Psychiatrie Verena Kaiser Wintersemester 2011/12 - anthropia

Psychotrope SubstanzenPsychiatrieVerlauf der Abhängigkeit und Therapiephasen- Ungefährlicher Gebrauch – Normalzustand- Durch psychische Belastung steigt die Toleranz – Patienten brauchen mehr → gefährlicher Gebrauch- Bei weiterer Steigerung: schädlicher Gebrauch- Bis hin zur chronischen Abhängigkeit (Diagnose der chronischen Abhängigkeit benötigt die Anamnese einesganzen Jahres)Brief intervention- Prinzip der medizinischen Versorgung: Normale ärztliche Tätigkeit: Fragen stellen, evaluieren, beraten, behandelnund assistieren- Ask: es wird nur selten gefragt, wie viel die Patienten konsumieren → Hemmung v.a. dort, wo ein Verdacht aufexzessiven Konsum besteht∙ Problem: was, wenn Patient zu viel trinkt? Was macht man mit dem Patienten?- BRIEF INTERVENTION — Primary care physicians may consider a brief intervention for patients who meet thecriteria for at-risk drinking or whom the clinician feels may develop problem drinking, although they are notcurrently alcohol dependent.- Brief interventions vary in intensity, ranging from a one-time discussion with a clinician, to several visits withfollow-up nurse phone calls. These interventions typically include an initial counseling session of 10 to 15 minutes,incorporating feedback, advice, and goal-setting; follow-up by visit or phone contact is helpful- The National Institute for Alcohol Abuse and Alcoholism (NIAAA) has developed a clinician's guide which outlinescomponents of a brief intervention. Four clinician components are identified:∙ Ask about alcohol use∙ Assess∙ Advise∙ Assist- For patients who have been identified as at-risk drinkers, clinicians should clearly state their assessment ("You aredrinking more than is medically safe") and offer assistance ("Are you willing to consider making changes in yourdrinking?").- For patients who express willingness to change, a goal and plan to achieve that goal (with supportive educationalmaterials) should be set.- Patients who are not ready to make changes should be encouraged to reflect on their drinking and the barriersthey perceive to change. The clinician's concern and willingness to help should be reaffirmedSpuren der EvolutionEthanol is a naturally occurring substance resulting from the fermentation by yeast of fruit sugars. The association between yeasts andangiosperms dates to the Cretaceous, and dietary exposure of diverse frugivorous taxa to ethanol is similarly ancient. Ethanol plumes canpotentially be used to localize ripe fruit, and consumption of low-concentration ethanol within fruit may act as a feeding stimulant. Ripeand over-ripe fruits of the Neotropical palm Astrocaryum standleyanum contained ethanol within the pulp at concentrations averaging0.9% and 4.5%, respectively. Fruit ripening was associated with significant changes in color, puncture resistance, sugar, and ethanolcontent. Natural consumption rates of ethanol via frugivory and associated blood levels are not known for any animal taxon. However,behavioral responses to ethanol may have been the target of natural selection for all frugivorous species, including many primates and thehominoid lineages ancestral to modern humans. Preexisting sensory biases associating this ancient psychoactive compound withnutritional reward might accordingly underlie contemporary patterns of alcohol consumption and abuse.Alkohol: tief verwurzelt → rasche Wahrnehmung des Alkoholgehalt war evolutionär sehr wichtig, um den Kaloriengehaltvon Früchten einzuschätzen → es wird vermutet, dass daher mit dem Alkohol positive Geschmackserlebnisse verknüpft sindSeite 51Verena Kaiser