Kay Uwe Petersen

Psychiatrische Komorbiditäten bei tabakbedingten Störungen

The coincidence of tobacco smoking and psychiatric disorders is of great epidemiological and therapeutic importance. Tobacco smoking by people with mental disorders leads to disproportionately high somatic health risks, an adverse clinical course, poorer clinical outcomes and reduced quality of life (QoL). The etiological causes of the high comorbidity between smoking and mental disorders are still unclear: currently, tobacco smoking is discussed as being either the consequence or contributory cause of psychological disorders or both disorders share common antecedents and interactions. Psychiatric patients are motivated to quit and smoking cessation is not generally less effective with smokers with mental disorders than with mentally healthy individuals. Specific smoking cessation programs in the inpatient and outpatient settings are time-consuming and complex but effective. Within the framework of the current S3 guidelines the international evidence has been updated and transformed into treatment guidelines following an elaborate consensus process. Basically the same interventional measures should be used as with mentally healthy individuals; however, smokers with a psychological comorbidity often need more intensive adjuvant psychotherapeutic interventions and often need pharmaceutical support, (bupropion, varenicline and nicotine replacement therapy). Due to the overall unsatisfactory findings the treatment guidelines are partially based on clinical consensus decisions. In this field, a considerable need for research has been determined.ZusammenfassungDie Koinzidenz von Tabakkonsum und psychiatrischen Störungen ist von hoher epidemiologischer und therapeutischer Bedeutung. Tabakrauchen bei Personen mit psychischen Störungen führt zu überproportionalen körperlichen Gesundheitsrisiken, ungünstigeren Störungsverläufen, schlechteren Therapieergebnissen und verminderter Lebensqualität (QoL). Die ätiologischen Gründe für die hohe Komorbidität zwischen Rauchen und psychischen Störungen sind noch unklar: Aktuell wird Tabakrauchen als Folge oder Mitursache psychischer Störungen diskutiert, oder beide Störungen besitzen gemeinsame Ursachen und Interaktionen. Psychiatrische Patienten sind aufhörmotiviert und Tabakentwöhnung ist bei Rauchern mit psychischer Störung nicht generell weniger erfolgreich als unter psychisch gesunden Personen. Spezifische Tabakentwöhnungsprogramme für psychiatrische Patienten in stationären und ambulanten Settings sind aufwendig und komplex, aber wirksam. Im Rahmen der aktuellen S3-Leitlinien wurde die internationale Evidenzlage aktualisiert und nach einem aufwendigen Konsensusprozess in Therapieempfehlungen transformiert. Im Wesentlichen sollen die gleichen Interventionsmaßnahmen zum Einsatz kommen wie bei psychisch gesunden Personen. Allerdings benötigen Raucher mit psychischer Komorbidität häufig psychotherapeutische Begleitinterventionen höherer Intensität und oftmals medikamentöse Unterstützung (Bupropion, Vareniclin, Nikotinersatztherapie). Aufgrund der insgesamt unbefriedigenden Befundlage basieren die Therapieempfehlungen teilweise auf klinischen Konsensentscheidungen. Es ist ein erheblicher Forschungsbedarf in diesem Bereich festzustellen.AbstractThe coincidence of tobacco smoking and psychiatric disorders is of great epidemiological and therapeutic importance. Tobacco smoking by people with mental disorders leads to disproportionately high somatic health risks, an adverse clinical course, poorer clinical outcomes and reduced quality of life (QoL). The etiological causes of the high comorbidity between smoking and mental disorders are still unclear: currently, tobacco smoking is discussed as being either the consequence or contributory cause of psychological disorders or both disorders share common antecedents and interactions. Psychiatric patients are motivated to quit and smoking cessation is not generally less effective with smokers with mental disorders than with mentally healthy individuals. Specific smoking cessation programs in the inpatient and outpatient settings are time-consuming and complex but effective. Within the framework of the current S3 guidelines the international evidence has been updated and transformed into treatment guidelines following an elaborate consensus process. Basically the same interventional measures should be used as with mentally healthy individuals; however, smokers with a psychological comorbidity often need more intensive adjuvant psychotherapeutic interventions and often need pharmaceutical support, (bupropion, varenicline and nicotine replacement therapy). Due to the overall unsatisfactory findings the treatment guidelines are partially based on clinical consensus decisions. In this field, a considerable need for research has been determined.

