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DOI: 10.1055/s-2005-919078
Duale Diagnose Psychose und Sucht
Theoretische Prinzipien und Konsequenzen für die klinische PraxisDoble Diagnosis - Psychosis and AddictionPublication History
Publication Date:
01 September 2006 (online)

Lernziele
Große epidemiologische Studien und die klinische Empirie belegen, dass Suchterkrankungen bei Patienten mit schizophrenen Störungen gehäuft vorkommen und Verlauf und Behandlung der komorbiden Patienten deutlich erschweren. Die Patientengruppe mit der Dualen Diagnose Psychose und Sucht zeigt überwiegend eine schlechte Compliance mit häufigen Rezidiven und notfallmäßigen stationären Aufnahmen sowie schlechte langfristige soziorehabilitative Ergebnisse. Diese Patientengruppe stellt uns vor eine besondere therapeutische Herausforderung, erfordert deren Behandlung doch die Verzahnung von Vorgehensweisen und Konzepten aus der psychiatrischen Krankenversorgung einerseits und der Suchttherapie andererseits. Ziel dieses Beitrages ist es, die ätiologischen Modelle zur Erklärung der Komorbidität Psychose und Sucht und die Konsequenzen der Komorbidität für den klinischen Verlauf zu vermitteln, sowie den aktuellen Stand zur Behandlung der Dualen Patienten darzustellen.
Literatur
- 1
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. Results from the
Epidemiologic Catchment Area (ECA) Study.
JAMA.
1990;
264
2511-2518
MissingFormLabel
- 2 Hubbard J R, Martin P R. Substance abuse in the mentally and physically disabled: an overview. In: Hubbard JR, Martin PR (Hrsg). Substance abuse in the mentally and physically disabled. New York, Basel: Marcel Dekker 2001: 1-10
MissingFormLabel
- 3 Cantor-Graae E, Nordstrom L G, McNeil T F. Substance abuse in schizophrenia: a review of the literature and a study of correlates in Sweden. Schizophr Res. 2001; 48 69-82
- 4
Drake R E, Mueser K T.
Psychosocial approaches to dual diagnosis.
Schizophr Bull.
2000;
26
105-118
MissingFormLabel
- 5 Lammertink M, Lohrer F, Kaiser R, Hambrecht M, Pukrop R. Differences in substance abuse patterns: multiple drug abuse alone versus schizophrenia with multiple drug abuse. Acta Psychiatr Scand. 2001; 104 361-366
- 6 Duke P J, Pantelis C, McPhillips M A, Barnes T R. Comorbid non-alcohol substance misuse among people with schizophrenia: epidemiological study in central London. Br J Psychiatry. 2001; 179 509-513
- 7
Dixon L.
Dual diagnosis of substance abuse in schizophrenia: prevalence and impact on outcomes.
Schizophr Res.
1999;
35 Suppl
S93-100
MissingFormLabel
- 8
Mueser K T, Yarnold P R, Rosenberg S D, Swett Jr C, Miles K M, Hill D.
Substance use disorder in hospitalized severely mentally ill psychiatric patients:
prevalence, correlates, and subgroups.
Schizophr Bull.
2000;
26
179-192
MissingFormLabel
- 9 Dervaux A, Bayle F J, Laqueille X, Bourdel M C, Le Borgne M H, Olie J P, Krebs M O. Is substance abuse in schizophrenia related to impulsivity, sensation seeking, or anhedonia?. Am J Psychiatry. 2001; 158 492-494
- 10
Mueser K T, Drake R E, Wallach M A.
Dual diagnosis: a review of etiological theories.
Addict Behav.
1998;
23
717-734
MissingFormLabel
- 11
Blanchard J J, Brown S A, Horan W P, Sherwood A R.
Substance use disorders in schizophrenia: review, integration, and a proposed model.
Clin Psychol Rev.
2000;
20
207-234
MissingFormLabel
- 12
Chambers R A, Krystal J H, Self D W.
A neurobiological basis for substance abuse comorbidity in schizophrenia.
Biol Psychiatry.
