A T, Luborsky L, Woody G E, O'Brien C P, Druley K A. Predicting response to alcohol and drug abuse treatments. Role of psychiatric severity.  Arch Gen Psychiatry. 1983;  40 620-625
    PubMedGoogle Scholar
  • 12 Powell B J, Penick E C, Liskow B I, Riesenmy K D, Campion S L, Brown E F. Outcomes of co-morbid alcoholic men: A 1-year follow-up.  Alcohol Clin Exp Res. 1992;  16 131-138
    PubMedGoogle Scholar
  • 13 Rounsaville B J, Dolinsky Z S, Babor T F, Meyer R E. Psychopathology as a predictor of treatment outcome in alcoholics.  Arch Gen Psychiatry. 1987;  44 505-513
    PubMedGoogle Scholar
  • 14 Alling C, Balldin J, Bökström K, Gottfries C G, Karlsson I, Langstrom G. Studies on duration of a late recovery period after chronic abuse of ethanol. A cross-sectional study of biochemical and psychiatric indicators.  Acta Psychiatr Scand. 1982;  66 384-397
    PubMedGoogle Scholar
  • 15 Scholz H. Die Rehabilitation bei chronischem Alkoholismus. Stuttgart; Enke 1986
    Google Scholar
  • 16 Dilling H, Mombour M, Schmidt M H. Internationale Klassifikation psychischer Störungen. ICD-10. 3. Aufl. Huber 2000
    Google Scholar
  • 17 Saß H, Wittchen H-U, Zaudig M. (Hrsg) .Diagnostisches und statistisches Manual psychischer Störungen DSM-IV. Göttingen; Hogrefe 1996
    Google Scholar
  • 18 Greenfield S F, Weiss R D, Muenz L R, Vagge L M, Kelly J F, BeIb L R, Michael J. The effect of depression on return to drinking: a prospective study.  Arch Gen Psychiatry. 1998;  55 259-265
    PubMedGoogle Scholar
  • 19 Mason B J, Kocsis J H, Ritvo E C, Cutler R B. A double-blind, placebo-controlled trial of desipramine for primary alcohol dependence stratified on the presence or absence of major depression.  JAMA. 1996;  275 761-767
    CrossrefPubMedGoogle Scholar
  • 20 McGrath P J, Nunes E V, Stewart J W, Goldman D, Agosti V, Ocepek-Welikson K, Quitkin F M. Imipramine treatment of alcoholics with primary depression.  Arch Gen Psychiatry. 1996;  53 232-240
    PubMedGoogle Scholar
  • 21 Wetterling T. Diagnostik und Behandlungsansätze depressiver Störungen bei Alkoholabhängigen.  Fortschr Neurol Psychiat. 1999;  67 131-141
    PubMedGoogle Scholar
  • 22 Cornelius J R, Salbum I M, Ehler J G, Jarrett P J, Cornelius M D, Perel M J, Thase M E, Black A. Fluoxetine in depressed alcoholics. A double-blind, placebo-controlled trial.  Arch Gen Psychiatry. 1997;  54 700-705
    CrossrefPubMedGoogle Scholar
  • 23 Janiri L, Gobbi G, Mannelli P, Pozzi G, Serretti A, Tempesta E. Effects of fluoxetine at antidepressant doses on short-term outcome of detoxified alcoholics.  Int Clin Psychopharmacol. 1996;  11 109-117
    PubMedGoogle Scholar
  • 24 Kranzler H R, Burleson J A, Korner P, Del Boca F K, Bohn M J, Brown J, Liebowitz N. Placebo-controlled trial of fluoxetine as an adjunct to relapse prevention.  Am J Psychiatry. 1995;  151 391-397
    PubMedGoogle Scholar
  • 25 Nunes E V, McGrath P J, Quitkin F M, Stewart J P, Harrison W, Tricamo E, Ocepek-Welikson K. Imipramine treatment of alcoholism with comorbid depression.  Am J Psychiatry. 1993;  150 963-965
    PubMedGoogle Scholar
  • 26 Powell B J, Campbell J L, Landon J F, Liskow B I, Thomas H M, Nickel E J, Dale T M, Penick E C, Samuelson S D, Lacoursiere R. A double-blind, placebo-controlled study of nortriptyline and bromocriptine in male alcoholics subtyped by comorbid psychiatric disorders.  Alcohol Clin Exp Res. 1995;  19 462-468
    PubMedGoogle Scholar
  • 27 Gorelick D A, Paredes A. Effect of fluoxetine on alcohol comsumption in male alcoholics.  Alcohol Clin Exp Res. 1992;  16 261-265
    PubMedGoogle Scholar
  • 28 Roy-Byrne P P, Pages K P, Russo J E, Jaffe C, Blume A W, Kingsley E, Cowley D S, Ries R K. Nefazodone treatment of major depression in alcohol-dependent patients: a double-blind, placebo-controlled trial.  J Clin Psychopharmacol. 2000;  20 129-136
    CrossrefPubMedGoogle Scholar
  • 29 Kranzler H R, Modesto-Lowe V, van Kirk J. Naltrexone vs. nefazodone for treatment of alcohol dependence. A placebo-controlled trial.  Neuropsychopharmacology. 2000;  22 493-503
    CrossrefPubMedGoogle Scholar
  • 30 Winokur G, Coreyll W, Akiskal H S, Maser J D, Keller M B, Endicott J, Mueller T. Alcoholism in manic-depressive (bipolar) illness. Familial illness, course of illness, and the primary-secondary distinction.  Am J Psychiatry. 1995;  152 365-372
