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Freier Beitrag

Posttraumatische Belastungsstörung bei opiatabhängigen methadonsubstituierten Patienten

Bedeutung der Art des Heroinkonsums, der Schwere der Abhängigkeit, der Schwere der psychischen Gesamtsymptomatik und des Geschlechtes

Published Online:February 28, 2015https://doi.org/10.1024/1661-4747/a000157

Abstract

Hintergrund: In der vorliegenden Arbeit wird der Zusammenhang zwischen der Posttraumatischen Belastungsstörung (PTBS) nach einem einmalig vorgekommenen Trauma und dem Heroinkonsum, der Schwere der Abhängigkeit und der Schwere der psychischen Gesamtsymptomatik sowie geschlechtsspezifische Unterschiede untersucht. Methode: Bei 48 opiatabhängigen methadonsubstituierten Patienten mit einem traumatischen Ereignis in der Anamnese, welches einmalig erlebt wurde, haben wir anhand mehrerer Interviews das Vorliegen einer PTBS, sowie den Heroingebrauch, die Schwere der Abhängigkeit (Addiction Severity Index; ASI) und die Schwere der psychischen Gesamtsymptomatik (Symptom Checkliste; SCL-90-R) untersucht. Ergebnisse: Insgesamt zeigten 18 Patienten (37 %) eine PTBS (8 Frauen, 10 Männer). Der Heroingebrauch der letzten 6 Monate lag bei der Gruppe mit PTBS signifikant niedriger. Die Schwere der Abhängigkeit war bei der Gruppe mit PTBS signifikant grösser. Bezogen auf die Gesamtgruppe (mit und ohne PTBS) lag die Schwere der Abhängigkeit (ASI) bei den Frauen höher als bei den Männern, insbesondere bezüglich der Bereiche «familiär/sozial» und «Drogen». Bei der Gruppe mit PTBS zeigte sich eine signifikant schwerere Beeinträchtigung durch die Abhängigkeit bezüglich des Bereichs «Arbeit/Unterhalt». Die Schwere der psychischen Gesamtsymptomatik zeigte keinen signifikanten Unterschied zwischen dem Vorliegen oder Fehlen einer PTBS. Diskussion: Die erhobenen Befunde entsprechen dem aktuellen Stand der Forschung über PTBS mit Substanzabhängigkeit. Es konnte zusätzlich gezeigt werden, dass der Heroingebrauch bei der Gruppe mit PTBS nach einmalig aufgetretenem Trauma signifikant niedriger war als der bei der Gruppe ohne PTBS. Es macht deutlich, dass die Rolle der Opioide im Zusammenhang mit den klassischen Symptomen der PTBS komplex ist und weiterer Untersuchungen bedarf.


Posttraumatic stress disorder in opiate-dependent patients with methadone treatment – Relevance of type of heroin addiction, severity of addiction, severity of overall psychopathological symptoms and gender

Background: The aim of this study is to demonstrate the relevance between the posttraumatic stress disorder (PTSD) after a non-recurring trauma and the use of heroin, the severity of addiction and the severity of the overall psychopathology, as well as sex specific differences. Method: 48 patients with an opiate dependency, enrolled in a methadone treatment and with at least one traumatic event, which occurred once in lifetime, were included. Based on several clinical interviews we determined the presence of a diagnosis of PTSD, the use of heroin, the severity of addiction (Addiction Severity Index; ASI) and of the overall psychopathology (Symptom Checklist; SCL-90-R). Results: 18 patients (37 %) had a diagnosis of PTSD (8 women, 10 men). Compared to Non-PTSD patients, PTSD patients had significantly lower use of heroin within the last 6 months while the severity of addiction was significantly higher. Women (with and without PTSD) showed a higher severity of addiction (ASI) particularly with regard to the items “social/family” and “drugs”. The group with PTSD showed a higher severity of addiction regarding the item “work/alimentation”. We found no significant difference of the severity of the overall psychopathology between patients with or without a diagnosis of PTSD. Discussion: The present data are consistent with the previous research findings on PTSD and substance use disorder. The present findings suggest that the use of heroin was significantly lower in the group with PTSD after a non-recurrent trauma. It illustrates that the role of opioids in regard to the classic symptoms of PTSD is diverse and needs to be further examined.

