Drogen und Nervensystem (Teil 3): Differenzialdiagnose drogenassoziierter Zustände und kurzer Ausblick

Weiterbildungsziele In diesem Beitrag sollen folgende Weiterbildungsziele vermittelt werden: Kenntnis der wichtigsten Intoxikations- und Entzugssymptome drogenassoziierter Zustände Kenntnis der wichtigsten Differenzialdiagnosen drogenassoziierter Zustände Kenntnis der Probleme der Polytoxikomanie Kenntnis der Gefahren und Problematik von so genannten „Designer Drugs” für den Konsumenten und den Arzt Kenntnis der medikamentösen therapeutischen Zukunftsperspektiven von Drogenabhängigkeit

Nachdem in den beiden vorangehenden Teilen dieser Übersichtsarbeit die Grundlagen der Drogenwirkung und Abhängigkeitsentwicklung sowie die einzelnen Drogen detailliert dargestellt worden sind, soll im nachfolgenden letzten Teil knapp und synoptisch die Differenzialdiagnose drogenassoziierter Zustände erläutert und ein kurzer Ausblick hinsichtlich zukünftiger Herausforderungen durch neue Drogen sowie therapeutischer Strategien getätigt werden.

Die klinisch-neurologische Differenzialdiagnose von drogeninduzierten Symptomen ist extrem breit (s. a. Tab. [1]).