Psycho- und Pharmakotherapie bei schädlichem Tabakgebrauch und -abhängigkeit

Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.

Methodik der S3-Leitlinien für alkohol- und tabakbezogene Störungen

BACKGROUND From 2010 until 2015 two interdisciplinary evidence-based guidelines were developed to summarize the current knowledge regarding screening, diagnostics and treatment of alcohol and tobacco-related disorders. METHODS Both guidelines were prepared under the auspices of the German Society for Psychiatry, Psychotherapy and Psychosomatics (Deutsche Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde, DGPPN) and the German Society for Addiction Research and Therapy (Deutsche Gesellschaft für Suchtforschung und -therapie, DG-Sucht). To meet the methodological criteria for the highest quality guidelines (S3 criteria) as defined by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) the following criteria were realized: (1) a systematic search, selection and appraisal of the international literature, (2) a structured process to reach consensus and (3) inclusion of all relevant representatives of future guideline users. RESULTS More than 60 clinical experts and researchers analyzed the scientific literature. In total 41 international and national guidelines (23 for alcohol and 18 for tobacco) were used. Moreover, 83 systematic Cochrane reviews (alcohol 28, tobacco 55) and 5863 articles (alcohol 2213, tobacco 3650) were analyzed. A total of 7 expert groups formulated 174 recommendations for the screening, diagnosis and treatment of alcohol-related disorders. Six expert groups created 81 recommendations for the screening, diagnosis and treatment of tobacco-related disorders. Approximately 50 scientific associations, professional organizations, patient and family initiatives, as well as representatives of the healthcare system formed a consensus group. In seven 1 and 2-day conferences, all clinical recommendations were discussed and approved by this group. Both guidelines will be revised on a regular basis to guarantee that the clinical recommendations are kept up to date. CONCLUSIONS Both systematically developed, evidence-based treatment guidelines are comprehensive instruments to provide orientation and assist the decision-making process for physicians, psychologists and other therapists as well as patients and their families in the diagnosis and treatment of alcohol and tobacco use related disorders.ZusammenfassungHintergrundIn den Jahren 2010 bis 2015 wurden zwei interdisziplinäre, evidenzbasierte Leitlinien entwickelt, die den gegenwärtigen Erkenntnisstand zum Screening, der Diagnose und Behandlung alkohol- und tabakbezogener Störungen wiedergeben sollen.MethodeDie Leitlinien wurden unter der Federführung der Deutschen Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) und der Deutschen Gesellschaft für Suchtforschung und -therapie (DG-Sucht) erarbeitet. Um die methodischen S3-Kriterien der Arbeitsgemeinschaft Wissenschaftlich Medizinischer Fachgesellschaften (AWMF) zu realisierten, erfolgte 1) eine systematische Recherche, Auswahl und Bewertung der internationalen Literatur sowie 2) eine strukturierte, interdisziplinäre Konsensfindung mit 3) der repräsentativen Beteiligung von Vertretern aller Adressaten.ErgebnisseMehr als 60 Expertinnen und Experten aus Klinik und Forschung werteten die wissenschaftliche Literatur aus. Es wurden insgesamt 41 internationale und nationale Behandlungsleitlinien (Alkohol: 23; Tabak: 18) gesichtet. Anschließend wurden 83 systematische Cochrane Reviews (Alkohol: 28; Tabak: 55) und 5863 Originalarbeiten (Alkohol: 2213; Tabak: 3650) ausgewertet. Sieben Expertengruppen erarbeiteten 174 Empfehlungen zum Screening, der Diagnose und Behandlung alkoholbezogener Störungen, 6 Expertengruppen erarbeiteten 81 Empfehlungen zum Screening, der Diagnostik und der Behandlung tabakbezogener Störungen. 