Literatur

  • Allen, B. , Lauterbach, D. (2007). Personality characteristics of adult survivors of childhood trauma. Journal of Traumatic Stress , 20, 587–595. First citation in articleCrossref, Google Scholar

  • Alonso, J. , Angermeyer, M. C. , Bernet, S. , Bruffaerts, R. , Brugha, T. S. , Bryson, H. , Vollebergh, W. A. M. (2004). Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica , 109, 21–27. First citation in articleCrossref, Google Scholar

  • American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association 4thed. First citation in articleGoogle Scholar

  • Back, S. E. , Waldrop, A. E. , Brady, K. T. (2009). Treatment challenges associated with comorbid substance use and posttraumatic stress disorder: clinicians' perspectives. The American Journal on Addictions , 18, 15–20. First citation in articleCrossref, Google Scholar

  • Backhaus, K. , Erichson, B. , Plinke, W. , Weiber, R. (2006). Multivariate Analysemethoden (11. Aufl.). Berlin: Springer. First citation in articleGoogle Scholar

  • Berger, W. , Mendlowicz, M. V. , Marques-Portella, C. , Kinrys, G. , Fontenelle, L. F. , Marmar, C. R. , … Figueira, I. (2009). Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systemic review. Progress in Neuro-Psychopharmacology & Biological Psychiatry , 33, 169–180. First citation in articleCrossref, Google Scholar

  • Brady, K. T. (1997). Posttraumatic stress disorder and comorbidity: recognizing the many faces of PTSD. Journal of Clinical Psychiatry , 58, 12–15. First citation in articleCrossref, Google Scholar

  • Breslau, N. , Davis, G. C. , Andreski, P. , Peterson, E. (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry , 48, 216–222. First citation in articleCrossref, Google Scholar

  • Cohen, J. (1988). Statistical power analysis for the behavior sciences (2nd Ed.). Hillsdale, NJ: Erlbaum. First citation in articleGoogle Scholar

  • Cottler, L. B. , Compten, W. M. 3rd, Mager, D. , Spitznagel, E. L. , Janca, A. (1992). Posttraumatic stress disorder among substance users from the general population. American Journal of Psychiatry , 149, 664–670. First citation in articleCrossref, Google Scholar

  • Davidson, J. R. , Hughes, D. , Blazer, D. G. , George, L. K. (1991). Post-traumatic stress disorder in the community: an epidemiological study. Psychological Medicine , 21, 713–721. First citation in articleCrossref, Google Scholar

  • Driessen, M. , Schulte, S. , Luedecke, Ch. , Schaefer, I. , Sutmann, F. , Ohlmeier, M. , … the TRAUMAB-Study Group (2008). Trauma PTSD in patients with alcohol, drug, or dual dependence: A multi-center study. Alcoholism: Clinical and Experimental Research , 32, 481–488. First citation in articleCrossref, Google Scholar

  • Ehlers, A. , Steil, R. , Winter, H. , Foa, E. B. (1996). Deutsche Übersetzung der Posttraumatic Stress Diagnostic Scale (PDS). Oxford: University. Warneford Hospital. First citation in articleGoogle Scholar

  • Finkelhor, D. (1994) The international epidemiology of child sexual abuse. Child Abuse & Neglect , 18, 409–417. First citation in articleCrossref, Google Scholar

  • Foa, E. B. , Cashman, L. , Jaycox, L. , Perry, K. (1997). The validation of a self report measure of PTSD: The Posttraumatic Diagnostic Scale (PDS). Psychological Assessment , 9, 445–451. First citation in articleCrossref, Google Scholar

  • Franke, G. H. (1995). SCL-90-R: Die Symptom-Checkliste von Derogatis. Deutsche Version. Göttingen: Beltz. First citation in articleGoogle Scholar

  • Griesel, D. , Wessa, M. , Flor, H. (2006). Psychometric qualities of the German version of the Posttraumatic Diagnostic Scale (PTDS). Psychological Assessment , 18, 262–268. First citation in articleCrossref, Google Scholar