Literatur

• 1 Neiman J, Haapaniemi H M, Hilborn M. Neurological complications of drug abuse: pathophysiological mechanisms.  Eur J Neurol. 2000;  7 595-606
• 2 Hill M D, Cooper P W, Perry J R. Chasing the dragon - neurological toxicity associated with inhalation of heroin vapour: case report.  CMAJ. 2000;  162 236-238
• 3 Long H, Deore K, Hoffman R S, Nelson L S. A fatal case of spongiform leukoencephalopathy linked to „chasing the dragon”.  J Toxicol Clin Toxicol. 2003;  41 887-891
• 4 Filley C M, Kleinschmidt-DeMasters B K. Toxic leukoencephalopathy.  New Engl J Med. 2001;  345 425-432
• 5 Alldredge B K, Lowenstein D H, Simon R P. Seizures associated with recreational drug abuse.  Neurology. 1989;  39 1037-1039
• 6 Zagoni P G, Albano C. Psychostimulants and epilepsy.  Epilepsia. 2002;  43 (Suppl 2) S28-S31
• 7 Ben-Abraham R, Szold O, Rudick V, Weinbroum A A. „Ecstasy” intoxication: life-threatening manifestations and resuscitative measures in the intensive care setting.  Eur J Emerg Med. 2003;  10 309-313
• 8 Miro O, Nogue S, Espinosa G. et al . Trends in illicit drug emergencies: the emerging role of gamma-hydroxybutyrate.  J Toxicol Clin Toxicol. 2002;  40 129-135
• 9 Dyer J E. γ-Hydroxybutyrate: a health-food product producing coma and seizure-like activity.  Am J Emerg Med. 1991;  9 321-324
• 10 Lowenstein D H, Massa S M, Rowbotham M C. et al . Acute neurologic and psychiatric complications associated with cocaine abuse.  Am J Med. 1987;  83 841-846
• 11 Andersen S N, Skullerud K. Hypoxic/brain ischemia damage, especially pallidal lesions, in heroin addicts.  Forensic Sci Int. 1999;  102 51-59
• 12 Fessler R D, Esshaki C M, Stankewitz R C. et al . The neurovascular complications of cocaine.  Surg Neurol. 1997;  47 339-345
• 13 Aggarwal S K, Williams V, Levine S R. et al . Cocaine-associated intracranial hemorrhage: absence of vasculitis in 14 cases.  Neurology. 1996;  46 1741-1743
• 14 Buxton N, McConachie N S. Amphetamine abuse and intracranial haemorrhage.  J R Soc Med. 2000;  93 472-477
• 15 Perez Jr J A, Arsura E L, Strategos S. Methamphetamine-related stroke: four cases.  J Emerg Med. 1999;  17 469-471
• 16 McEvoy A W, Kitchen N D, Thomas D G. Intracerebral haemorrhage and drug abuse in young adults.  Br J Neurosurg. 2000;  14 449-454
• 17 Moussouttas M. Cannabis use and cerebrovascular disease.  Neurologist. 2004;  10 47-53
• 18 Dhuna A, Pascual-Leone A, Belgrade M. Cocaine-related vascular headaches.  J Neurol Neurosurg Psychiatry. 1991;  54 803-806
• 19 Toth C. Medications and substances as a cause of headache: a systematic review of the literature.  Clin Neuropharmacol. 2003;  26 122-136
• 20 Poole R, Brabbing C. Drug-induced psychosis.  Br J Psychiatry. 1996;  168 135-138
• 21 Lejoyeux M, Mourad I, Ades J. Psychiatric disorders induced by drug dependence other than alcohol.  Encephale. 2000;  26 21-27
• 22 Rogers R D, Robbins T W. Investigating the neurocognitive deficits associated with chronic drug misuse.  Curr Opin Neurobiol. 2001;  11 250-257
• 23 Nordahl T E, Salo R, Leamon M. Neuropsychological effects of chronic methamphetamine use on neurotransmitters and cognition: a review.  J Neuropsychiatry Clin Neurosci. 2003;  15 317-325
• 24 Halpern J H, Pope Jr H G. Hallucinogen persisting perception disorder: what do we know after 50 years?.  Drug Alcohol Depend. 2003;  69 109-119
• 25 Halpern J H, Pope Jr H G, Sherwood A R. et al . Residual neuropsychological effects of illicit 3,4-methylendioxymethamphetamine (MDMA) in individuals with minimal exposure to other drugs.  Drug Alcohol Depend. 2004;  75 135-147
• 26 McCardle K, Luebbers S, Carter J D. et al . Chronic MDMA (ecstasy) use, cognition and mood.  Psychopharmacology. 2004;  173 434-439
• 27 Vecellio M, Schopper C, Modestin J. Neuropsychiatric consequences (atypical psychosis and complex-partial seizures) of ecstasy use: possibile evidence for toxicity-vulnerability predictors and implications for preventive and clinical care.  J Psychopharmacol. 2003;  17 342-345
• 28 Henquet C, Krabbendam L, Spauwen J. et al . Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people.  BMJ. 2005;  330 11 , doi: 10.1136/bmj.38267.664086.63 (published 1 December 2004)
• 29 Manfredi P L, Gonzales G R, Payne R. Reversible spastic paraparesis induced by high-dose intravenous metadone.  J Pain. 2001;  2 77-79