50 wissenschaftliche Fachgesellschaften, Berufs-, Betroffenen- und Angehörigenverbände sowie Organe des Gesundheitssystems bildeten eine Konsensusgruppe. Im Rahmen von sieben ein- und zweitägigen Konferenzen diskutierte und verabschiedete diese Gruppe alle Empfehlungen. Die Leitlinien sollen in regelmäßigem Abstand überarbeitet werden, um die Aktualität der klinischen Empfehlungen zu garantieren.SchlussfolgerungenDie systematisch entwickelten, evidenzbasierten Leitlinien sind umfangreiche Orientierungs- und Entscheidungshilfen für Ärzte, Psychologen und andere Therapeuten, aber auch für Betroffene und Angehörige bei der Diagnostik und Therapie alkohol- und tabakbezogener Störungen.SummaryBackgroundFrom 2010 until 2015 two interdisciplinary evidence-based guidelines were developed to summarize the current knowledge regarding screening, diagnostics and treatment of alcohol and tobacco-related disorders.MethodsBoth guidelines were prepared under the auspices of the German Society for Psychiatry, Psychotherapy and Psychosomatics (Deutsche Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde, DGPPN) and the German Society for Addiction Research and Therapy (Deutsche Gesellschaft für Suchtforschung und -therapie, DG-Sucht). To meet the methodological criteria for the highest quality guidelines (S3 criteria) as defined by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) the following criteria were realized: (1) a systematic search, selection and appraisal of the international literature, (2) a structured process to reach consensus and (3) inclusion of all relevant representatives of future guideline users.ResultsMore than 60 clinical experts and researchers analyzed the scientific literature. In total 41 international and national guidelines (23 for alcohol and 18 for tobacco) were used. Moreover, 83 systematic Cochrane reviews (alcohol 28, tobacco 55) and 5863 articles (alcohol 2213, tobacco 3650) were analyzed. A total of 7 expert groups formulated 174 recommendations for the screening, diagnosis and treatment of alcohol-related disorders. Six expert groups created 81 recommendations for the screening, diagnosis and treatment of tobacco-related disorders. Approximately 50 scientific associations, professional organizations, patient and family initiatives, as well as representatives of the healthcare system formed a consensus group. In seven 1 and 2-day conferences, all clinical recommendations were discussed and approved by this group. Both guidelines will be revised on a regular basis to guarantee that the clinical recommendations are kept up to date.ConclusionsBoth systematically developed, evidence-based treatment guidelines are comprehensive instruments to provide orientation and assist the decision-making process for physicians, psychologists and other therapists as well as patients and their families in the diagnosis and treatment of alcohol and tobacco use related disorders.

