甲基苯丙胺相关障碍。
Methamphetamine-Related Disorders.
机构信息
*All of the authors of the S3 guideline are listed in eTable1. They contributed equally to this article; Landschaftsverband Rheinland (Rhineland Regional Council, LVR)-Klinik Köln; Psychotherapeutic Practice Bayreuth; Allgemeine Hospitalgesellschaft (AHG) Klinik Mecklenburg; University Medical Center Göttingen; Technische Universität Chemnitz; Department of Psychiatry and Psychotherapy, University Hospital of Regensburg.
出版信息
Dtsch Arztebl Int. 2017 Jun 30;114(26):455-461. doi: 10.3238/arztebl.2017.0455.
BACKGROUND
Methamphetamine is considered more dangerous than other stimulants because of its acute complications, long-term neurotoxicity, and potential for drug dependence. Until now, there have been no evidence-based guidelines for the treatment of methamphetamine-related disorders, either in Germany or abroad.
METHODS
A systematic literature search was performed on the treatment of methamphetamine-related disorders. Based on this literature review, a multidisciplinary expert panel developed recommendations using the nominal group technique.
RESULTS
The evidence base for the treatment of methamphetamine-related disorders is sparse. The efficacy of psychotherapeutic techniques such as cognitive behavioral therapy and contingency management and the efficacy of complex, disorder-specific treatment programs have been proven in ran - domized controlled trials, but it remains unclear which method is best. Persons carrying a diagnosis of substance abuse should be offered psychotherapy. Structured exercise programs, whether self-directed or professionally led, can improve addiction-specific endpoints as well as comorbid disorders and should, therefore, be offered as well. Pharmacotherapy has shown little to no effect in relatively low-quality clinical trials with low case numbers and high dropout rates, and therefore only a few weak recommendations were made. These include tranquilizers for the short-term treatment of agitation and atypical antipsychotics if necessary. Attempts to substitute other substances, such as methylphenidate or dexamphetamine, for methamphetamine have not yielded any robust evidence to date. Sertraline should not be administered due to serious adverse events.
CONCLUSION
Many of the recommendations in the guideline are made with a weak grade of recommendation because of the poor evidence base and the modest size of the reported therapeutic effects. In acute situations, symptomoriented treatment is recommended. Psychotherapy and exercise should be offered as well.
背景
冰毒被认为比其他兴奋剂更危险，因为它会导致严重的急性并发症、长期神经毒性和潜在的药物依赖性。迄今为止，无论是在德国还是在其他国家，都没有针对冰毒相关障碍的循证治疗指南。
方法
系统地检索了治疗冰毒相关障碍的文献。基于文献综述，一个多学科专家小组使用名义小组技术制定了建议。
结果
冰毒相关障碍的治疗证据基础薄弱。心理治疗技术，如认知行为疗法和条件管理，以及针对特定障碍的复杂治疗方案的疗效已在随机对照试验中得到证实，但仍不清楚哪种方法效果最好。诊断为物质滥用的患者应接受心理治疗。结构化的运动方案，无论是自我指导还是专业指导，都可以改善成瘾相关的终点以及合并症，因此也应提供这些方案。药物治疗在数量少、退出率高的低质量临床试验中效果甚微，仅得出了少数几个较弱的建议。这些建议包括在短期内治疗激越的镇静剂和必要时使用非典型抗精神病药。迄今为止，用其他物质（如哌甲酯或右旋苯丙胺）替代冰毒的尝试并未产生任何可靠证据。由于严重的不良反应，不应使用舍曲林。
结论
由于证据基础薄弱和报告的治疗效果有限，指南中的许多建议的推荐等级都较低。在急性情况下，建议进行对症治疗。还应提供心理治疗和运动治疗。
Zotero 插件