Substanz-bezogene Störungen: Auf dem Weg zu ICD-11 und DSM-V

 

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Zusammenfassung

Perspektiven zur Entwicklung „Substanzbezogener Störungen” für DSM-V werden gemäß einer Expertenkonferenz aufgezeigt, die von der amerikanischen Psychiatergesellschaft (APA) unter dem Vorsitz von M.A. Schuckit und J.B. Saunders organisiert wurde. Internationale Experten hatten die Erwartung, dass eine weitreichende Kompatibilität mit der ICD-11 der WHO erreicht werden könnte. Es wurde davon ausgegangen, dass es bei den Substanz-bezogenen Störungen auch in DSM-V weiterhin ein Abhängigkeitssyndrom, eine klinisch bedeutsame Nicht-Abhängigkeits-Kategorie und eine unterschwellige (Risiko-)Kondition geben wird. Es werden wohl kategoriale und dimensionale Kriterien, letztere als quantitative Ausformulierungen der kategorialen Merkmale aufgenommen werden. Neben generellen wurden auch Substanz-spezifische Abhängigkeits-Kriterien diskutiert. Forschungsbedarf wurde für das Problem der Abgrenzung Substanz-induzierter von (Substanz-)unabhängigen psychischen Störungen konstatiert, um die Komorbidität der Patienten mit Substanz-bezogenen Störungen angemessen zu codieren. Es ist offen, ob das Ziel erreicht werden kann, biologische Kriterien zur Verminderung der Beurteilungsvarianz bei Substanz-bezogenen Störungen in DSM-V aufzunehmen.

Abstract

The development of substance abuse disorders (SUD) for DSM-V is put into perspective according to an expert meeting organized by APA and chaired by M.A. Schuckit and J.B. Saunders. Substantial compatibility with ICD-11 of WHO was expected to be achieved. A dependence syndrome, a non-dependence category as well as a subthreshold condition is supposed to be included in the SUD section in DSM-V. Categorical criteria will possibly be supplemented by dimensions conceptualized as quantitative formulations of criteria content. General and substance-specific criteria may be included for dependence. The comorbidity problem requires more research to separate substance-induced from substance-independent mental disorders in patients with SUDs. It was an open discussion, whether the aim to include biological criteria for better defining of SUDs will be achieved in DSM-V.

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Prof. Dr. med. Lutz G. Schmidt

Psychiatrische Klinik und Poliklinik, Johannes Gutenberg-Universität

Untere Zahlbacher Str. 8

55131 Mainz

Email: schmidt@psychiatrie.klinik.uni-mainz.de