Psychopharmakologische Behandlung von nicht suizidalem selbstverletzendem Verhalten

P. L. Plener; G. Libal; J. M. Fegert; M. G. Kölch

doi:10.1055/s-0038-1628475

Nervenheilkunde, Table of Contents

Nervenheilkunde 2013; 32(01/02): 38-41
DOI: 10.1055/s-0038-1628475

Selbstverletzendes Verhalten

Schattauer GmbH

Psychopharmakologische Behandlung von nicht suizidalem selbstverletzendem Verhalten

Psychopharmacological treatment of non-suicidal self-injury

P. L. Plener

¹Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Ulm

,

G. Libal

²Praxis für Kinder- und Jugendpsychiatrie, Ulm

,

J. M. Fegert

¹Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Ulm

,

M. G. Kölch

¹Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Ulm

³Kliniken für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Berlin

› Author Affiliations

Abstract

Zusammenfassung

Neben verschiedenen Behandlungsoptionen für nicht suizidales selbstverletzendes Verhalten (NSSV), stellt sich in der Praxis die Frage nach der Ergänzung durch psychopharmakologische Komponenten. Diese Arbeit will einen Überblick über Studien zur pharmakologischen Behandlung von NSSV bieten und den Kliniker darüber informieren, wann eine solche Option gerechtfertigt erscheint und welche Substanzen dafür in Betracht kommen. Im Rahmen einer systematischen Literaturrecherche der vergangenen 20 Jahre konnten 21 Studien identifiziert werden. Insgesamt ist die Evidenz für die pharmakologische Behandlung von NSSV sehr begrenzt. Je nach begleitendem Symptomcluster finden sich Hinweise für die Wirksamkeit von Sselektiven Serotoninwiederaufnahmehemmern, atypischen Antipsychotika oder Opioidantagonisten. Eine solche Behandlung soll nur in Kombination mit Psychotherapie erfolgen und nicht als Einzeltherapie.

Summary

Among different treatment modalities for non-suicidal self-injury (NSSI), the practitioner might consider adding a psychopharmacologic agent. This review summarizes studies dealing with pharmacologic treatment of NSSI and intends to inform the clinician about when such a treatment trial might be warranted and which substances should be considered. We conducted a systematic literature research of the past 20 years and were able to identify 21 studies. The evidence for pharmacological interventions in NSSI is very limited. According to the accompanying symptom clusters efficacy has been reported for selective serotonin reuptake inhibitors, atypical antipsychotics and opioid antagonists. To date the evidence for pharmacologic treatment options for NSSI is very limited. Medication should only be used in combination with psychotherapeutic treatment and not as monotherapy

Schlüsselwörter

Nicht suizidales selbstverletzendes Verhalten - Psychopharmakologie - Suizidalität - atypische Antipsychotika - selektive Serotoninwiederaufnahmehemmer

Keywords

Non-suicidal self-injury - psychopharmacology - suicidality - atypical antipsychotics - selective serotonin reuptake inhibitors