Psycho- und Pharmakotherapie bei schädlichem Tabakgebrauch und -abhängigkeit@@@Psychotherapy and pharmacotherapy for harmful tobacco use and tobacco dependency

Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.

Psychotherapy and pharmacotherapy for harmful tobacco use and tobacco dependency

Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.

[Psychiatric comorbidities with tobacco-related disorders].

The coincidence of tobacco smoking and psychiatric disorders is of great epidemiological and therapeutic importance. Tobacco smoking by people with mental disorders leads to disproportionately high somatic health risks, an adverse clinical course, poorer clinical outcomes and reduced quality of life (QoL). The etiological causes of the high comorbidity between smoking and mental disorders are still unclear: currently, tobacco smoking is discussed as being either the consequence or contributory cause of psychological disorders or both disorders share common antecedents and interactions. Psychiatric patients are motivated to quit and smoking cessation is not generally less effective with smokers with mental disorders than with mentally healthy individuals. Specific smoking cessation programs in the inpatient and outpatient settings are time-consuming and complex but effective. Within the framework of the current S3 guidelines the international evidence has been updated and transformed into treatment guidelines following an elaborate consensus process. Basically the same interventional measures should be used as with mentally healthy individuals; however, smokers with a psychological comorbidity often need more intensive adjuvant psychotherapeutic interventions and often need pharmaceutical support, (bupropion, varenicline and nicotine replacement therapy). Due to the overall unsatisfactory findings the treatment guidelines are partially based on clinical consensus decisions. In this field, a considerable need for research has been determined.ZusammenfassungDie Koinzidenz von Tabakkonsum und psychiatrischen Störungen ist von hoher epidemiologischer und therapeutischer Bedeutung. Tabakrauchen bei Personen mit psychischen Störungen führt zu überproportionalen körperlichen Gesundheitsrisiken, ungünstigeren Störungsverläufen, schlechteren Therapieergebnissen und verminderter Lebensqualität (QoL). Die ätiologischen Gründe für die hohe Komorbidität zwischen Rauchen und psychischen Störungen sind noch unklar: Aktuell wird Tabakrauchen als Folge oder Mitursache psychischer Störungen diskutiert, oder beide Störungen besitzen gemeinsame Ursachen und Interaktionen. Psychiatrische Patienten sind aufhörmotiviert und Tabakentwöhnung ist bei Rauchern mit psychischer Störung nicht generell weniger erfolgreich als unter psychisch gesunden Personen. Spezifische Tabakentwöhnungsprogramme für psychiatrische Patienten in stationären und ambulanten Settings sind aufwendig und komplex, aber wirksam. Im Rahmen der aktuellen S3-Leitlinien wurde die internationale Evidenzlage aktualisiert und nach einem aufwendigen Konsensusprozess in Therapieempfehlungen transformiert. Im Wesentlichen sollen die gleichen Interventionsmaßnahmen zum Einsatz kommen wie bei psychisch gesunden Personen. Allerdings benötigen Raucher mit psychischer Komorbidität häufig psychotherapeutische Begleitinterventionen höherer Intensität und oftmals medikamentöse Unterstützung (Bupropion, Vareniclin, Nikotinersatztherapie). Aufgrund der insgesamt unbefriedigenden Befundlage basieren die Therapieempfehlungen teilweise auf klinischen Konsensentscheidungen. Es ist ein erheblicher Forschungsbedarf in diesem Bereich festzustellen.AbstractThe coincidence of tobacco smoking and psychiatric disorders is of great epidemiological and therapeutic importance. Tobacco smoking by people with mental disorders leads to disproportionately high somatic health risks, an adverse clinical course, poorer clinical outcomes and reduced quality of life (QoL). The etiological causes of the high comorbidity between smoking and mental disorders are still unclear: currently, tobacco smoking is discussed as being either the consequence or contributory cause of psychological disorders or both disorders share common antecedents and interactions. Psychiatric patients are motivated to quit and smoking cessation is not generally less effective with smokers with mental disorders than with mentally healthy individuals. Specific smoking cessation programs in the inpatient and outpatient settings are time-consuming and complex but effective. Within the framework of the current S3 guidelines the international evidence has been updated and transformed into treatment guidelines following an elaborate consensus process. Basically the same interventional measures should be used as with mentally healthy individuals; however, smokers with a psychological comorbidity often need more intensive adjuvant psychotherapeutic interventions and often need pharmaceutical support, (bupropion, varenicline and nicotine replacement therapy). Due to the overall unsatisfactory findings the treatment guidelines are partially based on clinical consensus decisions. In this field, a considerable need for research has been determined.

Psychiatrische Komorbiditäten bei tabakbedingten Störungen@@@Psychiatric comorbidities with tobacco-related disorders