  • Glover, H. (1993). A preliminary trial of nalmefene for the treatment of emotional numbing in combat veterans with post-traumatic stress disorder. The Israel Journal of Psychiatry and Related Sciences , 30, 255–263. First citation in articleGoogle Scholar

  • Glover, H. (1995). A different opinion regarding the use of opiate antagonists in PTSD: comments on “An unusual reaction to opioid blockade with naltrexone in a case of post-traumatic stress disorder”. Journal of Traumatic Stress , 8, 483–489. First citation in articleCrossref, Google Scholar

  • Hien, D. A. , Jiang, H. , Campbell, A. N. , Hu, M. C. , Miele, G. M. , Cohen, L. R. , … Nunes, E. V. (2010). Do treatment improvements in PTSD severity affect substance use outcome? A secondary analysis from a randomized clinical trial in NIDA's Clinical Trials Network. American Journal of Psychiatry , 167, 95–101. First citation in articleCrossref, Google Scholar

  • Hien, D. A. , Nunes, E. , Levin, F. R. , Fraser, D. (2000). Posttraumatic stress disorder and short-term outcome in early methadone treatment. Journal of Substance Abuse Treatment , 19, 31–37. First citation in articleCrossref, Google Scholar

  • Ibarra, P. , Bruehl, S. P. , McCubbin, J. A. , Carlson, C. R. , Wilson, J. F. , Norton, J. A. , … Montgomery, T. B. (1994). An unusual reaction to opioid blockade with naltrexone in a case of post-traumatic stress disorder. Journal of Traumatic Stress , 7, 303–309. First citation in articleCrossref, Google Scholar

  • Kessler, R. C. , Sonnega, A. , Bromet, E. , Highes, M. , Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry , 52, 1048–1060. First citation in articleCrossref, Google Scholar

  • Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. American Journal of Psychiatry , 142, 1259–1264. First citation in articleGoogle Scholar

  • Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry , 4, 231–244. First citation in articleGoogle Scholar

  • Krausz, M. , Briken, P. (2002). Sexueller Missbrauch bei opiatabhängigen Frauen in Relation zu biografischen Faktoren, Suchtentwicklung und psychischer Symptomatik. Suchttherapie , 3, 178–183. First citation in articleCrossref, Google Scholar

  • Lauterbach, D. , Vora, R. , Rakow, M. (2005).The relationship between posttraumatic stress disorder and self-reported health problems. Psychosomatic Medicine , 67, 939–947. First citation in articleCrossref, Google Scholar

  • Lubin, G. , Weizman, A. , Shmushkevitz, M. , Valevski, A. (2002). Short-term treatment of post-traumatic stress disorder with naltrexone: an open-label preliminary study. Human Psychopharmacology , 17, 181–185. First citation in articleCrossref, Google Scholar

  • Maercker, A. , Forstmeier, S. , Enzler, A. , Krüsi, G. , Hörler, E. , Maier, Ch. , … Ehlert, U. (2008). Adjustment disorders, posttraumatic stress disorder, and depressive disorders in old age: findings from a community survey. Comprehensive Psychiatry , 49, 113–120. First citation in articleCrossref, Google Scholar

  • McLellan, A. T. , Luborsky, L. , Woody, G. E. , O'Brien, C. P. (1980). An improved diagnostic evaluation instrument for substance abuse patients. The Addiction Severity Index. Journal of Nervous and Mental Disease , 168, 26–33. First citation in articleCrossref, Google Scholar

  • Mills, K. L. , Lynskey, M. , Teesson, M. , Ross, J. , Darke, S. (2005). Post-traumatic stress disorder among people with heroin dependence in the Australian treatment outcome study (ATOS): prevalence and correlates. Drug and Alcohol Dependence , 77, 243–249. First citation in articleCrossref, Google Scholar

  • Mills, K. L. , Teesson, M. , Ross, J. , Peters, L. (2006). Trauma, PTSD, and substance use disorders: findings from the australian national survey of mental health and well-being. American Journal of Psychiatry , 163, 652–658. First citation in articleCrossref, Google Scholar

