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Psychopharmakotherapie im Notarztdienst

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Zusammenfassung

Psychiatrische Störungen sind eine häufige Einsatzursache für den Notarzt. Dennoch bestehen in der praktischen Versorgung z. T. erhebliche Probleme in Diagnostik und Therapie psychiatrischer Patienten. Während für die wichtigsten somatischen Notfälle Therapiestandards entweder bereits etabliert oder zumindest in Prüfung sind, existieren für psychiatrische Notfälle keine evidenzbasierten Therapieleitlinien. Ziel dieses Beitrags ist es, anhand einer Auswertung der verfügbaren Literatur einen Überblick über die differentialtherapeutischen Möglichkeiten einer medikamentösen Krisenintervention und Empfehlungen zur Behandlung bei unterschiedlichen psychiatrischen Störungen im Notarztdienst zu geben.

Es erfolgte eine umfangreiche Literaturrecherche für den Zeitraum von 1971 bis 2002. Es fanden sich zu dieser Fragestellung 31 Doppelblindstudien, die die Wirksamkeit und Verträglichkeit unterschiedlicher Antipsychotika und Benzodiazepine beurteilten. Nach zusätzlicher Auswertung pharmakologischer Daten und der Fachinformationen wurden neben einer allgemeinen Darstellung und Bewertung von Antipsychotika und Benzodiazepinen für den Notarztdienst differentialtherapeutische Überlegungen erläutert und Dosierungsempfehlungen gegeben. Danach erscheint für den Einsatz im Notarztdienst bei den Antipsychotika vor allem das Haloperidol (z. B. Haldol) geeignet, bei den Benzodiazepinen ist das Lorazepam (z. B. Tavor) dem Diazepam (z. B. Valium) vorzuziehen. Eine antipsychotische Medikation ist besonders bei Schizophrenien, Manien, drogeninduzierten Psychosen und Delirien, eine Medikation mit Benzodiazepinen vor allem bei primär psychogenen oder reaktiven Angst-, Unruhe- oder Erregungszuständen indiziert. Zur Klärung der Frage, ob neuere, so genannte "atypische" Antipsychotika für die psychiatrische Akuttherapie auch in der Notfallmedizin den Stellenwert des Haloperidol einnehmen können, bedarf es kontrollierter Studien.

Abstract

Psychiatric emergencies are a common cause for a call for the pre-clinical emergency physician (EP). However, previous studies reported serious problems in diagnosing and particularly treating these patients. Although evidence-based treatment guidelines and algorithms exist for the most important somatic disorders the EP has to deal with, they do not for psychiatric emergencies. It is the aim of this review, subsequent to an extensive overview on the available literature, to provide the reader with differentiated suggestions for pharmacological crisis intervention as well as with treatment recommendations for different psychiatric disorders with an emphasis on the special needs in the pre-clinical emergency medicine.

After conducting a literature research from 1971 to 2002, 31 double-blind trials were found comparing different antipsychotics and benzodiazepines for efficacy and tolerability. Further, pharmacological data and product information of the most commonly used drugs were evaluated. Following, antipsychotics and benzodiazepines were generally assessed for their usefulness in the pre-clinical emergency medicine, the advantages of different drugs for specific indications are presented and dosage recommendations are given. As an antipsychotic, haloperidol still is the drug of choice. Within the benzodiazepines, lorazepam seems to have advantages over diazepam. An antipsychotic medication is particularly indicated for the treatment of schizophrenia, mania, drug-induced psychoses and deliria whereas benzodiazepines are favourable for the treatment of anxiety, restlessness and agitation due to neurotic or reactive circumstances. There is some evidence suggesting that newer generation, so-called "atypical" antipsychotics may play a role in the treatment of psychiatric emergencies, however, controlled trials are necessary to substantiate their potential benefits in the pre-clinical emergency medicine.

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Authors and Affiliations

  1. Universitätsnervenklinik Psychiatrie und Psychotherapie, Universitätskliniken des Saarlandes

    F.-G. Pajonk

  2. Institut für Transfusionsmedizin, Universitätsklinikum Essen

    B. Fleiter

  3. Universitätsnervenklinik Psychiatrie und Psychotherapie, Universitätskliniken des Saarlandes, 66421, Homburg

    F.-G. Pajonk

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Correspondence to F.-G. Pajonk.

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Pajonk, FG., Fleiter, B. Psychopharmakotherapie im Notarztdienst. Anaesthesist 52, 577–585 (2003). https://doi.org/10.1007/s00101-003-0549-0

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