The coincidence of tobacco smoking and psychiatric disorders is of great epidemiological and therapeutic importance. Tobacco smoking by people with mental disorders leads to disproportionately high somatic health risks, an adverse clinical course, poorer clinical outcomes and reduced quality of life (QoL). The etiological causes of the high comorbidity between smoking and mental disorders are still unclear: currently, tobacco smoking is discussed as being either the consequence or contributory cause of psychological disorders or both disorders share common antecedents and interactions. Psychiatric patients are motivated to quit and smoking cessation is not generally less effective with smokers with mental disorders than with mentally healthy individuals. Specific smoking cessation programs in the inpatient and outpatient settings are time-consuming and complex but effective. Within the framework of the current S3 guidelines the international evidence has been updated and transformed into treatment guidelines following an elaborate consensus process. Basically the same interventional measures should be used as with mentally healthy individuals; however, smokers with a psychological comorbidity often need more intensive adjuvant psychotherapeutic interventions and often need pharmaceutical support, (bupropion, varenicline and nicotine replacement therapy). Due to the overall unsatisfactory findings the treatment guidelines are partially based on clinical consensus decisions. In this field, a considerable need for research has been determined.ZusammenfassungDie Koinzidenz von Tabakkonsum und psychiatrischen Störungen ist von hoher epidemiologischer und therapeutischer Bedeutung. Tabakrauchen bei Personen mit psychischen Störungen führt zu überproportionalen körperlichen Gesundheitsrisiken, ungünstigeren Störungsverläufen, schlechteren Therapieergebnissen und verminderter Lebensqualität (QoL). Die ätiologischen Gründe für die hohe Komorbidität zwischen Rauchen und psychischen Störungen sind noch unklar: Aktuell wird Tabakrauchen als Folge oder Mitursache psychischer Störungen diskutiert, oder beide Störungen besitzen gemeinsame Ursachen und Interaktionen. Psychiatrische Patienten sind aufhörmotiviert und Tabakentwöhnung ist bei Rauchern mit psychischer Störung nicht generell weniger erfolgreich als unter psychisch gesunden Personen. Spezifische Tabakentwöhnungsprogramme für psychiatrische Patienten in stationären und ambulanten Settings sind aufwendig und komplex, aber wirksam. Im Rahmen der aktuellen S3-Leitlinien wurde die internationale Evidenzlage aktualisiert und nach einem aufwendigen Konsensusprozess in Therapieempfehlungen transformiert. Im Wesentlichen sollen die gleichen Interventionsmaßnahmen zum Einsatz kommen wie bei psychisch gesunden Personen. Allerdings benötigen Raucher mit psychischer Komorbidität häufig psychotherapeutische Begleitinterventionen höherer Intensität und oftmals medikamentöse Unterstützung (Bupropion, Vareniclin, Nikotinersatztherapie). Aufgrund der insgesamt unbefriedigenden Befundlage basieren die Therapieempfehlungen teilweise auf klinischen Konsensentscheidungen. Es ist ein erheblicher Forschungsbedarf in diesem Bereich festzustellen.AbstractThe coincidence of tobacco smoking and psychiatric disorders is of great epidemiological and therapeutic importance. Tobacco smoking by people with mental disorders leads to disproportionately high somatic health risks, an adverse clinical course, poorer clinical outcomes and reduced quality of life (QoL). The etiological causes of the high comorbidity between smoking and mental disorders are still unclear: currently, tobacco smoking is discussed as being either the consequence or contributory cause of psychological disorders or both disorders share common antecedents and interactions. Psychiatric patients are motivated to quit and smoking cessation is not generally less effective with smokers with mental disorders than with mentally healthy individuals. Specific smoking cessation programs in the inpatient and outpatient settings are time-consuming and complex but effective. Within the framework of the current S3 guidelines the international evidence has been updated and transformed into treatment guidelines following an elaborate consensus process. Basically the same interventional measures should be used as with mentally healthy individuals; however, smokers with a psychological comorbidity often need more intensive adjuvant psychotherapeutic interventions and often need pharmaceutical support, (bupropion, varenicline and nicotine replacement therapy). Due to the overall unsatisfactory findings the treatment guidelines are partially based on clinical consensus decisions. In this field, a considerable need for research has been determined.

[Methodology of the S3 guidelines on alcohol and tobacco-related disorders].