2001;
50
71-83
MissingFormLabel
- 13 Gouzoulis-Mayfrank E. Komorbidität Psychose und Sucht - Von den Grundlagen zur Praxis - Mit Manual für Psychoedukatives
Training. Darmstadt: Steinkopff 2003
MissingFormLabel
- 14 Hambrecht M, Haefner H. H. Substance abuse and the onset of schizophrenia. Biol Psychiatry. 1996; 40 1155-1163
- 15 Linszen D H, Dingemans P M, Lenior M E. Cannabis abuse and the course of recent-onset schizophrenic disorders. Arch Gen Psychiatry. 1994; 51 273-279
- 16 Andreasson S, Allebeck P, Engstrom A, Rydberg U. Cannabis and schizophrenia. A longitudinal study of Swedish conscripts. Lancet. 1987; 2 1483-1486
- 17 Lee M A, Meltzer H Y. Substance abuse in schizophrenia. Biological factors mediating comorbidity and the
potential role of atypical antipsychotic drugs. In: Hubbard JR, Martin PR (Hrsg). Substance abuse in the mentally and physically disabled. New York: Marcel Dekker 2001: 77-101
MissingFormLabel
- 18 Hunt G E, Bergen J, Bashir M. Medication compliance and comorbid substance abuse in schizophrenia: impact on community survival 4 years after a relapse. Schizophrenia Research. 2002; 54 253-264
- 19 Ziedonis D M, D'Avanzo K. Schizophrenia and Substance abuse. In: Kranzler HR, Rounsaville BJ (Hrsg). Dual diagnosis and treatment. New York: Marcel Dekker 1998: 427-465
MissingFormLabel
- 20
Drake R E, Mercer-McFadden C, Mueser K T, McHugo G J, Bond G R.
Review of integrated mental health and substance abuse treatment for patients with
dual disorders.
Schizophr Bull.
1998;
24
589-608
MissingFormLabel
- 21
Drake R E, Mueser K T, Brunette M F, McHugo G J.
A review of treatments for people with severe mental illnesses and co-occurring substance
use disorders.
Psychiatr Rehabil J.
2004;
27
360-374
MissingFormLabel
- 22 Bechdolf A, Pohlmann B, Reck C, Klosterkötter J, Gouzoulis-Mayfrank E. Motivationsbehandlung bei Patienten mit der Doppeldiagnose Psychose und Sucht: Eine
Übersicht. Fortschr Neurol Psychiat 2005, in Druck
MissingFormLabel
- 23
Bennett M E, Bellack A S, Gearon J S.
Treating substance abuse in schizophrenia. An initial report.
J Subst Abuse Treat.
2001;
20
163-175
MissingFormLabel
- 24 Barrowclough C, Haddock G, Tarrier N, Lewis S W, Moring J, O'Brien R, Schofield N, McGovern J. Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. Am J Psychiatry. 2001; 158 1706-1713
- 25 Dámelio R, Wodbrock T, Klein T, Behrendt B, Falkai P, Oest M. GOAL - Gesund und ohne Abhängigkeit leben. Ein integrativer Ansatz zur Therapie von
Patienten mit einer Psychose aus dem schizophrenen Formenkreis und komorbidem Substanzkonsum. In: Behrendt B, Schaub A (Hrsg). Psychoedukation und Selbstmanagement. Verhaltenstherapeutische
Ansätze zur Krankheitsbewältigung für die klinische Praxis. Tübingen: DGVT Verlag 2004
MissingFormLabel
- 26
Mueser K T, Fox L.
A family intervention program for dual disorders.
Community Ment Health J.
2002;
38
253-270
MissingFormLabel
- 27 Dixon L, Adams C, Lucksted A. Update on family psychoeducation for schizophrenia. Schizophr Bull. 2000; 26 5-20
- 28 Buckley P F. Substance abuse in schizophrenia: a review. J Clin Psychiatry. 1998; 59 Suppl 3 26-30
- 29 Krystal J H, D'Souza D C, Madonick S, Petrakis I L. Toward a rational pharmacotherapy of comorbid substance abuse in schizophrenic patients. Schizophrenia Research. 1999; 35 Suppl S35-S49
- 30 Potvin S, Stip E, Roy J Y. Clozapine, quetiapine and olanzapine among addicted schizophrenic patients: towards testable hypotheses. Int Clin Psychopharmacol. 2003; 18 121-132
- 31 Noordsy D L, Green A I. Pharmacotherapy for schizophrenia and co-occurring substance use disorders. Curr Psychiatry Rep. 2003; 5 340-346
- 32
Green A I.