Full Text

References

Literatur
1 Nock MK. Self-injury. Annual Review of Clinical Psychology 2010; 06: 339-63.
2 Stanford S. et al. Psychological subtyping finds pathological, impulsive, and ‘normal’ groups among adolescents who self-harm. Journal of Child Psychology and Psychiatry 2009; 50: 807-15.
3 Favazza AR. Repetitive Self-Mutilation. Psychiatric Annals 1992; 22: 60-3.
4 Sandman CA. Psychopharmacologic treatment of nonsuicidal self-injury. In: Nock MK. (Ed.) Understanding nonsuicidal self-injury. Origins, Assessment, and Treatment. Washington D.C: American Psychological Association; 2009: 291-323.
5 Parikh MS. et al. Psychopharmacology of aggression in children and adolescents with autism: A critical review of efficacy and tolerability. Journal of Child and Adolescent Psychopharmacology 2008; 18: 157-78.
6 Häßler F. et al. Psychopharmacological therapy of self-injurious behavior in mentally retarded individuals. Nervenarzt 1999; 70: 1025-8.
7 Lloyd-Richardson EE. et al. Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine 2007; 37: 1183-92.
8 Mercer D. et al. Meta-analyses of mood stabilizers, antidepressants and antipsychotics in the treatment of borderline personality disorder: Effectiveness for depression and anger symptoms. Journal of Personality Disorders 2009; 23: 156-74.
9 Plener PL. et al. Use of medication in the treatment of nonsuicidal self-injury in youth. In Nixon MK, Heath NL. (Eds.) Self-Injury in Youth. New York: Routledge; 2009: 275-309.
10 Harper G. Psychopharmacological treatment. In Walsh BW. (Ed.) Treating Self-Injury. A Practical Guide. New York: Guilford Press; 2006: 212-20.
11 Soomro GM. Deliberate self-harm (and attempted suicide). Clin Evid (Online) 2008; pii: 1012.
12 Smith BD. Self-mutilation and pharmacotherapy. Psychiatry 2005; 10: 29-37.
13 Ingenhoven T. et al. Effectiveness of pharamcotherapy for severe personality disorders: metaanalysis of randomized controlled trials. J Clin Psychiatry 2010; 71: 14-25.
14 Bloom CM. et al. Toward new avenues in the treatment of nonsuicidal self-injury. J Pharm Pract 2011; 24: 472-77.
15 Ripoll LH. et al. Evidence-based pharmacotherapy for personality disorders. International Journal of Neuropsychopharmacology 2011; 14: 1257-88.
16 Pies RW. et al. Self-injurious behavior: Pathophysiology and implications for treatment. Journal of Clinical Psychiatry 1995; 56: 580-8.
17 Roberts N. Adolescent self-mutilatory behavior: Psychopharmacological treatment. Child and Adolescent Psychopharmacology News 2003; 08: 10-2.
18 Groschwitz RC. et al. The neurobiology of non-suicidal. Suicidology Online 2012; 03: 24-32.
19 Verkes RJ. et al. Reduction by paroxetine of suicidal behavior in patients with repeated suicide attempts but not major depression. American Journal of Psychiatry 1998; 155: 543-7.
20 Simpson EB. et al. Combined dialectical behavior therapy and fluoxetine in the treatment of borderline personality disorder. Journal of Clinical Psychiatry 2004; 65: 379-85.
21 Markovitz PJ. et al. Fluoxetine in the treatment of Borderline and Schizotypal Personality Disorders. American Journal of Psychiatry 1991; 18: 1064-67.
22 Hawton KKE. et al. Psychosocial and pharmacological treatments for deliberate self harm. The Cochrane library 2009; 1-42.
23 Fegert JM. Depressionsbehandlung mit SSRI in der Kinder- und Jugendpsychiatrie. Ein Forschungsoder ein Informationsdebakel? Nervenheilkunde 2004; 23: 1-67.
24 Brent DA. Antidepressants and pediatric depression The risk of doing nothing. New England Journal of Medicine 2004; 351: 1598-1601.
25 Whittington CJ. et al. Selective Serotonin Reuptake Inhibitors in childhood depression: Systematic review of published versus unpublished data. The Lancet 2004; 36: 1341-5.
26 Nemeroff CB. et al. Impact of publicity concerning pediatric suicidality data on physician practice patterns in the United States, Archives of General Psychiatry. 2007; 64: 466-72.
27 Hammad TA. www.fda.gov/ohrms/dockets/ac/04/briefing/2004-4065b1-10-TAB08-HammadsReview.pdf.2004
28 Didham RC. et al. Suicide and self-harm following prescription of SSRIs and other antidepressants: confounding by indication. Br J Clin Pharmacol 2005; 60: 519-525.
29 Teicher MH. et al. Antidepressant drugs and the emergence of suicidal tendencies. Drug Safety 1993; 08: 186-212.
