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Motivationsbehandlung für Patienten mit der Doppeldiagnose Psychose und Sucht

Ergebnisse einer randomisierten Studie

State-dependent motivational interviewing for people with schizophrenia and substance use

Results of a randomised controlled trial

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Zusammenfassung

Hintergrund

Patienten mir der Doppeldiagnose Psychose und Sucht weisen häufig einen besonders ungünstigen Krankheitsverlauf auf und sind nur schwer zur poststationären Inanspruchnahme ambulanter, integrierter Behandlungsprogramme zu motivieren. Die vorliegende Studie vergleicht erstmals die Effekte einer an diesem Problem ansetzenden Motivationsbehandlung („motivational interviewing“, MI) mit einer unspezifisch-stützenden Intervention (ST) gleichen zeitlichen Umfangs. Primäres Zielkriterium war die Teilnahme an einer poststationären integrierten Behandlung. Zusätzlich untersucht wurden mögliche postinterventionelle Effekte auf Substanzkonsum, Krankheitsverlauf, Medikamtencompliance und Stadium der Abstinenzmotivation.

Material und Methoden

Insgesamt 60 stationäre Patienten mit Doppeldiagnosen wurden randomisiert mit 4 Sitzungen MI oder ST behandelt. Die verblindeten Datenerhebungen fanden vor, unmittelbar nach, 3 und 6 Monate nach der jeweiligen Intervention statt.

Ergebnisse

70,0% der MI- (n=30) und 40,0% der ST-Patienten (n=30) nahmen postinterventionell an der ambulanten integrierten Behandlung teil (p=0,020). Bezüglich der sekundären Ziele (Suchtmittelkonsum) fanden sich in der explorativen Auswertung keine Gruppenunterschiede.

Schlussfolgerung

Das Studiendesign erlaubt erstmals eine eindeutige Rückführung der positiven Effekte bezüglich der Aufnahme einer ambulanten Anschlussbehandlung auf die spezifische Interventionsart des MI und unterstreicht damit seine Wirksamkeit. Die Etablierung des vorgestellten Behandlungskonzepts im Rahmen stationärer Settings könnte somit einen wichtigen Fortschritt in der Versorgung des belasteten Doppeldiagnoseklientels bedeuten.

Summary

Background

Comorbid substance use disorder in patients with schizophrenia is associated with poor clinical and social outcome and low compliance with integrated outpatient treatment programs. For the first time the present trial compares the efficacy of four sessions of motivational interviewing (MI) and four sessions of supportive therapy (ST). The primary outcome was compliance with integrated outpatient treatment post-intervention. Secondary outcomes were substance use, psychopathology, compliance with medication and stage of change in psychotherapy.

Methods

Sixty inpatients with schizophrenia and substance use disorder were randomised to receive either four sessions of MI or four sessions of ST. Masked assessments took place at baseline, post-treatment and 3- and 6-month follow-ups.

Results

The integrated outpatient program was attended by 70.0% of the MI (n=30) and 40.0% of the ST patients (n=30; p=0.020). There were no differences regarding secondary outcome between MI and ST groups.

Conclusion

The study design allows one for the first time to attribute the findings to the specific effects of MI and thereby emphasizes the effectiveness of this particular treatment approach. In summary, these findings show that the integration of short-term MI for people with both psychosis and substance abuse could significantly improve their chances of attending appropriate outpatient settings and thereby improve their well-being.

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Literatur

  1. Margolese HC, Malchy L, Negrete JC et al (2004) Drug and alcohol use among patients with schizophrenia and psychoses: levels and consequences. Schizophr Res 67:157–166

    Article  PubMed  Google Scholar 

  2. Haywood TW, Kravitz HM, Grossman LS et al (1995) Predicting the „revolving door“ phenomenon among patients with schizophrenic, schizoaffective and affective disorders. Am J Psychiatry 152:313–319

    Google Scholar 

  3. Bowers MB, Mazure CM, Nelson CJ et al (1990) Psychotogenic drug abuse and neuroleptic response. Schizophr Bull 16:81–85

    Article  PubMed  Google Scholar 

  4. Janssen B, Gaebel W, Haerter M et al (2006) Evaluation of factors influencing medication compliance in inpatient treatment of psychotic disorders. Psychopharmacology (Berl) 187:229–236

    Google Scholar 

  5. Hawton K, Sutton L, Haw C et al (2005) Schizophrenia and suicide: systematic review of risk factors. Br J Psychiat 187:9–20