    PubMedGoogle Scholar
  • 31 Lejoyeux M, Ades J. Evaluation of lithium treatment in alcoholism.  Alcohol Alcohol. 1993;  28 273-279
    PubMedGoogle Scholar
  • 32 Schuckit M A, Hesselbrock V. Alcohol dependency and anxiety disorders: what is the relationship?.  Am J Psychiatry. 1994;  151 1723-1734
    PubMedGoogle Scholar
  • 33 LaBounty L P, Hatsukami D, Morgan S F, Nelson L. Relapse among alcoholics with phobic and panic symptoms.  Addict Behav. 1992;  17 9-15
    CrossrefPubMedGoogle Scholar
  • 34 Tomasson K, Vaglum P. The 2-year course following detoxification treatment of substance abuse: the possible influence of psychiatric comorbidity.  Eur Arch Psychiatry Clin Neurosci. 1997;  247 320-327
    PubMedGoogle Scholar
  • 35 Ciraulo D A, Sands B F, Shader R I. Critical review of liability for benzodiazepine abuse among alcoholics.  Am J Psychiatry. 1988;  145 1501-1506
    PubMedGoogle Scholar
  • 36 Addington J, Duchak V. Reasons for substance use in schizophrenia.  Acta Psychiat Scand. 1997;  96 329-333
    CrossrefPubMedGoogle Scholar
  • 37 Brunette M F, Mueser K T, Xie H, Drake R E. Relationships between symptoms of schizophrenia and substance abuse.  J Nerv Ment Dis. 1997;  185 13-20
    PubMedGoogle Scholar
  • 38 Lambert M, Haasen C, Mass R, Krausz M. Konsummuster und Konsummotivation des Suchtmittelgebrauchs bei schizophrenen Patienten.  Psychiat Prax. 1997;  24 185-189
    PubMedGoogle Scholar
  • 39 Pristach C A, Smith C M. Self-reported effects of alcohol use on symptoms of schizophrenia.  Psychiatric Serv. 1996;  47 421-423
    PubMedGoogle Scholar
  • 40 Kozaric-Kovacic D, Folnegovic-Smalc V, Folnegovic Z, Maruic A. lnfluence of alcoholism on the prognosis of schizophrenic patients.  J Stud Alcohol. 1995;  56 622-627
    PubMedGoogle Scholar
  • 41 Buckley P F. Substance abuse in schizophrenia: a review.  J Clin Psychiatry. 1998;  59, Suppl 3 26-30
    PubMedGoogle Scholar
  • 42 Wilkins J N. Pharmacotherapy of schizophrenia patients with comorbid substance abuse.  Schizophrenia Bull. 1997;  23 215-228
    PubMedGoogle Scholar
  • 43 Verheul R, Hartgers C, van den Brink W, Koeter M W. The effect of sampling, diagnostic criteria and assessment procedures on the observed prevalence of DSM-III-R personality disorders among treated alcoholics.  J Stud Alcohol. 1998;  59 227-236
    PubMedGoogle Scholar
  • 44 Schuckit M A, Tipp J E, Anthenelli R M. et al . Anorexia nervosa and bulimia nervosa in alcohol-dependent men and women and their relatives.  Am J Psychiatry. 1996;  153 74-82
    PubMedGoogle Scholar
  • 45 Sinha R, O'Malley S S. Alcohol and eating disorders: implications for alcohol treatment and health services research.  Alcohol Clin Exp Res. 2000;  24 1312-1319
    PubMedGoogle Scholar
  • 46 Vitiello M V. Sleep, alcohol and alcohol abuse.  Addict Biol. 1997;  2 151-158
    PubMedGoogle Scholar
  • 47 Drummond S P, Gillin J C, Smith T L, DeModena A. The sleep of abstinent pure primary alcoholic patients: natural course and relationship to relapse.  Alcohol Clin Exp Res. 1998;  22 1796-802
    PubMedGoogle Scholar
  • 48 Pelissolo A, Lepine J P. Les traitements pharmacologiques des troubles de la personnalite. Aspects methodologiques et revue des resultats obtenus.  Encephale. 1999;  25 496-507
    PubMedGoogle Scholar
  • 49 Krausz M, Watermann U. Behandlungsmöglichkeiten bei Doppeldiagnosen. In: Uchtenhagen A, Zieglgänsberger W (Hrsg) Suchtmedizin. München; Urban & Fischer 2000 5: 376-383
    Google Scholar
  • 50 Veltrup C. Abstinenzgefährdung und Abstinenzbeendigung bei Alkoholabhängigen nach einer umfassenden stationären Entzugsbehandlung. Münster; Waxmann 1995
    Google Scholar
  • 51 Schuckit M A, Tipp J E, Bucholz K K, Nurnberger J I, Hesselbrock V M, Crowe R R, Kramer J. The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls.  Addiction. 1997;  92 1289-1304
    CrossrefPubMedGoogle Scholar
  • 52 Humphreys K, Weisner C. Use of exclusion criteria in selecting research subjects and its effect on the generalizability of alcohol treatment outcome studies.  Am J Psychiatry. 2000;  157 588-594
    CrossrefPubMedGoogle Scholar

Prof. Dr. Dipl.-Chem. Tilman Wetterling

Klinik für Psychiatrie und Psychotherapie I der Johann Wolfgang Goethe-Universität

Heinrich-Hoffmann-Straße 10

60528 Frankfurt/Main

Email: wetterling@em.uni-frankfurt.de

      >