BACKGROUND From 2010 until 2015 two interdisciplinary evidence-based guidelines were developed to summarize the current knowledge regarding screening, diagnostics and treatment of alcohol and tobacco-related disorders. METHODS Both guidelines were prepared under the auspices of the German Society for Psychiatry, Psychotherapy and Psychosomatics (Deutsche Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde, DGPPN) and the German Society for Addiction Research and Therapy (Deutsche Gesellschaft für Suchtforschung und -therapie, DG-Sucht). To meet the methodological criteria for the highest quality guidelines (S3 criteria) as defined by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) the following criteria were realized: (1) a systematic search, selection and appraisal of the international literature, (2) a structured process to reach consensus and (3) inclusion of all relevant representatives of future guideline users. RESULTS More than 60 clinical experts and researchers analyzed the scientific literature. In total 41 international and national guidelines (23 for alcohol and 18 for tobacco) were used. Moreover, 83 systematic Cochrane reviews (alcohol 28, tobacco 55) and 5863 articles (alcohol 2213, tobacco 3650) were analyzed. A total of 7 expert groups formulated 174 recommendations for the screening, diagnosis and treatment of alcohol-related disorders. Six expert groups created 81 recommendations for the screening, diagnosis and treatment of tobacco-related disorders. Approximately 50 scientific associations, professional organizations, patient and family initiatives, as well as representatives of the healthcare system formed a consensus group. In seven 1 and 2-day conferences, all clinical recommendations were discussed and approved by this group. Both guidelines will be revised on a regular basis to guarantee that the clinical recommendations are kept up to date. CONCLUSIONS Both systematically developed, evidence-based treatment guidelines are comprehensive instruments to provide orientation and assist the decision-making process for physicians, psychologists and other therapists as well as patients and their families in the diagnosis and treatment of alcohol and tobacco use related disorders.ZusammenfassungHintergrundIn den Jahren 2010 bis 2015 wurden zwei interdisziplinäre, evidenzbasierte Leitlinien entwickelt, die den gegenwärtigen Erkenntnisstand zum Screening, der Diagnose und Behandlung alkohol- und tabakbezogener Störungen wiedergeben sollen.MethodeDie Leitlinien wurden unter der Federführung der Deutschen Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) und der Deutschen Gesellschaft für Suchtforschung und -therapie (DG-Sucht) erarbeitet. Um die methodischen S3-Kriterien der Arbeitsgemeinschaft Wissenschaftlich Medizinischer Fachgesellschaften (AWMF) zu realisierten, erfolgte 1) eine systematische Recherche, Auswahl und Bewertung der internationalen Literatur sowie 2) eine strukturierte, interdisziplinäre Konsensfindung mit 3) der repräsentativen Beteiligung von Vertretern aller Adressaten.ErgebnisseMehr als 60 Expertinnen und Experten aus Klinik und Forschung werteten die wissenschaftliche Literatur aus. Es wurden insgesamt 41 internationale und nationale Behandlungsleitlinien (Alkohol: 23; Tabak: 18) gesichtet. Anschließend wurden 83 systematische Cochrane Reviews (Alkohol: 28; Tabak: 55) und 5863 Originalarbeiten (Alkohol: 2213; Tabak: 3650) ausgewertet. Sieben Expertengruppen erarbeiteten 174 Empfehlungen zum Screening, der Diagnose und Behandlung alkoholbezogener Störungen, 6 Expertengruppen erarbeiteten 81 Empfehlungen zum Screening, der Diagnostik und der Behandlung tabakbezogener Störungen. 50 wissenschaftliche Fachgesellschaften, Berufs-, Betroffenen- und Angehörigenverbände sowie Organe des Gesundheitssystems bildeten eine Konsensusgruppe. Im Rahmen von sieben ein- und zweitägigen Konferenzen diskutierte und verabschiedete diese Gruppe alle Empfehlungen. Die Leitlinien sollen in regelmäßigem Abstand überarbeitet werden, um die Aktualität der klinischen Empfehlungen zu garantieren.SchlussfolgerungenDie systematisch entwickelten, evidenzbasierten Leitlinien sind umfangreiche Orientierungs- und Entscheidungshilfen für Ärzte, Psychologen und andere Therapeuten, aber auch für Betroffene und Angehörige bei der Diagnostik und Therapie alkohol- und tabakbezogener Störungen.SummaryBackgroundFrom 2010 until 2015 two interdisciplinary evidence-based guidelines were developed to summarize the current knowledge regarding screening, diagnostics and treatment of alcohol and tobacco-related disorders.MethodsBoth guidelines were prepared under the auspices of the German Society for Psychiatry, Psychotherapy and Psychosomatics (Deutsche Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde, DGPPN) and the German Society for Addiction Research and Therapy (Deutsche Gesellschaft für Suchtforschung und -therapie, DG-Sucht). To meet the methodological criteria for the highest quality guidelines (S3 criteria) as defined by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) the following criteria were realized: (1) a systematic search, selection and appraisal of the international literature, (2) a structured process to reach consensus and (3) inclusion of all relevant representatives of future guideline users.ResultsMore than 60 clinical experts and researchers analyzed the scientific literature. In total 41 international and national guidelines (23 for alcohol and 18 for tobacco) were used. Moreover, 83 systematic Cochrane reviews (alcohol 28, tobacco 55) and 5863 articles (alcohol 2213, tobacco 3650) were analyzed. A total of 7 expert groups formulated 174 recommendations for the screening, diagnosis and treatment of alcohol-related disorders. Six expert groups created 81 recommendations for the screening, diagnosis and treatment of tobacco-related disorders. Approximately 50 scientific associations, professional organizations, patient and family initiatives, as well as representatives of the healthcare system formed a consensus group. In seven 1 and 2-day conferences, all clinical recommendations were discussed and approved by this group. Both guidelines will be revised on a regular basis to guarantee that the clinical recommendations are kept up to date.ConclusionsBoth systematically developed, evidence-based treatment guidelines are comprehensive instruments to provide orientation and assist the decision-making process for physicians, psychologists and other therapists as well as patients and their families in the diagnosis and treatment of alcohol and tobacco use related disorders.

