Diagnostik und Therapie des Alkoholentzugssyndroms: Fokus auf Delirium tremens und Entzugskrampfanfall

 

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Zusammenfassung

Einleitung Die schwerwiegendsten Komplikationen des Alkoholentzugssyndroms sind der Entzugskrampfanfall und das Delirium tremens. Die Übersichtsarbeit stellt das notwendige diagnostische, therapeutische und prophylaktische Vorgehen sowie nichtpharmakologische Therapiemaßnahmen beim Delirium tremens und eine mögliche Integration von Videoaufnahmen des Delirium tremens im Rahmen der Motivationsbehandlung dar. Methodik Systematische Literaturrecherche mithilfe der Datenbank Pubmed. Ergebnisse und Diskussion Beim Auftreten eines Entzugskrampfanfalls bzw. eines Delirium tremens muss zwischen einer Basisdiagnostik und einer weiterführenden, zustandsabhängigen Diagnostik (Bildgebung, Liquorpunktion) unterschieden werden. In der Behandlung und Prophylaxe des Entzugssyndroms haben Sedativa einen hohen Stellenwert. Eine dauerhafte antikonvulsive Medikation nach einem Entzugskrampfanfall ist äußerst kritisch zu prüfen.

Abstract

Introduction Delirium tremens and withdrawal seizures are serious complications of an alcohol withdrawal syndrome. This review presents the diagnostic procedures required in case of the occurrence of a withdrawal seizure and delirium tremens as well as possible treatment options including prophylactic medication regimen for alcohol withdrawal syndrome. Furthermore non-pharmacological procedures accompanying delirium tremens and a potential integration of viewing videotapes of delirium tremens in the course of alcohol-specific therapy are discussed. Methods A systematic literature research using Pubmed has been carried out to find recent studies and review articles dealing with alcohol withdrawal syndrome. Results and Discussion Regarding the diagnostic algorithm in case of the occurrence of a withdrawal seizure or a delirium tremens basic diagnostic procedures and special diagnostics including neuro-imaging or cerebrospinal fluid puncture depending on patients' clinical condition have to be considered. Sedatives are important in treatment of alcohol withdrawal seizures and delirium tremens as well as in the prophylaxis of alcohol withdrawal syndrome. A long-lasting prescription of anticonvulsant medication in patients suffering from withdrawal seizure should be considered critically and can be carried out only under certain conditions.

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Dr. med. Ulrich C. Lutz

Universitätsklinik für Psychiatrie und Psychotherapie

Osianderstraße 24

72076 Tübingen

Email: Ulrich.Lutz@med.uni-tuebingen.de