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Übersichtsarbeit

(Psycho-)Stimulanzien in Psychopharmakotherapie und pharmakologischem Neuroenhancement und ihre suchtmedizinischen Implikationen

Published Online:June 19, 2017https://doi.org/10.1024/0939-5911/a000484

Abstract

Zusammenfassung.Zielsetzung: Ziel des Artikels ist es, dem Leser eine Übersicht über die Wirkungen und die Verbreitung von (Psycho-)Stimulanzien zur Verbesserung kognitiver Funktionen bei Gesunden (pharmakologisches kognitives Neuroenhancement [PCE]) unter besonderer Berücksichtigung suchtmedizinischer Aspekte zu geben. Methodik: Systematische Literaturrecherche via PubMed nach Psychostimulanzien („stimulants“), die zur geistigen Leistungssteigerung („cognitive enhancement“) eingesetzt werden, und Literaturrecherche in aktuellen Büchern aus dem Bereich Sucht. Ergebnisse: Nach heutigem Kenntnisstand spielt die Gruppe der (Psycho-)Stimulanzien die zentrale Rolle beim Phänomen des PCE. Hierzu zählen sowohl die frei verkäuflichen Methylxanthine wie Koffein aber auch illegale bzw. verschreibungspflichtige Amphetamine und deren Derivate wie Methylphenidat, die zum PCE missbraucht werden. Gleichermaßen werden die verschreibungspflichtigen Substanzen dieser Gruppe aber auch gemäß ihrer Indikation psychopharmakotherapeutisch angewendet. Dabei liegt das Ziel der Psychopharmakotherapie in der Verbesserung der vorliegenden Symptome und im Bezug zu krankheitsbedingten kognitiven Einbußen in der Wiederherstellung des krankheitsbedingt verloren gegangenen kognitiven Funktionsniveaus mit einem für die jeweilige psychische Erkrankung indizierten Medikament. Ziel des PCE ist hingegen die Verbesserung der kognitiven Leistungsfähigkeit verschiedener kognitiver Domänen wie z. B. Vigilanz, Konzentration und Gedächtnis über ein „normales Maß“ hinaus. Schlussfolgerung: Der Artikel zeigt die Überschneidung der (Psycho-)Stimulanzien zur Pharmakotherapie und zum PCE und verdeutlicht insbesondere das Suchtrisiko bei Kranken und Gesunden.


Stimulants in psychopharmaco-therpay and pharmacological neuroenhancement

Abstract.Aim: This review gives an overview of the effects and prevalence rates of (psycho-)stimulants presumed to increase cognitive functions in healthy subjects, with a special emphasis on the abuse potential. Methods: We performed a systematic search of the literature via pubmed with the keywords “stimulants” and “cognitive enhancement”; we also did an additional literature search in the most recent books in the field of addiction. Results: Regarding the recent phenomenon of pharmacological cognitive (neuro-)enhancement (PCE), the group of putative PCE drugs is dominated by the group of (psycho-)stimulants such as over the counter (OTC) drugs like methylxanthines (e. g., caffeine) and the illicit or prescription drug group of amphetamines and its derivates (e. g., methylphenidate). Prescription stimulants have clear indications for certain disorders such as attention deficit syndrome. In this respect, the goal of psychopharmacotherapy is to reduce the symptoms caused by the psychiatric disorder by restoring the “original” cognitive performance through the use of prescription drugs. The aim of stimulant PCEs, on the other hand, is to increase cognitive performance beyond the original/natural state of a healthy person in various cognitive domains (e. g., vigilance, concentration, memory, etc.). Conclusion: The article shows a significant interference of stimulant use for medical treatment and PCE. Stimulants have a considerable risk of addiction in patients as well as healthy individuals in the absence of any psychiatric disorder.

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