Epidemiologische und ätiologische Aspekte von Depression und Angst - Psychische Komorbidität bei alkoholbezogenen Störungen

Zusammenfassung

Das gemeinsame Auftreten von Alkoholabhängigkeit oder -missbrauch mit weiteren psychischen Störungen erfuhr in den letzten Jahrzehnten immer breitere Beachtung. In epidemiologischen Studien konnten hohe Prävalenzraten ermittelt werden. Am häufigsten zeigen alkoholabhängige Personen Angststörungen oder affektive Störungen (insbesondere Frauen) und Persönlichkeitsstörungen, vorwiegend aus Cluster B (narzisstische, histrionische und/oder antisoziale Persönlichkeitsstörung) (insbesondere Männer). Trotz teilweise sehr unterschiedlicher Prävalenzzahlen (überwiegend ein methodologisches Problem) liegen konsistente Befunde vor, welche die klinische Relevanz des Bereichs „Komorbidität” unterstreichen. Der Verlauf einer alkoholbezogenen Störung ist oftmals schwerer und die Behandlungsergebnisse weniger erfolgreich, wenn zusätzlich weitere psychische Störungen vorliegen. In diesem Zusammenhang stellt insbesondere Suizidalität ein nicht zu vernachlässigendes Problem dar. Ätiologische Hypothesen lassen sich grob in zwei Kategorien unterteilen: a) kausale Zusammenhänge zwischen Alkoholkonsum und psychischer Störung, b) gemeinsame ätiologische Faktoren tragen zur Genese beider Störungsbereiche bei. Im Fall von Angststörungen waren lange Zeit Selbstmedikationshypothesen sehr dominierend, die vor allem für Phobien relevant zu sein scheinen. Erst in letzter Zeit verschob sich der Aufmerksamkeitsfokus hin zu angstauslösenden Effekten des Alkoholkonsums. Bei affektiven Störungen spielen Annahmen einiger möglicher gemeinsamer ätiologischer Faktoren (Depressions-Spektrum-Erkrankung) neben depressions-fördernden Wirkungen des Alkohols eine entscheidende Rolle.

Summary

Increasing attention has been given to the association between alcoholism and other mental disorders over the last decades. Epidemiological studies revealed high prevalence rates of other mental disorders in persons with alcohol use disorders. Most persons suffer from anxiety or mood disorders (predominantly women) or cluster B personality disorders (predominantly men). Despite varying prevalence rates (due to methodological problems), research findings underline the clinical relevance of comorbidity. The course of alcohol use disorders often seems to be less favourable with poor treatment outcomes, given the presence of a comorbid disorder. Suicidality is one of the critical issues in this context. Aetiological hypotheses can roughly be divided into two categories: a) causal relationships between alcohol consumption and other mental disorders, b) shared aetiological factors contribute to the pathogenesis of both disorders. In cases of anxiety disorders self-medication hypotheses were dominant for a long period of time, which especially seemed to be relevant for phobias. Recently the focus of attention rather switched to anxiety-eliciting effects of alcohol consumption. In cases of mood diseases the assumption of some possibly shared aetiological factors plays an important role (depression-spectrum-disease) beside the depression supporting effects of alcohol.

