Psychiatrie Verena Kaiser Wintersemester 2011/12 - anthropia

Psychotrope SubstanzenPsychiatrieRESULTS: Thirty-five patients with DT died between January 2000 and June 2006. The majority (31; 88.6%) were male with a mean (+/-standard deviation [SD]) age of 51.7 (+/-7.6) years. Hyperthermia in the first 24 hours of DT diagnosis (OR = 10.0, 95% CI = 2.3 to 42.7),persistent tachycardia (OR = 24.0, 95% CI = 3.3 to 177.4), and use of restraints (OR = 7.50, 95% CI = 1.7 to 32.8) were associated withincreased mortality by univariate analysis, while an emergency department (ED) diagnosis of DT (OR = 0.18, 95% CI = 0.05 to 0.6) and use ofclonidine (OR = 0.10, 95% CI = 0.01 to 0.78) were associated with decreased mortality. In the CLR model, restraint use and hyperthermiawere the only variables that remained significant (OR = 5.8, 95% CI = 1.0 to 32.2; and OR = 6.1, 95% CI = 1.2 to 30.4, respectively).CONCLUSIONS: The use of restraints and hyperthermia is associated with increased odds of death for patients with DT. This study highlightsthe need for further research into modifiable factors influencing mortality from DT.Intensive careBenzodiazepineWirkstoff Name Halbwertszeit (Metaboliten-HWZ)Alprazolam Xanor 12–15 hChlordiazepoxid Librium 5–30 h (48–96 h)Clobazam Frisium 18 h (36–80–120 h)Clonazepam Rivotril 30–40 hDiazepam Valium, Gewacalm 24–48 h (50–80 h)Flunitrazepam Rohypnol 16–35hLorazepam Temesta 12,9–16,2 hMidazolam Dormikum 1,5–2,5 hNitrazepam Mogadon 18–30 hOxazepam Praxiten 5–15 hTetrazepam Myolastan 18 hTriazolam Halcion 1,4–4,6 hKurzwirksame Benzodiazepine- Oxazepam (Praxiten)∙ 30-300 mg /Tag in 3-4 Gaben- Lorazepam (Temesta)∙ 3-10 mg /Tag in 3-4 Gaben- Gut „titrierbar“- Geeignet für Symptomgesteuerte EntzugsbehandlungLangwirksame Benzodiazepine- Diazepam (Valium)∙ 10-45 mg / Tag in 2-3 Gaben- Clobazam (Frisium)∙ 20-40mg / Tag in 2-3 Gaben- Konstante Wirkung- Gefahr der Überdosierung- Bei complianten Patienten für den ambulanten Entzug geeignetAlkoholentzug: alternative Psychopharmaka ?- Antiepileptika∙ Valproat: negative Datenlage im Vergleich mit BZD∙ Carbamazepin (Tegretol): negative Datenlage im Vergleich mit BZD∙ Oxcarbazepin (Trileptal): gute Daten aber nicht besser als BZD∙ Pregabalin (Lyrica): gute Daten aber nicht besser als BZDSeite 57Verena Kaiser