    Article  Google Scholar 

  6. Regier DA, Farmer ME, Rae DS et al (1990) Comorbidity of mental disorders with alcohol and other drug abuse. JAMA 264:2511–2518

    Article  PubMed  CAS  Google Scholar 

  7. Wobrock T, Soyka M (2009) Pharmacotherapy of patients with schizophrenia and substance abuse. Expert Opin Pharmacother 10:353–367

    Article  PubMed  CAS  Google Scholar 

  8. Bellack AS, DiClemente C (1999) Treating substance abuse among patients with schizophrenia. Psychiatr Serv 50:75–80

    PubMed  CAS  Google Scholar 

  9. Gouzoulis-Mayfrank E (2003) Komorbidität Psychose und Sucht. Steinkopff, Darmstadt

  10. Meister K, Rietschel L, Burlon M et al (2010) Dual diagnosis psychosis and substance use disorders in adolescents – part 2. Fortschr Neurol Psychiatr 78:90–100

    Article  PubMed  CAS  Google Scholar 

  11. Ziedonis DM, Fisher W (1994) Assessment and treatment of comorbid substance abuse in individuals with schizophrenia. Psychiatr Ann 24:447–493

    Google Scholar 

  12. Drake RE, Mueser KT (2000) Psychosocial approaches to dual diagnosis. Schizophr Bull 26:105–118

    Article  PubMed  CAS  Google Scholar 

  13. Ziedonis DM, Trudeau K (1997) Motivation to quit using substances among individuals with schizophrenia: implications for a motivation-based treatment model. Schizophr Bull 23:229–238

    Article  PubMed  CAS  Google Scholar 

  14. Heckhausen H (1988) Motivation und Handeln. Springer, Berlin

  15. Miller WR, Rollnick S (1991) Motivational Interviewing. Guilford Press, New York

  16. Prochaska JO, DiClemente CC (1992) Stages of change in the modification of problem behaviors. In: Hersen M, Eisler RM, Miller PM (Hrsg) Progress in behavior modification. Sycamore Publishing Company, Sycamore

  17. Bechdolf A, Pohlmann B, Geyer C et al (2005) Motivationsbehandlung bei Patienten mit der Doppeldiagnose Psychose und Sucht: Eine Übersicht. Fortschr Neurol Psychiatr 73:728–735

    Article  PubMed  CAS  Google Scholar 

  18. Cleary M, Hunt GE, Matheson S et al (2009) Psychosocial treatments for people with co-occurring severe mental illness and substance misuse: systematic review. J Adv Nurs 65:238–258

    Article  PubMed  Google Scholar 

  19. Horsfall J, Cleary M, Hunt GE et al (2009) Psychosocial treatments for people with co-occurring severe mental illnesses and substance use disorders (dual diagnosis): a review of empirical evidence. Harvard Rev Psychiatry 17:24–34

    Article  Google Scholar 

  20. Baker A, Lewin T, Reichler H et al (2002) Motivational interviewing among psychiatric in-patients with substance use disorders. Acta Psychiatr Scand 106:233–240

    Article  PubMed  Google Scholar 

  21. Graeber DA, Moyers TB, Griffith G et al (2003) A pilot study comparing motivational interviewing and an educational intervention in patients with schizophrenia and alcohol use disorders. Community Ment Health J 39:189–202

    Article  PubMed  Google Scholar 

  22. Martino S, Carroll KM, O‘Malley SS et al (2000) Motivational interviewing with psychiatrically ill substance abusing patients. Am J Addict 9:88–91

    Article  PubMed  CAS  Google Scholar 

  23. Martino S, Carroll KM, Nich C et al (2006) A randomized controlled pilot study of motivational interviewing for patients with psychotic and drug use disorders. Addiction 101:1479–1492

    Article  PubMed  Google Scholar 

  24. Swanson AJ, Pantalon MV, Cohen KR (1999) Motivational interviewing and treatment adherence among psychiatric and dually diagnosed patients. J Nerv Ment Dis 187:630–635

    Article  PubMed  CAS  Google Scholar 

  25. Martino S, Caroll KM, Kostas D et al (2002) Dual diagnosis motivational interviewing. A modification of motivational interviewing for substance-abusing patients with psychotic disorders. J Subst Abuse Treat 23:297–308

    Article  PubMed  Google Scholar 

  26. Gouzoulis-Mayfrank E (2008) Komorbidität von Sucht und anderen psychischen Störungen – Grundlagen und evidenzbasierte Therapie. Fortschr Neurol Psychiatr 76:263–271