Methodik der S3-Leitlinien für alkohol- und tabakbezogene Störungen@@@Methodology of the S3 guidelines on alcohol and tobacco-related disorders

BACKGROUND From 2010 until 2015 two interdisciplinary evidence-based guidelines were developed to summarize the current knowledge regarding screening, diagnostics and treatment of alcohol and tobacco-related disorders. METHODS Both guidelines were prepared under the auspices of the German Society for Psychiatry, Psychotherapy and Psychosomatics (Deutsche Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde, DGPPN) and the German Society for Addiction Research and Therapy (Deutsche Gesellschaft für Suchtforschung und -therapie, DG-Sucht). To meet the methodological criteria for the highest quality guidelines (S3 criteria) as defined by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) the following criteria were realized: (1) a systematic search, selection and appraisal of the international literature, (2) a structured process to reach consensus and (3) inclusion of all relevant representatives of future guideline users. RESULTS More than 60 clinical experts and researchers analyzed the scientific literature. In total 41 international and national guidelines (23 for alcohol and 18 for tobacco) were used. Moreover, 83 systematic Cochrane reviews (alcohol 28, tobacco 55) and 5863 articles (alcohol 2213, tobacco 3650) were analyzed. A total of 7 expert groups formulated 174 recommendations for the screening, diagnosis and treatment of alcohol-related disorders. Six expert groups created 81 recommendations for the screening, diagnosis and treatment of tobacco-related disorders. Approximately 50 scientific associations, professional organizations, patient and family initiatives, as well as representatives of the healthcare system formed a consensus group. In seven 1 and 2-day conferences, all clinical recommendations were discussed and approved by this group. Both guidelines will be revised on a regular basis to guarantee that the clinical recommendations are kept up to date. CONCLUSIONS Both systematically developed, evidence-based treatment guidelines are comprehensive instruments to provide orientation and assist the decision-making process for physicians, psychologists and other therapists as well as patients and their families in the diagnosis and treatment of alcohol and tobacco use related disorders.ZusammenfassungHintergrundIn den Jahren 2010 bis 2015 wurden zwei interdisziplinäre, evidenzbasierte Leitlinien entwickelt, die den gegenwärtigen Erkenntnisstand zum Screening, der Diagnose und Behandlung alkohol- und tabakbezogener Störungen wiedergeben sollen.MethodeDie Leitlinien wurden unter der Federführung der Deutschen Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) und der Deutschen Gesellschaft für Suchtforschung und -therapie (DG-Sucht) erarbeitet. Um die methodischen S3-Kriterien der Arbeitsgemeinschaft Wissenschaftlich Medizinischer Fachgesellschaften (AWMF) zu realisierten, erfolgte 1) eine systematische Recherche, Auswahl und Bewertung der internationalen Literatur sowie 2) eine strukturierte, interdisziplinäre Konsensfindung mit 3) der repräsentativen Beteiligung von Vertretern aller Adressaten.ErgebnisseMehr als 60 Expertinnen und Experten aus Klinik und Forschung werteten die wissenschaftliche Literatur aus. Es wurden insgesamt 41 internationale und nationale Behandlungsleitlinien (Alkohol: 23; Tabak: 18) gesichtet. Anschließend wurden 83 systematische Cochrane Reviews (Alkohol: 28; Tabak: 55) und 5863 Originalarbeiten (Alkohol: 2213; Tabak: 3650) ausgewertet. Sieben Expertengruppen erarbeiteten 174 Empfehlungen zum Screening, der Diagnose und Behandlung alkoholbezogener Störungen, 6 Expertengruppen erarbeiteten 81 Empfehlungen zum Screening, der Diagnostik und der Behandlung tabakbezogener Störungen. 50 wissenschaftliche Fachgesellschaften, Berufs-, Betroffenen- und Angehörigenverbände sowie Organe des Gesundheitssystems bildeten eine Konsensusgruppe. Im Rahmen von sieben ein- und zweitägigen Konferenzen diskutierte und verabschiedete diese Gruppe alle Empfehlungen. Die Leitlinien sollen in regelmäßigem Abstand überarbeitet werden, um die Aktualität der klinischen Empfehlungen zu garantieren.SchlussfolgerungenDie systematisch entwickelten, evidenzbasierten Leitlinien sind umfangreiche Orientierungs- und Entscheidungshilfen für Ärzte, Psychologen und andere Therapeuten, aber auch für Betroffene und Angehörige bei der Diagnostik und Therapie alkohol- und tabakbezogener Störungen.SummaryBackgroundFrom 2010 until 2015 two interdisciplinary evidence-based guidelines were developed to summarize the current knowledge regarding screening, diagnostics and treatment of alcohol and tobacco-related disorders.MethodsBoth guidelines were prepared under the auspices of the German Society for Psychiatry, Psychotherapy and Psychosomatics (Deutsche Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde, DGPPN) and the German Society for Addiction Research and Therapy (Deutsche Gesellschaft für Suchtforschung und -therapie, DG-Sucht). To meet the methodological criteria for the highest quality guidelines (S3 criteria) as defined by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) the following criteria were realized: (1) a systematic search, selection and appraisal of the international literature, (2) a structured process to reach consensus and (3) inclusion of all relevant representatives of future guideline users.ResultsMore than 60 clinical experts and researchers analyzed the scientific literature. In total 41 international and national guidelines (23 for alcohol and 18 for tobacco) were used. Moreover, 83 systematic Cochrane reviews (alcohol 28, tobacco 55) and 5863 articles (alcohol 2213, tobacco 3650) were analyzed. A total of 7 expert groups formulated 174 recommendations for the screening, diagnosis and treatment of alcohol-related disorders. Six expert groups created 81 recommendations for the screening, diagnosis and treatment of tobacco-related disorders. Approximately 50 scientific associations, professional organizations, patient and family initiatives, as well as representatives of the healthcare system formed a consensus group. In seven 1 and 2-day conferences, all clinical recommendations were discussed and approved by this group. Both guidelines will be revised on a regular basis to guarantee that the clinical recommendations are kept up to date.ConclusionsBoth systematically developed, evidence-based treatment guidelines are comprehensive instruments to provide orientation and assist the decision-making process for physicians, psychologists and other therapists as well as patients and their families in the diagnosis and treatment of alcohol and tobacco use related disorders.