• 30 Stamboulis E, Psimaras A, Malliara-loulakaki S. Brachial and lumbar plexitis as a reaction to heroin.  Drug Alcohol Depend. 1988;  22 205-207
• 31 Bernasconi A, Kuntzer T, Ladbon N. et al . Complications neurologiques périphériques et médullaires de la toxicomanie intraveineuse à l'héroine.  Rev Neurol. 1996;  152 688-694
• 32 Pestaner J P, Southall P E. Sudden death during arrest and phencyclidine intoxication.  Am J Forensic Med Pathol. 2003;  24 119-122
• 33 Green A R, O'Shea E, Colado M I. A review or the mechanisms involved in the acute MDMA (ecstasy)-induced hyperthermic response.  Eur J Pharmacol. 2004;  500 3-13
• 34 Holmes S B, Banerjee A K, Alexander W D. Hyponatraemia and seizures after ecstasy use.  Postgrad Med J. 1999;  75 32-34
• 35 Hartung T K, Schofield E, Short A I. et al . Hyponatraemic states following 3,4-methylendioxymethamphetamine (MDMA, „Ecstasy”) ingestion.  Q J Med. 2002;  95 431-437
• 36 Nath A, Maragos W F, Avison M J. et al . Acceleration of HIV dementia with methamphetamine and cocaine.  J Neurovirol. 2001;  7 66-71
• 37 Friedman H, Eisenstein T K. Neurological basis of drug dependence and its effects on the immune system.  J Neuroimmunol. 2004;  147 106-108
• 38 Vallejo R, Leon-Casasola O de, Ramsun B. Opioid therapy and immunosuppression: a review.  Am J Ther. 2004;  11 354-365
• 39 Connor T J. Methylendioxymethamphetamine (MDMA, „Ecstasy”): a stressor on the immune system.  Immunology. 2004;  111 357-367
• 40 Bialer P A. Designer drugs in the general hospital.  Psychiatr Clin North Am. 2002;  25 231-243
• 41 Staack R F, Maurer H H. Metabolism of designer drugs of abuse.  Curr Drug Metab. 2005;  6 259-274
• 42 Sassenbroeck D K Van, Calle P A, Rousseau F M. et al . Medical problems related to recreational drug use at nocturnal dance parties.  Eur J Emerg Med. 2003;  10 302-308
• 43 Refstad S. Paramethoxyamphetamine (PMA) poisoning: a „party drug” with lethal effect.  Acta Anaesthesiol Scand. 2003;  47 1298-1299
• 44 Becker J, Neis P, Röhrich J, Zörntlein S. A fatal Paroxymethamphetamin intoxication.  Legal Med. 2003;  5 (Suppl) S138-S141
• 45 Amato L, Davoli M, Minozzi S. et al .Metadone at tapered doses for the management of opioid withdrawal. Cochrane Database Syst Rev 2005 Jul 20 (3) CD003409
• 46 Ferri M, Davoli M, Amato L. Heroin maintenance for chronic heroin dependents. Cochrane Database Syst Rev 2005 Apr 18 (2) CD003410
• 47 Amato L, Davoli M, Perucci C A. et al . An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research.  J Subst Abuse Treat. 2005;  28 321-329
• 48 Kosten T R, O'Connor P G. Management of drug and alcohol withdrawal.  New Engl J Med. 2003;  348 1786-1795
• 49 Umbricht A, Hoover D R, Tucker M J. et al . Opioid detoxification with buprenorphine, clonidine, or methadone in hospitalized heroin-dependent patients with HIV infection.  Drug Alcohol Depend. 2003;  69 263-272
• 50 Bochud Tornay C, Favrat B, Monnat M. et al . Ultra-rapid opiate detoxification using deep sedation and prior oral buprenorphine preparation: long-term results.  Drug Alcohol Depend. 2003;  69 283-288
• 51 Digiusto E, Lintzeris N, Breen C. et al for the NEPOD Research Group . Short-term outcomes of five heroin detoxification methods in the Australian NEPOD Project.  Addict Behav. 2005;  30 443-456
• 52 Richmond R, Zwar N. Review of bupropion for smoking cessation.  Drug Alcohol Rev. 2003;  22 203-222
• 53 Aubin H J, Lebargy F, Berlin I. et al . Efficacy of bupropion and predictors of successful outcome in a sample of French smokers: a randomized placebo-controlled trial.  Addiction. 2004;  99 1206-1218
• 54 Fernandez J R, Allison D B. Rimonabant Sanofi-Synthélabo.  Curr Opin Invest Drugs. 2004;  5 430-435
• 55 Boyd S T, Fremming B A. Rimonabant - a selective CB1 antagonist.  Ann Pharmacother. 2005;  39 684-690
• 56 Gaal L F Van, Rissanen A M, Scheen A J. et al . Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study.  Lancet. 2005;  365 1389-1397
• 57 Kantak K M. Vaccines against drugs of abuse: a viable treatment option?.  Drugs. 2003;  63 341-352
• 58 Martell B A, Mitchell E, Poling J. et al . Vaccine pharmacotherapy for the treatment of cocaine dependence.  Biol Psychiatry. 2005;  58 158-164
• 59 Ashcroft R E, Franey C. Further ethical and social issues in using a cocaine vaccine: response to Hall and Carter.  J Med Ethics. 2004;  30 341-343