30 Donovan S. et al. Deliberate self-harm following antidepressant drugs. British Journal of Psychiatry 2000; 177: 551-6.
31 Goodyer I. et al. Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: Randomised controlled trial. British Medical Journal 2007; 335: 142-50.
32 Brent DAl. et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioural therapy for adolescents with SSRI-resistant depression: The TORDIA randomized controlled trial. Journal of the American Medical Association 2008; 299: 901-13.
33 Brent DA. et al. Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI-resistant depression in adolescents (TORDIA) study. American Journal of Psychiatry 2009; 166: 418-26.
34 Wöckel L. et al. Psychopharmakotherapie einer ambulanten und stationären Inanspruchnahmepopulation adoleszenter Patienten mit Borderline Persönlichkeitsstörung. Z Kinder Jugendpsychiatr Psychother 2010; 38: 37-49.
35 Kölch M. et al. Verhaltensaktivierung durch SSRI als Gefahr für Amoktaten von Jugendlichen?. Nervenheilkunde 2010; 29: 451-5.
36 Gibbons RD. et al. Suicidal thoughts and behaviour with antidepressant treatment. Arch Gen Psychiatry. 2012 Epub ahead of print: doi:10.1001/archgenpsychiatry.2011.2048..
37 Grootens KP. et al. Emerging evidence for the use of atypical antipsychotics in borderline personality disorder. Pharmacopsychiatry 2005; 38: 20-3.
38 Abraham PF. et al. Evidenced-based pharmacologic treatment of borderline personality disorder: A shift from SSRIs to anticonvulsants and atypical antipsychotics?. Journal of Affective Disorders 2008; 111: 21-30.
39 Schulz SC. et al. Olanzapine for the treatment of boderline personality disorder: Variable dose 12-week randomised double-blind placebo-controlled study. British Journal of Psychiatry 2008; 193: 485-92.
40 Linehan MM. et al. Olanzapine plus dialectical behaviour therapy for women with high irritability who meet criteria for borderline personality disorder: A double-blind, placebo-controlled pilot study. Journal of Clinical Psychiatry 2008; 69: 999-1005.
41 Soler J. et al. Double-blind, placebo-controlled study of Dialectical Behavior Therapy plus olanzapine for Borderline Personality disorder. Am J Psychiatry 2005; 162: 1221-4.
42 Chengappa KNR. et al. Clozapine reduces severe self-mutilation and aggression in psychotic patients with Borderline Personality disorder. Journal of Clinical Psychiatry 1999; 60: 477-84.
43 Hilger E. et al. Quetiapine in the treatment of borderline personality disorder. World Journal Biological Psychiatry 2003; 04: 42-4.
44 Nickel MK. et al. Aripiprazole in the treatment of patients with borderline personality disorder: A double-blind, placebo-controlled study. American Journal of Psychiatry 2006; 163: 833-8.
45 Nickel MK. et al. Aripiprazole in treatment of borderline patients, part II: An 18-month follow-up. Psychopharmacology 2007; 191: 1023-26.
46 Good CR. Adjunctive Quetiapine targets selfharm behaviors in adolescent females with major depressive disorder. Journal of Child and Adolescent Psychopharmacology 2006; 16: 235-6.
47 Libal G. et al. Ziprasidone as a weight-neutral treatment alternative in the treatment of self-injurious behavior in adolescent females. Child and Adolescent Psychopharmacology News 2005; 10: 1-6.
48 Cordàs TA. et al. Oxacarbazepine for self-mutilating bulimic patients. International Journal of Neuropsychopharmacology 2006; 09: 769-71.
49 Bellino S. et al. Oxcarbazepine in the treatment of borderline personality disorder: A pilot study. Journal of Clinical Psychiatry 2005; 66: 1111-5.
50 Cassano P. et al. Topiramate for self-mutilation in a patient with borderline personality disorder. Bipolar Disorders 2001; 03: 161.
51 Pittenger C. et al. Initial evidence of the beneficial effects of glutamate-modulating agents in the treatment of self-injurious behavior associated with borderline personality disorder. J Clin Psychiatry 2005; 66: 1492-3.
52 Kapusta ND. et al. Lithium in drinking water and suicide mortality. Br J Psychiatry 2011; 198: 346-50.
53 Masters KJ. Anti-suicidal and self-harm properties of lithium carbonate. CNS Spectrums 2008; 13: 109-10.
54 Philipsen A. et al. Clonidine in acute aversive inner tension and self-injurious behavior in female patients with borderline personality disorder. Journal of Clinical Psychiatry 2004; 65: 1414-19.
