Alkoholkonsumstörungen und Suizidalität: Ein narratives Review

Zusammenfassung

Epidemiologisch ist die Häufigkeit von Suizidalität bei Personen mit einer Alkoholkonsumstörung hoch und in der Diagnostik und Behandlung der Betroffenen oftmals eine Herausforderung. Ziel dieser narrativen Übersicht ist es, nicht nur Risikofaktoren für suizidale Ideationen und Handlungen zu identifizieren, sondern auch Hinweise auf Diagnostik und Behandlung aufzuzeigen. Risikofaktoren beinhalten affektiven Störungen, impulsives und aggressives Verhalten, Drogenkonsumstörungen sowie die Schwere der Alkoholabhängigkeit. Veränderungen in der Neurotransmission des serotonergen und noradrenergen Systems und eine Dysfunktion des präfrontalen Kortex sind von biologischer Seite beteiligt. Behandlungssuchende Alkoholkranke weisen oftmals multiple Risikofaktoren auf. Für die Diagnostik weist eine Vorgeschichte von Suizidversuchen auf eine höhere Krankheitslast komorbider psychischer Störungen hin. In der Behandlung wurden psychotherapeutische Strategien wie die kognitive Therapie, die DBT (dialektisch behaviorale Therapie) und die Behandlung der affektiven Störungen mit Antidepressiva als mögliche Behandlungsansätze vorgestellt. Zukünftige Studien sollten die Wirksamkeit dieser Ansätze bestätigen und neue Strategien entwickeln und erproben.

Abstract

Epidemiological data shows high rates of suicidal behavior in alcohol-dependent individuals, which presents a challenge in diagnosing and treating affected patients. This narrative aims to identify risk factors for suicidal ideation and action, with tips to diagnosis and treatment. Risk factors include affective disorder, aggressive and impulsive behaviors, other drug use disorders and a more severe course of alcohol dependence. Biologically important are alterations in the serotonergic and noradrenergic neurotransmissions, and dysfunction of prefrontal cortical regions. Treatment-seeking, alcohol-dependent individuals often present with multiple risk factors. In diagnostics, history of suicide attempts yields a high comorbidity of alcohol dependence with mental disorders. Pilot trials support the use of CBT and DBT in this population as the best currently available approaches of psychotherapy. Treatment of affective disorders with antidepressants presents the most promising pharmacological approach. Future studies may clarify the relative efficacy of current psychotherapeutic and pharmacological approaches, and help develop new and innovative strategies.

Schlüsselwörter

Alkoholabhängigkeit - Alkoholbezogene Störungen - suizidale Ideationen - Suizidversuche - Suizid

Key words

alcohol dependence; alcohol use disorders - suicidal ideations - suicide attempts - suicide

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