Psychische Erkrankungen in der Lebensspanne ... - DGPPN

Topic 2 G Psychische Störungen durch psychotrope Substanzen, F1 // Mental disorders due to psychoactive substance use, F1
the SSAGA (Semi-Structured Assessment on Genetics in Alcoholism)
while personality traits including impulsivity were assessed
using the TPQ (Tridimensional Personality Questionnaire).
Discussion / Results: Most important predictors of suicide at tempts
during the 5-year follow-up were depressive episodes and history of
previous suicidal behaviors. Furthermore, in suicidal cannabis-dependent
individuals, the onset of several psychiatric disorder cumulate
within three years before the first attempt. Depression and
history of suicidal behavior significantly increase the risk for suicide
attempts in cannabis-dependent subjects. This finding parallels
risk profiles for suicidal behaviors in other samples with alcohol-
and other substance use disorders beside cannabis. The accumulation
of various psychiatric disorders within 3 years before first suicide
attempts indicates a possible treatment intervention to prevent
subsequent suicide attempts.
004
Personality disorders in a clinical sample of cannabis dependent
young adults
Anna Watzke (Ev. Krankenhaus Bethanien, Fachklinik Gristower
Wiek, Gristow)
C. O. Schmidt, J. Zimmermann, U. Preuss
Method: In total 99 adolescents and young adults, aged 16 – 36
years, diagnosed with a cannabis dependence according to DSM IV
(SCID I), were investigated during their detoxification treatment in
an addiction treatment ward. Subjects were excluded if concomitant
alcohol- or other substance dependences were diagnosed. Furthermore,
subjects with other current DSM-IV Axis I diagnosis, or
severe somatic or neurological disorders were excluded. Personality
disorders were assessed with the SCID II screening interview.
Discussion / Results: There is evidence of PDs in the vast majority
of the cannabis-dependent young inpatients. Almost 90 % of the
subjects fulfilled the screening criteria of an antisocial PD, more
than half had a paranoid PD and more than a third reported a Borderline
PD. More than one third of the sample fulfilled the screening
criteria of three or more PDs. There was no consistent relationships
between PDs and concurrent consumption of other drugs,
severity of drug addiction or delinquencies. Diagnosis and treatment
of these subjects has to provide not only addiction-specific
approaches but also strategies to improve dysfunctional behavior
caused by personality disorder characteristics.
Cannabis addiction is commonly associated with the presence of
personality disorders (PDs). However, most previous studies focussed
on singular disorders like Borderline or Antisocial PDs.
There is little data available on the full range of PDs among cannabis
addicted subjects. Even less is known about the prevalence of
PDs among cannabis dependent adolescents and young adults in
inpatient settings. This issue has been addressed with the present
study.
Donnerstag, 26. 11. 2009, 08.30 – 10.00 Uhr, Saal Riga
S-044 Symposium
Neuropsychotherapie der Sucht
Vorsitz: J. Wrase (Berlin), F. Kiefer (Mannheim)
001
Cue reactivity bei Rauchern – überraschende fMRT Ergebnisse und
mögliche Behandlungskonsequenzen
Mira Bühler (ZI Mannheim, Suchtklinik)
Introduction: Drug addiction is characterized by an unhealthy pri-
42
ority for drug consumption with a compulsive, uncontrolled drugintake
pattern due to a disturbed motivational system. However,
only some individuals get addicted while others maintain a regular
but controlled drug use. Whether or not the transition occurs,
might dependent on how individuals process drug-related stimuli
(drug cues) relative to non-drug related stimuli (non-drug cues).
Method: To assess cue-elicited mesocorticolimbic brain activation
in the context of nicotine dependence, we conducted several functional
magnetic resonance imaging studies. In these imaging studies
we assessed processing of drug cues (smoking-related stimuli,
tobacco advertising) and non-drug reward cues (monetary cues,
erotic stimuli, control advertising) in non-smokers, non-dependent
occasional smokers and nicotine dependent smokers.
Discussion / Results: The results of these different imaging studies
all pointed in a similar direction: surprisingly, we found similar or
even less activation in the mesocorticolimbic reward system in response
to smoking cues in severe dependent smokers compared to
non-dependent occasional smokers. Furthermore, dependent smokers
showed less reactivity of the reward system to non-drug cues
such as monetary cues, control advertising and erotic stimuli than
occasional or non-smokers. Our results are in line with pre vious
findings suggesting that the mesocorticolimbic system is hypoactive
in drug addiction. In addition, our data provide evidence that
cue-reactivity might be a general feature of drug use rather than
being specific to drug addiction. This could also explain the lack of
predictive power of cue-elicited craving on relapse rates. Our results
indicate that reducing cue-reactivity could be a suboptimal
strategy in treating nicotine dependence. Implications of this finding
on treatment strategies are outlined and potential alter native
preventive approaches and therapeutic treatments are discussed.
002
Störung des verbalen und visuellen Lernen bei Patienten mit Alkoholabhängigkeit
in der frühen Abstinenz
Thorsten Kienast (PUK Charité im SHK, Berlin)
003
Einfluss von Verlangen und Motivation auf die neuronale cue reactivity
und Konsequenzen für die Therapie
Tagrid Lemenager (Zi-Mannheim, Suchtforschung)
Introduction: The functional imaging literature on alcohol associated
cue-reactivity in alcoholics shows a high heterogeneity of
study results. We investigated whether the influence of context- and
emo tion-related craving in alcohol dependent patients is able to
explain some of these heterogeneous results. In order to do so,
we distin guished different dimensions of „alcohol temptation“
(craving) and assess the relationship to brain activity.
Method: 53 abstinent alcoholics underwent fMRI while watching
alcohol associated, abstract and neutral stimuli. Contrasts were
created to get evidence on different levels of activation in association
with alcohol-related stimuli compared to stimuli of neutral
valence. Different context- and emotion-related craving was assessed
with four extracted components of the alcohol abstinence
self efficacy (AASE) „temptation“-scale (reward, relief, testing personal
control, psychological or physical needs), whose 20 items
were previously subjected to a principle component analysis. Image
processing and statistical analysis were performed using SPM5.
The influence of the four components on neural cue-reactivity was
assessed by using a multiple linear regression analysis.
Discussion / Results: The results indicate that different motivationrelated
craving is able to explain some of the heterogeneous study
results in neural cue-reactivity. Individualized psychotherapeutic
interventions based on these results will be discussed.