Behandlung von schädlichem und abhängigem Tabakkonsum

Kapitel 4 umfasst alle Leitlinienempfehlungen zur Behandlung von tabakbezogenen Storungen mit ihrem Hintergrundtext und Empfehlungen zur weiteren Forschung. Inhalt sind: die Forderung der Ausstiegsmotivation, die Indikation und Durchfuhrung niederschwelliger Interventionen, Masnahmen zur Harm Reduction, psychotherapeutische, pharmakologische und somatische Ansatze, Techniken und Methoden zur Unterstutzung der Tabakabstinenz und Ruckfallprophylaxe. Spezielle Empfehlungen werden fur allgemeine Indikationsfelder (Alter, Geschlecht, Schwangerschaft) sowie somatische und psychische Komorbiditaten auf evidenzbasierter Basis mit den zugehorigen Hintergrundempfehlungen formuliert. Den Abschluss bilden Empfehlungen zu Setting und Versorgungssituation. Drei klinische Behandlungsalgorithmen stellen den allgemeinen Therapieprozess sowie die psychotherapeutischen und pharmakologischen Prozesse von der ersten Problematisierung des Tabakkonsums bis zum Erreichen der Abstinenz dar. Zum Verstandnis der Empfehlungstabellen wird das vorherige Lesen der Methodenabschnitte der Zusammenfassung (Kap. 1) dringend empfohlen, zum Verstandnis der klinischen Algorithmen Abschn. 2.1.4.