Schizophrenia and comorbid substance use disorder: effects of antipsychotics.
J Clin Psychiatry.
2005;
66 Suppl 6
21-26
MissingFormLabel
- 33 Brown E S, Nejtek V A, Perantie D C, Rajan T N, Rush A J. Cocaine and amphetamine use in patients with psychiatric illness: a randomized trial of typical antipsychotic continuation or discontinuation. J Clin Psychopharmacol. 2003; 23 384-388
- 34 Zimmet S V, Strous R D, Burgess E S, Kohnstamm S, Green A I. Effects of clozapine on substance use in patients with schizophrenia and schizoaffective disorder: a retrospective survey. J Clin Psychopharmacol. 2000; 20 94-98
- 35 Drake R E, Xie H, McHugo G J, Green A I. The effects of clozapine on alcohol and drug use disorders among patients with schizophrenia. Schizophr Bull. 2000; 26 441-449
- 36 Potvin S, Stip E, Roy J Y. The effect of quetiapine on cannabis use in 8 psychosis patients with drug dependency. Can J Psychiatry. 2004; 49 711
- 37 Warsi M, Sattar S P, Bhatia S C, Petty F. Aripiprazole reduces alcohol use. Can J Psychiatry. 2005; 50 244
- 38 Beresford T P, Clapp L, Martin B, Wiberg J L, Alfers J, Beresford H F. Aripiprazole in schizophrenia with cocaine dependence: a pilot study. J Clin Psychopharmacol. 2005; 25 363-366
- 39 Brown E S, Jeffress J, Liggin J D, Garza M, Beard L. Switching outpatients with bipolar or schizoaffective disorders and substance abuse from their current antipsychotic to aripiprazole. J Clin Psychiatry. 2005; 66 756-760
- 40
Sayers S L, Campbell E C, Kondrich J, Mann S C, Cornish J, O'Brien C, Caroff S N.
Cocaine abuse in schizophrenic patients treated with olanzapine versus haloperidol.
J Nerv Ment Dis.
2005;
193
379-386
MissingFormLabel
- 41 Green A I, Burgess E S, Dawson R, Zimmet S V, Strous R D. Alcohol and cannabis use in schizophrenia: effects of clozapine and risperidone. Schizophrenia Research. 2003; 60 81-85
- 42 Levin F R, Evans S M, Coomaraswammy S, Collins E D, Regent N, Kleber H D. Flupenthixol treatment for cocaine abusers with schizophrenia: a pilot study. Am J Drug Alcohol Abuse. 1998; 24 343-360
- 43 Soyka M, Aichmuller C, Bardeleben U, Beneke M, Glaser T, Hornung-Knobel S, Wegner U. Flupenthixol in relapse prevention in schizophrenics with comorbid alcoholism: results from an open clinical study. Eur Addict Res. 2003; 9 65-72
- 44 Maxwell S, Shinderman M S. Use of naltrexone in the treatment of alcohol use disorders in patients with concomitant major mental illness. J Addict Dis. 2000; 19 61-69
- 45
Petrakis I L, O'Malley S, Rounsaville B, Poling J, Hugh-Strong C, Krystal J H.
Naltrexone augmentation of neuroleptic treatment in alcohol abusing patients with
schizophrenia.
Psychopharmacology.
2004;
172
291-297
MissingFormLabel
- 46
Petrakis I L, Poling J, Levinson C, Nich C, Carroll K, Rounsaville B.
Naltrexone and disulfiram in patients with alcohol dependence and comorbid psychiatric
disorders.
Biol Psychiatry.
2005;
57
1128-1137
MissingFormLabel
Univ.-Prof. Dr. med. Euphrosyne Gouzoulis-Mayfrank
Klinik und Poliklinik für Psychiatrie und PsychotherapieKlinikum der Universität zu
Köln
Kerpener Straße 62
50931 Köln
Email: e.gouzoulis@uni-koeln.de