Chronische Suizidalität – eine besondere Form der Suizidalität?

ZUSAMMENFASSUNG

Hintergrund Chronisch suizidale Patienten fordern unser Versorgungssystem immer wieder heraus, wobei Betroffene selbst einen hohen Leidensdruck beklagen und oft keine spezifische Behandlung erhalten. Der Begriff „chronische Suizidalität“ ist aber unscharf definiert und es ist unklar, welche Implikationen sich z. B. bei der Beurteilung der Suizidalität oder der Behandlung ableiten lassen.

Methode Chronische Suizidalität wird anhand der vorhandenen Literatur aus verschiedenen Perspektiven beleuchtet: Psychologische Mechanismen und Hintergründe, Neurobiologie, Therapie sowie die klinische Einschätzung des Suizidrisikos.

Ergebnisse Es gibt keine belastbaren Hinweise, dass psychologische Funktionen bei akuter und chronischer Suizidalität prinzipiell verschieden sind. Der Begriff „chronisch“ zeigt aber möglicherweise zusätzlich auf, dass bei einem Betroffenen psychobiologische Verstärkermechanismen zur Aufrechterhaltung, bzw. Wiederkehren der Symptomatik beitragen. Die dialektisch-behaviorale Therapie sowie die Akzeptanz-Commitment-Therapie haben sich bei der Behandlung chronisch suizidaler Symptomatik wirksam gezeigt, sind aber noch zu wenig diagnoseübergreifend im Einsatz, bzw. wissenschaftlich überprüft. Für die Einschätzung des Schweregrades der Suizidalität soll der Begriff „chronisch“ nicht verwendet werden.

Diskussion Die vorliegende Übersicht versucht, die unterschiedlichen Aspekte zur chronischen Suizidalität zu beleuchten, erhebt aber nicht den Anspruch umfassend zu sein und ist aufgrund einer begrenzten Zahl spezifischer Studien unvollständig. Auch vor dem Hintergrund der hohen individuellen Krankheitslast und der Grenzen im aktuellen Versorgungsangebot besteht deutlicher Forschungsbedarf, um spezifische antisuizidale Interventionen Patienten mit chronischer Suizidalität zugänglich zu machen.

ABSTRACT

Background While suffering from a high burden of disease and seldom receiving specific treatment, chronically suicidal patients challenge health care providers. Nevertheless, the definition of “chronic suicidality” is fuzzy according to current literature, and it is unclear what it implicates with respect to suicide risk and treatment.

Methods Different perspectives of chronic suicidality are presented including psychological mechanisms and motives, neurobiology, therapy, and the assessment of suicide risk.

Results Data do not assume that acute and chronic suicidality differ with respect to psychological functions. Nevertheless, “chronic“ implies potential reinforcement mechanisms that are responsible for the development and maintenance of suicidal symptomatology. The Dialectic Behavioral Therapy and Acceptance Commitment Therapy have shown to reduce suicidality in chronic suicidal patients while they are not yet sufficiently

applied and validated across diagnoses. The term “chronic” may not be used to stratify patient’s suicide risk.

Discussion While different aspects of chronic suicidality are highlighted, several others are not. Further, there is a lack of clinical studies that are urgently needed to improve availability of effective anti-suicidal interventions and reduce the individual burden of disease.

Schlüsselwörter

Chronische Suizidalität - Borderline-Persönlichkeitsstörung - Verstärker - Verhaltensanalyse - DBT

Key words

Chronic suicidality - borderline personality disorder - reinforcement - behavioral analysis - DBT

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