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S2K Leitlinie Notfallpsychiatrie 2019

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S2K Leitlinie Notfallpsychiatrie 2019 S2k-Leitlinie „Notfallpsychiatrie“ (Stand: 13.04.2019) AWMF-Registernummer: 038-023 Federführende Fachgesellschaft: Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Ner- venheilkunde (DGPPN) KonsentierenDe Fachgesellschaften: Deutsche Gesellschaft Interdisziplinäre Notfall- und Akutmedizin (DGINA) Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI) Autorengruppe: Mitglieder des Referats Notfallpsychiatrie der DGPPN unter Federführung von: Prof. Dr. med. Frank-Gerald Pajonk Prof. Dr. med. Thomas Messer Prof. Dr. med. Horst Berzewski KoorDination unD ReDaktion: Leitlinienkoordinator: Prof. Dr. med. Frank-Gerald Pajonk, Praxis Isartal, Kloster Schäftlarn 8, 82067 Kloster Schäftlarn Ko-Koordinator: Prof. Dr. med. Thomas Messer Danuvius Klinik, Krankenhausstr. 68, 85276 Pfaffenhofen 1 Inhaltsverzeichnis 1 Präambel .................................................................................................................... 7 2 Abkürzungen .............................................................................................................. 8 3 Einführung ................................................................................................................ 11 3.1 Hintergrund der Leitlinie und Problemstellung .............................................................. 11 3.1.1 Definition des psychiatrischen Notfalls ......................................................................................... 12 3.1.2 Häufigkeit psychiatrischer Notfälle ............................................................................................... 15 3.1.3 Notfallpsychiatrisch relevante Störungsbilder und Situationen ................................................... 18 3.1.4 Datenlage zur notfallpsychiatrischen Versorgung in den unterschiedlichen Versorgungssektoren 20 3.2 Schwierigkeiten bei der Durchführung von Untersuchungen in der NotfAllpsychiatrie .. 25 3.3 Ziele der Leitlinie .......................................................................................................... 26 3.4 Zielgruppen und Geltungsbereich .................................................................................. 26 4 Methoden der Leitlinie ............................................................................................. 28 4.1 Definition und Aufgaben von Leitlinien ......................................................................... 28 4.2 Auftraggeber ................................................................................................................. 29 4.3 Autorengruppe ............................................................................................................. 29 4.4 Konsentierende Fachgesellschaften .............................................................................. 31 4.5 Beteiligung von Patienten und Angehörigen ................................................................. 33 4.6 Methodik der Leitlinienerstellung ................................................................................. 33 4.7 Interessenkonflikte ....................................................................................................... 35 4.8 Finanzierung der vorliegenden Leitlinie ......................................................................... 35 4.9 Verabschiedung der Leitlinie ......................................................................................... 36 4.10 Gültigkeitsdauer, AktuAlisierung, AnsprechpArtner ....................................................... 36 5 Notfallpsychiatrisch relevante Syndrome und Störungen .......................................... 37 5.1 Bewusstseinsstörungen, Verwirrtheitszustände ............................................................ 37 5.2 Delir .............................................................................................................................. 39 2 5.3 Psychische und Verhaltensstörungen durch psychotrope Substanzen ........................... 43 5.3.1 Intoxikationen und Räusche .......................................................................................................... 43 5.3.2 Entzug ............................................................................................................................................ 45 5.3.3 Missbrauch und Abhängigkeit ....................................................................................................... 46 5.4 Angstsyndrome ............................................................................................................. 52 5.5 Erregungszustände ........................................................................................................ 55 5.6 Suizidalität .................................................................................................................... 59 5.7 Paranoid-halluzinatorische Syndrome ........................................................................... 64 5.8 Maniforme Syndrome ................................................................................................... 67 5.9 Stupor und KatAtonie .................................................................................................... 69 5.10 Anorexia nervosA .......................................................................................................... 72 5.11 Psychosoziale Krise und Traumatisierungen .................................................................. 76 5.12 Psychische Störungen als Folge von Katastrophen und Großschadensereignissen ........ 79 5.13 Amok ............................................................................................................................ 80 6 Diagnostik ................................................................................................................ 83 6.1 MedicAl CleArAnce ......................................................................................................... 84 6.2 Psychischer Befund ....................................................................................................... 87 7 Maßnahmen und Therapie ....................................................................................... 91 7.1 Vorgehen beim Erstkontakt .......................................................................................... 91 7.2 Psychotherapeutische Krisenintervention ..................................................................... 92 7.3 Pharmakotherapie ........................................................................................................ 93 7.3.1 Geeignete Psychopharmaka .......................................................................................................... 94 7.3.2 Antipsychotika ............................................................................................................................. 100 7.3.3 Benzodiazepine ........................................................................................................................... 104 7.4 Soziale Unterstützung ................................................................................................. 105 7.5 Deeskalation, Sicherheit und MaßnAhmen bei Gefährdung ......................................... 108 7.5.1 Prävention aggressiven Verhaltens ............................................................................................. 109 7.5.2 Umgang mit aggressiven Patienten ............................................................................................ 112 3 8 Störungsspezifische Versorgung ............................................................................. 115 8.1 Bewusstseinsstörungen, Verwirrtheit ......................................................................... 115 8.1.1 Präklinik ....................................................................................................................................... 115 8.1.2 Notaufnahme .............................................................................................................................. 116 8.1.3 Psychiatrische Klinik .................................................................................................................... 116 8.2 Delir ............................................................................................................................ 118 8.2.1 Präklinik ....................................................................................................................................... 129 8.2.2 Notaufnahme .............................................................................................................................. 130 8.2.3 Psychiatrische Klinik .................................................................................................................... 130 8.3 Substanzbedingte Störungen ...................................................................................... 131 8.3.1 Präklinik ....................................................................................................................................... 139 8.3.2 Notaufnahme .............................................................................................................................. 140 8.3.3 Psychiatrische Klinik .................................................................................................................... 142 8.4 Angstsyndrome ........................................................................................................... 143 8.4.1 Präklinik ......................................................................................................................................
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