    Article  PubMed  CAS  Google Scholar 

  27. Drake RE, Mueser KT, Brunette MF et al (2004) A review of treatments for people with severe mental illnesses and co-occurring substance use disorders. Psychiatr Rehabil J 27:360–374

    Article  PubMed  Google Scholar 

  28. Brunette MF, Mueser KT (2006) Psychosocial interventions for the long-term management of patients with severe mental illness and co-occurring substance use disorder. J Clin Psychiatry 67(Suppl 7):10–17

    Article  PubMed  Google Scholar 

  29. McLellan AT, Luborsky L, Woody GE et al (1980) An improved diagnostic evaluation instrument for substance abuse patients: the Addiction Severity Index. J Nerv Ment Dis 168:26–33

    Article  PubMed  CAS  Google Scholar 

  30. McConnaughy EA, DiClemente CC, Prochaska JO et al (1989) Stages of change in psychotherapy: a follow-up report. Psychother Theory Res Pract 26:494–503

    Article  Google Scholar 

  31. Callaghan RC, Taylor L, Moore BA et al (2008) Recovery and URICA stage-of-change scores in three marijuana treatment studies. J Subst Abuse Treat 35:419–426

    Article  PubMed  Google Scholar 

  32. Willoughby FW, Edens JF (1996) Construct validity and predictive utility of the stages of change scale for alcoholics. J Subst Abuse 8:275–291

    Article  PubMed  CAS  Google Scholar 

  33. Petry NM (2005) Stages of change in treatment-seeking pathological gamblers. J Consult Clin Psychol 73:312–322

    Article  PubMed  Google Scholar 

  34. Soler J, Trujols J, Pascual JC (2008) Stages of change in dialectical behaviour therapy for borderline personality disorder. Br J Clin Psychol 47:417–426

    Article  PubMed  Google Scholar 

  35. Bott KE, Rumpf HJ, Bischof G et al (2003) Der Alkoholabstinenz-Selbstwirksamkeitsfragebogen: deutsche Version (AASE-G). In: Glöckner-Rist A, Rist F, Küfner H (Hrsg) Elektronisches Handbuch zu Erhebungsinstrumenten im Suchtbereich (EHES), Version 3.00. Mannheim: Zentrum für Umfragen, Methoden und Analysen. www.psy.uni-muenster.de/institut1/ehes/startseite.htm

  36. Kay SR, Fiszbein A, Lindenmayer JP et al (1986) Positive and negative syndromes in schizophrenia as a function of chronicity. Acta Psychiatr Scand 74:507–518

    Article  PubMed  CAS  Google Scholar 

  37. Endicott J, Spitzer RL, Fliess JL et al (1976) The Global Assessment Scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 33:766–771

    Article  PubMed  CAS  Google Scholar 

  38. Kemp R, Hayward P, Applewhaite G et al (1996) Compliance therapy in psychotic patients: randomised controlled trial. Brit Med J 312:345–349

    Article  PubMed  CAS  Google Scholar 

  39. Buchkremer G, Klingberg S, Holle R et al (1997) Psychoeducational psychotherapy for schizophrenic patients and their key relatives or care-givers: results of a 2-year follow-up. Acta Psychiatr Scand 96:483–491

    Article  PubMed  CAS  Google Scholar 

  40. Pohlmann B, Bechdolf A (2005) Stadienabhängige Motivationsbehandlung für Patienten mit Doppeldiagnosen. Unveröffentlichtes Behandlungsmanual

  41. Lindemeyer J (1999) Alkoholabhängigkeit. In: Schulte D (Hrsg) Fortschritte der Psychotherapie. Hogrefe, Göttingen

  42. Marlatt GA, Gordon JR (1985) Relapse prevention: maintenance strategies in the treatment of addictive behaviors. Guilford, New York

  43. WHO (2008) Taschenführer zur ICD-10-Klassifkation psychischer Störungen. 4. Aufl. Huber, Bern

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  1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    A. Bechdolf M. Sc., B. Pohlmann, J. Güttgemanns, C. Geyer, K. Lindner, C. Ferber & E. Gouzoulis-Mayfrank

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  1. A. Bechdolf M. Sc.
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Bechdolf, A., Pohlmann, B., Güttgemanns, J. et al. Motivationsbehandlung für Patienten mit der Doppeldiagnose Psychose und Sucht. Nervenarzt 83, 888–896 (2012). https://doi.org/10.1007/s00115-011-3331-6

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