55 Osuch EA. et al. Neurobiological perspectives on Self-injury. In Nixon MK, Heath NL. (eds.) Self-Injury in Youth. New York London: Routledge; 2009: 79-111.
56 Sher L. et al. Biological Models of Nonsuicidal Self-Injury. In: Nock MK. (Ed.) Understanding Nonsuicidal Self-Injury. Origins, Assessment, and Treatment. Washington D.C: American Psychological Association; 2009: 99-117.
57 Stanley B. et al. Non-suicidal self-injurious behavior, endogenous opioids and monoamine neurotransmitters. J Affect Disord 2010; 124: 134-40.
58 Sandman CA. The opiate hypothesis in autism and self-injury. Journal of Child and Adolescent Psychopharmacology 1990/91; 01: 193-99.
59 Symons FJ. et al. Self-injurious behaviour and the efficacy of naltrexone treatment: A quantitative synthesis. Mental Retardation and Developmental Disabilities Research Reviews 2004; 10: 193-200.
60 Roth AS. et al. Naltrexone as a treatment for repetitive self-injurious behaviour: An open–label trial. Journal of Clinical Psychiatry 1996; 57: 233-37.
61 Griengl H. et al. Naltrexone as a treatment of selfinjurious behavior-a case report. Acta Psychiatrica Scandinavica 2001; 103: 234-6.
62 Mc MDGee. Cessation of self-mutilation in a patient with borderline personality disorder treated with naltrexone. Journal of Clinical Psychiatry 1997; 58: 32-33.
63 Sonne S. et al. Naltrexone treatment of self-injurious thoughts and behaviours. Journal of Nervous and Mental Disease 1996; 184: 192-5.
64 Cowdry RW. et al. Pharmacotherapy for Borderline Personality Disorder. Archives of General Psychiatry 1988; 45: 111-9.
65 Rothschild AJ. et al. Comparison of the frequency of behavioural disinhibition on alprazolam, clonazepam, or no benzodiazepine in hospitalized psychiatric patients. Journal of Clinical Psychopharmacology 2000; 20: 7-11.
66 Berman ME. et al. The effects of diazepam on human self-aggressive behaviour. Psychopharmacology (Berl) 2005; 178: 100-6.
67 Owen C. et al. The role of fatty acids in the development and treatment of mood disorders. Current Opinion in Psychiatry 2008; 21: 19-24.
68 Garland MR. et al. Lipids and essential fatty acids in patients presenting with self-harm. British Journal of Psychiatry 2007; 190: 112-7.
69 Hallahan B. et al. Omega-3 fatty acid supplementation in patients with recurrent self-harm. British Journal of Psychiatry 2007; 190: 118-22.
70 Harbour R. et al. A new system for grading recommendations in evidence based guidelines. British Medical Journal 2001; 323: 334-6.
71 Nose M. et al. Efficacy of pharmacotherapy against core traits of borderline personality disorder: Meta-analysis of randomized controlled trials. International Clinical Psychopharmacology 2006; 21: 345-53.
72 Villalba R. et al. Repetitive self-injurious behavior: A neuropsychiatric perspective and review of pharmacologic treatments. Seminars in Clinical Neuropsychiatry 2000; 05: 215-26.
73 Nitkowski D. et al. Behavioural analysis of self-injurious behaviour. Nervenheilkunde 2009; 28: 227-31.
74 Katz LY. et al. The role of behavioral analysis in the pharmacotherapy of emotionally-dysregulated problem behaviors. Child and Adolescent Psychopharmacology News 2005; 10: 1-5.
75 Mobascher A. et al. Behandlung der Borderline Persönlichkeitsstörung mit atypischen Antipsychotika. Nervenarzt 2007; 78: 1003-13.
76 Plener PL. et al. Non-suicidal self-injury as autonomous diagnosis – implications for research and clinic of the DSM-5 proposal to establish the diagnosis of Non-Suicidal Self-Injury in adolescents. Z Kinder Jugendpsychiatr Psychother 2012; 40: 113-20.
77 Whitlock J. et al. The relationship between self-injurious behaviour and suicide in a young adult population. Archives of Pediatric and Adolescent Medicine 2007; 161: 634-40.
78 Andover MS. et al. The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: distinguishing risk factors and psychosocial correlates. Child and Adolescent Psychiatry and Mental Health 2012; 06: 11.
79 Shaffer D. et al. Proposal to the DSM-V Childhood Disorder and Mood Disorder Work Groups to Include Non-Suicidal Self-Injury (NSSI) as a DSM-V Disorder. www.dsm5.org/Proposed%20Revision%20Attachments/APA%20DSM-5%20NSSI%20Proposal.pdf 2009
80 Groschwitz R, Plener PL. Psychotherapie von nicht suizidalem selbstverletzendem Verhalten. Nervenheilkunde 2013; 32: 30-36.