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DOI: 10.1055/s-0028-1109979
© Georg Thieme Verlag KG Stuttgart · New York
Psychose und Sucht bei Jugendlichen und Jungerwachsenen
Teil 2: Verlauf und Behandlung
Dual Diagnosis Psychosis and Substance Use Disorders in Adolescents – Part 2
Publication History
Publication Date:
09 February 2010 (online)

Zusammenfassung
Trotz hoher Prävalenz der Doppeldiagnose (DD) Psychose und Sucht bei ersterkrankten Jugendlichen und Jungerwachsenen und hoher klinischer Relevanz, bedingt durch den ungünstigen Krankheitsverlauf bei persistierendem Drogenkonsum, existieren nur wenige randomisierte kontrollierte Therapiestudien. Nach therapeutischen Empfehlungen sollte bei dieser Gruppe die psychiatrische Therapie und Suchttherapie integriert werden. Dieser Beitrag skizziert integrierte Versorgungsmodelle und störungsspezifische Kurzzeittherapien aus klinischer und evidenzbasierter Perspektive mit Fokus auf die für DD-Patienten adaptierte Motivationsbehandlung, deren Effektivität bei Suchtstörungen alleine belegt ist. Ziel dieses Beitrags ist es, psychosoziale Behandlungen aufzuzeigen, die den Substanzkonsum bei Jugendlichen und Jungerwachsenen mit Psychose effizient reduzieren könnten. Fünf randomisiert kontrollierte Studien werden besprochen. Diese Überblicksarbeit findet keine Überlegenheit einer speziellen psychosozialen Intervention. Entweder konnten gefundene Effekte nicht repliziert werden oder es konnte kein klarer Vorteil gegenüber Vergleichsbedingungen für substanzspezifische oder andere psychiatrische Zielkriterien bestätigt werden.
Abstract
Despite the high prevalence of comorbid substance use disorders (SUD) in young schizophrenic patients and the association of persisting SUD and poor outcome, there are only few randomized controlled psychological treatment studies in this special dual diagnosis group available. According to therapeutic recommendations, efficient treatment models need to integrate traditional psychiatric therapy and therapy of addiction offered in one setting. Short-term interventions have adapted Motivational interviewing (MI) for dual diagnosis, which has been shown to be effective among other substance abuse disorders. However a recent Cochrane review showed that insufficient evidence exists to show that any psychosocial treatment method for dual diagnosis is superior to others. The aim of this review was to assess the current evidence for the efficacy of psychosocial interventions for reducing substance in young patients with psychosis. Five randomized-controlled studies were identified. This review did not find any specific psychosocial intervention that had been replicated and consistently showed clear advantages over comparison condition for substance-related and other psychiatric outcomes.
Schlüsselwörter
Doppeldiagnose - Krankheitsverlauf - integrierte Versorgung - störungsspezifische Psychotherapien - Evidenzbasierung
Key words
dual diagnosis - psychosis - substance use disorder - clinical course - evidence-based psychosocial treatments
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PD Dr. Martin Lambert
Psychosen-Ersterkennungs- und Behandlungsprojekt (PEB)
Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin
Universitätsklinikum Hamburg-Eppendorf
Martinistr. 52
20246 Hamburg
Email: lambert@uke.de