  • Moylan, P. L. , Jones, H. E. , Haug, N. A. , Kissin, W. B. , Svikis, D. S. (2001). Clinical and psychosocial characteristics of substance-dependent pregnant women with and without PTSD. Addictive Behaviors , 26, 469–474. First citation in articleCrossref, Google Scholar

  • Najt, P. , Fusar-Poli, P. , Brambilla, P. (2011). Co-occuring mental and substance abuse disorder: A review on the potential predictors and clinical outcomes. Psychiatry Research , 186, 159–164 First citation in articleCrossref, Google Scholar

  • Ouimette, P. , Goodwin, E. , Brown, P. J. (2006). Health and well being of substance use disorder patients with and without posttraumatic stress disorder. Addictive Behaviors , 31, 1415–1423. First citation in articleCrossref, Google Scholar

  • Ouimette, P. , Read, J. P. , Wade, M. , Tirone, V. (2010). Modeling associations between posttraumatic stress symptoms and substance use. Addictive Behaviors , 35, 64–67. First citation in articleCrossref, Google Scholar

  • Saladin, M. E. , Brady, K. T. , Dansky, B. S. , Kilpatrick, D. G. (1995). Understanding comorbidity between PTSD and substance use disorders: two preliminary investigations. Addictive Behaviors , 20, 643–655. First citation in articleCrossref, Google Scholar

  • Schaefer, I. , Schultz, M. , Verthein, U. , Krausz, M. (2004). Traumatisierungen bei Suchtpatienten – Relevanz und spezifische Behandlung in der ambulanten Suchttherapie. Suchttherapie , 5, 118–123. First citation in articleCrossref, Google Scholar

  • Schaefer, I. , Najavits, L. M. (2007). Clinical challenges in the treatment of patients with posttraumatic stress disorder and substance abuse. Current Opinion in Psychiatry , 20, 614–618. First citation in articleCrossref, Google Scholar

  • Stein, M. B. , Walker, J. R. , Hazen, A. L. , Forde, D. R. (1997). Full and partial posttraumatic stress disorder: findings from a community survey. American Journal of Psychiatry , 154, 1114–1119. First citation in articleCrossref, Google Scholar

  • Stieglitz, R. D. (2008). Diagnostik und Klassifikation in der Psychiatrie – Konzepte und Methoden der Klinischen Psychiatrie. Stuttgart: Kohlhammer. First citation in articleGoogle Scholar

  • Terr, L. C. (1991). Childhood traumas: an outline and overview. American Journal of Psychiatry , 148, 10–20. First citation in articleCrossref, Google Scholar

  • Trickey, D. , Siddaway, A. P. , Meiser-Stedman, R. , Serpell, L. , Field, A. P. (2012). A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clinical Psychology Review , 32, 122–138. First citation in articleCrossref, Google Scholar

  • Tull, M. T. , Gratz, K. L. , Aklin, W. M. , Lejuez, C. W. (2010). A preliminary examination of the relationship between posttraumatic stress symptoms and crack/cocaine, heroin, and alcohol dependence. Journal of Anxiety Disorders , 24, 55–62. First citation in articleCrossref, Google Scholar

  • Van der Kolk, B. A. , Greenberg, M. S. , Orr, S. P. , Pitman, R. K. (1989). Endogenous opioids, stress induced analgesia, and posttraumatic stress disorder. Psychopharmacology Bulletin , 25, 417–421. First citation in articleGoogle Scholar

  • Villagomez, R. E. , Meyer, T. J. , Lin, M. M. , Brown, L. S. Jr. (1995). Post-traumatic stress disorder among inner city methadone maintenance patients. Journal of Substance Abuse Treatment , 12, 253–257. First citation in articleCrossref, Google Scholar

  • Wittchen, H.-U. , Wunderlich, U. , Gruschwitz, S. , Zaudig, M. (1997). SKID-I. Strukturiertes Klinisches Interview für DSM-IV. Achse I. Psychische Störungen. Interviewheft. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • World Health Organisation (1991). International Classification of Diseases (ICD-10). Geneva, Switzerland: World Health Organisation. First citation in articleGoogle Scholar