Tabakabhängigkeit und Raucherentwöhnung bei psychiatrischen Patienten

Zusammenfassung:

Die Prävalenz des Rauchens ist bei psychiatrischen Patienten im Vergleich mit psychisch Gesunden außerordentlich hoch. Vor allem Patienten mit anderen Abhängigkeitserkrankungen sowie Patienten mit schizophrenen Störungen sind häufig auch abhängige Raucher. Damit verbunden ist ein erhöhtes Risiko für eine tabakassoziierte Morbidität und Mortalität. Soziale Faktoren reichen nicht aus, um die hohe Raucherprävalenz zu erklären. Zahlreiche Untersuchungen weisen darauf hin, daß das Rauchen bei psychischen Störungen eine Form der Selbstmedikation darstellt. Vermutlich sind biologische Bedingungen, beispielsweise die Aktivierung dopaminerger oder cholinerger zentraler Strukturen, aber auch die Beeinflussungen des Psychopharmakastoffwechsels als begünstigend anzunehmen.

Versuche, die Häufigkeit des Rauchens bei psychiatrischen Patienten einzuschränken, sind zumeist ergebnislos: Sowohl präventive Maßnahmen als auch Raucherentwöhnungstherapien werden schlecht angenommen bzw. selten mit Erfolg durchgeführt. Die Raucherentwöhnung stationärer psychiatrischer Patienten wird häufig zusätzlich durch die gleichzeitige Gabe von Psychopharmaka kompliziert.

Neuere Untersuchungen jedoch belegen die Wirksamkeit von Entwöhnungsstrategien insbesondere auch bei schizophrenen, drogenabhängigen oder alkoholabhängigen Patienten. Den Ursachen der Abstinenzunfähigkeit kann durch intensivere Behandlungsstrategien innerhalb einer stationären Behandlungsmaßnahme, aber auch durch einen großzügigeren Einsatz von Nikotinersatzpräparaten wirkungsvoll begegnet werden. Der Einsatz von Nikotinersatzpräparaten wirkt starken Entzugssymptomen entgegen und ist insbesondere unter der Hypothese einer biologischen Ursache der Nikotinabhängigkeit als kausale Intervention zu verstehen.

Smoking is far more prevalent among psychiatric patients than with healthy individuals. Particularly patients with substance-related disorders and schizophrenia often are addicted smokers. This is of great importance, as heavy smoking is clearly accompanied by a higher morbidity and mortality. Up to now there is no convincing explanation for the high prevalence of smoking. Numerous studies point to the fact that smoking is practised as a form of self-medication by psychiatric patients. The influences on cerebral dopaminergic or cholinergic transmission or even psychopharmacological treatment may reinforce smoking behaviour.

Efforts to reduce the frequency of smoking in case of psychiatric patients have mostly proved fruitless. Prevention strategies as well as smoking cessation therapies seldom achieve success due to the poor motivation. Besides that smoking cessation often is complicated due to the simultaneous psychopharmacological treatment. The latest investigations, however, confirm the efficacy of cessation strategies, also in case of schizophrenia, mood or substance related disorders. Intensive behavioural treatment strategies as well as high dose nicotine replacement achieve encouraging long-term abstinence rates. Nicotine replacement by patch, gum or nasal spray might be a kind of causal treatment, assuming biological mechanisms to be responsible for heavy smoking.

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