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Medikamentöse Therapie der Angst bei Patienten mit fortgeschrittenen Tumorerkrankungen bzw. Patienten in der palliativen Situation

Systematische Literaturübersicht

Drug therapy of anxiety and fear in palliative care patients with cancer or other illnesses

A systematic review

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Zusammenfassung

Hintergrund

Die medikamentöse Therapie der Angst ist ein wichtiger Bestandteil der Palliativversorgung. In dieser Literaturübersicht wird die vorliegende Evidenz für den Einsatz von Medikamenten zur Therapie der Angst bei Patienten in der terminalen Phase ihres Lebens dargestellt.

Material und Methoden

Die Literaturdatenbanken PubMed, Embase CINAHL, PsycLIT und PsycINFO wurden bis Januar 2012 systematisch nach Studien zum Einsatz von medikamentösen Therapien der Angst in der Palliativversorgung durchsucht. Zusätzlich wurden die Cochrane Library und literaturangabenrelevante Veröffentlichungen und Lehrbücher ausgewertet. In einer Kategorisierung der Studien wurde der Endpunkt der medikamentösen Therapie der Angst abgegrenzt.

Ergebnisse

Insgesamt wurden 4 kontrollierte und 3 nichtkontrollierte Studien zur Pharmakotherapie der Angst, 2 retrospektive Analysen, ein Fallbericht, eine systematische Cochrane-Übersichtsarbeit sowie eine nichtsystematische Übersichtsarbeit eingeschlossen. Das zeigt eine sehr geringe Datenlage zur Therapie der nichtsymptombezogenen Angst in der Palliativversorgung. Insgesamt haben die Benzodiazepine den größten Stellenwert in der Therapie der Angst. Allerdings kann aus den vorhandenen Studien keine evidenzbasierte Therapieempfehlung abgeleitet werden.

Schlussfolgerung

Zusammenfassend kann aufgrund dieser Literaturübersicht keine generelle Empfehlung für die medikamentöse Therapie der Angst in der Palliativversorgung ausgesprochen werden. Auch für den gebräuchlichen Einsatz von Benzodiazepinen, Antidepressiva, Neuroleptika, Hypnotika, Antihistaminika und β-Blockern zur Therapie der Angst bei terminal erkrankten Patienten konnte keine ausreichende Evidenz gefunden werden. Diese Medikamente werden allerdings in anderen Patientenpopulationen mit schweren Erkrankungen erfolgreich zur Therapie der Angst eingesetzt. Daher ist der Einsatz dieser Substanzen bei Palliativpatienten sinnvoll. Die aktuelle Studienlage erlaubt keine Empfehlung einzelner Substanzen oder Dosierungen. Anhand der Datenlage wird deutlich, dass Studien zur medikamentösen Angsttherapie bei terminal erkrankten Patienten dringend notwendig sind.

Abstract

Background

Pharmacological treatment of anxiety is an important part of drug treatment in palliative care. In this review we searched for the current evidence of pharmacological treatment of anxiety in palliative care.

Materials and methods

A systematic search of PubMed, Embase, PsycLIT, PsycINFO, CINAHL for studies of anxiety in palliative care was carried out in January 2012. Furthermore we searched the Cochrane Library, references of literature and leading textbooks. Studies were identified and information was filled in a standardized extraction sheet. Studies have been categorized and anxiety as an endpoint determined.

Results

A total of four controlled studies, three uncontrolled studies, two retrospective studies, one case report, two surveys, one systematic Cochrane review and one unsystematic review were analyzed and included in this review. This indicates an overall low number of studies for the pharmacological treatment of anxiety in palliative care. According to our results, benzodiazepines are the most commonly used drugs in palliative care. However, based on our review, there is no evidence-based recommendation for the therapeutic use in palliative care.

Conclusions

With the existing evidence no general recommendations for pharmacological treatment of anxiety in palliative care can be given. Even for the commonly used benzodiazepines, neuroleptics, antidepressants, antihistamines and beta blockers for the treatment of anxiety no evidence based recommendations can be made. However, these medications are commonly used to treat anxiety in other patient populations and can also be used in palliative care patients. According to our review we cannot recommend a single drug or give recommendations regarding the dosage of drugs. There is a strong need for randomized controlled trials to evaluate the effect of drug treatment of anxiety in palliative care patients.

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Danksagung

Die Arbeit wurde nach den Vorgaben der Steuerungsgruppe der Therapieempfehlungen Palliativmedizin der Arzneimittelkommission der Deutschen Ärzteschaft (Lukas Radbruch, Friedemann Nauck, Bernd Alt-Epping, Roman Rolke, Mariam Ujeyl, Rainer Lasek) und ohne externe Förderung durchgeführt.

Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: S. Lorenzl übt Beratertätigkeiten für ULB und TEVA aus.

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Authors and Affiliations

  1. Interdisziplinäres Zentrum für Palliativmedizin, Klinikum Großhadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München, Deutschland

    G. Nübling, S. Allmendinger & S. Lorenzl

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  1. G. Nübling
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  3. S. Lorenzl
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Correspondence to G. Nübling.

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Nübling, G., Allmendinger, S. & Lorenzl, S. Medikamentöse Therapie der Angst bei Patienten mit fortgeschrittenen Tumorerkrankungen bzw. Patienten in der palliativen Situation. Schmerz 26, 537–549 (2012). https://doi.org/10.1007/s00482-012-1241-6

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