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Suizidprophylaktische Wirkung von Lithium

Aktueller Forschungsstand und Implikationen für die Therapie affektiver Störungen

Anti-suicidal effect of lithium

Current state of research and its clinical implications for the long-term treatment of affective disorders

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Zusammenfassung

Die Behandlung suizidaler Patienten gehört zu den anspruchvollsten Herausforderungen für alle Professionen im Gesundheitswesen. Aufgrund der enormen gesundheitspolitischen Bedeutung ist die Therapie suizidalen Verhaltens in den letzten Jahren mehr und mehr in den Mittelpunkt psychiatrischer Forschung gerückt und nimmt einen größeren Stellenwert in der Erarbeitung von Behandlungs- und Präventionsstrategien ein. Für Lithium als eine der ältesten in der Psychiatrie verwendeten psychotropen Substanzen wurde seit Anfang der 1990iger Jahre ein eigenständiger, im Vergleich zu anderen Psychopharmaka wahrscheinlich spezifischer antisuizidaler Effekt nachgewiesen. Trotz dieses Wissens und des heute ebenfalls in nationalen und internationalen Leitlinien dokumentierten Stellenwertes von Lithium in der Akut- und Erhaltungstherapie affektiver Störungen ist Lithium hinsichtlich seiner Verschreibungshäufigkeit im Vergleich zu anderen Psychopharmaka unterrepräsentiert. Der folgende Beitrag gibt eine chronologische Zusammenfassung aller wichtigen Studien, welche die antisuizidale Wirkung von Lithium untersucht haben, und diskutiert die daraus resultierenden therapeutischen Implikationen.

Summary

Treatment of patients with suicidal behaviour is one of the most challenging tasks for health care professionals. Due to the high mortality, morbidity and costs related to suicide, the development of treatment and preventive strategies for suicidal behaviour have been a focus of psychiatric research. For lithium, one of the oldest pharmacological agents used in psychiatry, anti-suicidal effects have been found since the early 90s in many international studies. Despite this unambiguous evidence and corresponding recommendations in national and international guidelines for the acute and maintenance therapy of affective disorders, the use of lithium is still underrepresented. The following article provides a review of studies investigating the anti-suicidal effects of lithium in affective disorders. Clinical implications for the treatment of affective disorders are discussed.

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Interessenkonflikt

Die korrespondierende Autorin weist für sich und seine Koautoren auf folgende Beziehungen hin: Dr. Lewitzka, Prof. Müller-Oerlinghausen, Prof. Felber geben an, dass keine Interessenkonflikte bestehen. Professor Dr. Dr. Bauer erhielt Forschungszuwendungen vom Stanley Medical Research Institute, NARSAD und Eli Lilly & Company. Er ist als Berater für AstraZeneca, Lilly, Servier, Lundbeck, BristolMyers Squibb und Otsuka tätig. Professor Bauer erhielt Vortragshonorare von AstraZeneca, Lilly, GlaxoSmithKline, Lundbeck, BristolMyers Squibb und Otsuka.

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  1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland

    U. Lewitzka, M. Bauer & W. Felber

  2. Department of Psychiatry, Flourish Mood Disorder Clinical Research Program, IWK Health Centre, Dalhousie University, 5850 University Ave, B3K 6R8, Halifax, NS, Kanada

    U. Lewitzka

  3. -, Berlin, Deutschland

    B. Müller-Oerlinghausen

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  1. U. Lewitzka
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  2. M. Bauer
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Correspondence to U. Lewitzka.

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Lewitzka, U., Bauer, M., Felber, W. et al. Suizidprophylaktische Wirkung von Lithium. Nervenarzt 84, 294–306 (2013). https://doi.org/10.1007/s00115-012-3542-5

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