Key words

comorbidity - alcoholism - anxiety - mood disorders

Literatur

• 1 Angst J, Gamma A, Neuenschwander M, Ajdadic V, Eich D, Rössler W. Syndrom-Spektren im Längsschnitt: Angst, Depression, Hypomania und Alkohol.  In: Soyka M, Möller HJ, Wittchen HU (Hrsg.). Psychopathologie im Längsschnitt. Landsberg/Lech, ecomed. 2003;  15-27
• 2 Angst J, Vollrath M. The natural history of anxiety disorders.  Acta Psychiatr Scand. 1991;  84 446-452
• 3 Atkinson R. Depression, alcoholism and ageing: a brief review.  Int J Geriatr Psychiat. 1999;  14 905-910
• 4 Ballenger JC, Goodwin FK, Major LF, Brown GL. Alcohol and central serotonin metabolism in man.  Arch Gen Psychiatry. 1979;  36 224-227
• 5 Bakken K, Landheim AS, Vaglum P. Primary and secondary misusers: do they differ in substance-induced and substance-independent mental disorders?.  Alcohol Alcohol. 2003;  38 54-59
• 6 Bibb J, Chambless DL. Alcohol use and abuse among diagnosed agoraphobics.  Behav Res Ther. 1986;  24 49-58
• 7 Blume SB. Sex-related differences in depressed alcoholics. Reply to Schuckit et al., 1997.  Am J Psychiatry. 1998;  155 1464-1465
• 8 Cadoret RJ, Winokur G, Langbehn D, Troughton E, Yates WR, Stewart MA. Depression spectrum disease.  In: The role of gene-environment interactions.  Am J Psychiatry. 1996;  153 892-899
• 9 Cloninger CR, Reich T, Wetzel R. Alcoholism and affective disorders: familial associations and genetic models.  In Goodwin DW, Erickson CK (eds.): Alcoholism and affective disorders.  New York, Sp Medical and Scientific Books. 1979;  57-87
• 10 Coffman JA, Petty F. Plasma GABA levels in chronic alcoholics.  Am J Psychiatry. 1985;  142 1204-1205
• 11 Conger JJ. Alcoholism: theory problem and challenge. II. Reinforcement theory and the dynamics of alcoholism.  Q J Stud Alcohol. 1956;  13 296-305
• 12 Cornelius JR, Salloum IM, Mezzich J, Cornelius MD, Fabrega H, Ehler JG, Ulrich RF, Thase ME, Mann JJ. Disproportionate suicidality in patients with comorbid major depression and alcoholism.  Am J Psychiatry. 1995;  152 358-364
• 13 Davidson KM, Blackburn IM. Comorbid depression and drinking outcome in those with alcohol dependence.  Alcohol Alcohol. 1998;  33 482-487
• 14 Driessen M, Arolt V, John U, Veltrup C, Dilling H. Psychiatric comorbidity in hospitalized alcoholics after detoxification treatment.  Eur Addict Res. 1996;  2 17-23
• 15 Driessen M, Meier S, Hill A, Wetterling T, Lange W, Junghanns K. The course of anxiety, depression and drinking behaviours after completed detoxification in alcoholics with and without comorbid anxiety and depressive disorders.  Alcohol Alcohol. 2001;  36 249-255
• 16 Eriksson E, Humble M. Serotonin in psychiatric pathophysiology. A review of data from experimental and clinical research.  In: Pohl R, Gershon S (Hrsg.). The biological basis of psychiatric treatment. Progress in basic clinical pharmacology, vol. 3.  Basel, Karger. 1990;  66-119
• 17 George DT, Nutt DJ, Dwyer BA, Linnoila M. Alcoholism and panic disorder: is the comorbidity more than coincidence?.  Acta Psychiatr Scand. 1990;  81 97-107
• 18 Goodwin DW, Schulsinger F, Knop J, Mednick S, Guze SB. Psychopathology in adopted and non-adopted daughters of alcoholics.  Arch Gen Psychiatry. 1977;  34 1005-1009
• 19 Hall SM. The abstinence phobias: links between substance abuse and anxiety.  Int J Addict. 1984;  19 613-631
• 20 Hasegawa K, Mukasa H, Nakazawa Y, Kodama H, Nakamura K. Primary and secondary depression in alcoholism - clinical features and family history.  Drug Alcohol Depend. 1991;  27 275-281
• 21 Haywood TW, Kravitz HM, Grossman LS, Cavanaugh JL, Davis JM, Lewis DA. Predicting the „revolving door” phenomenon among patients with schizophrenic, schizoaffective, and affective disorders.  Am J Psychiatry. 1995;  152 856-861
• 22 Helzer JE, Pryzbeck TR. The cooccurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment.  J Stud Alcohol. 1988;  49 219-224
• 23 Hesselbrock MN, Meyer RE, Keener J. Psychopathology in hospitalised alcoholics.  Arch Gen Psychiatry. 1985;  42 1050-1055
• 24 Himle JA, Abelson JL, Haghightgou H, Hill EM, Nesse RM, Curtis GC. Effect of alcohol on social phobic anxiety.  Am J Psychiatry. 1999;  156 1237-1243
• 25 Hunt WA. Brain mechanisms that underlie the reinforcing effects of ethanol.  In: Cox M (Hrsg.). Why people drink, vol. 4.  Gardner. 1990;  71-83
• 26 Kendler K, Kessler RC, Neale MC, Heath AC, Eaves LJ. The prediction of major depression in women: towards an integrated etiologic model.  Am J Psychiatry. 1993;  150 1139-1148
• 27 Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime cooccurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the United States: results from the National Comorbidity Survey.  Arch Gen Psychiatry. 1997;  51 8-19
• 28 Kranzler HR, Del FK Boca, Rounsaville BJ. Comorbid psychiatric diagnoses predicts three-year outcomes in alcoholics.  J Sud Alcohol. 1996;  57 619-626
• 29 Kushner MG, Abrams K, Borchardt C. The relationship between anxiety disorders and alcohol use disorders: a review of major perspectives and findings.  Clin Psychol Rev. 2000;  20 149-173
• 30 Kushner MG, Kenneth JS, Erickson DJ. Prospective analysis of the relationship between DSM-III anxiety disorders and alcohol use disorders.  Am J Psychiatry. 1999;  156 723-732
• 31 Kushner MG, Kenneth J, Sher KJ, Beitman BD. The relation between alcohol problems and the anxiety disorders.  Am J Psychiatry. 1990;  147 685-695
• 32 Lipton RI. The effect of moderate alcohol use and the relationship between stress and depression.  Am J Public Health. 1994;  84 1913-1917
• 33 Logue PE, Gentry WD, Linnoila M, Erwin CW. Effects of alcohol consumption on state anxiety changes in male and female non-alcoholics.  Am J Psychiatry. 1978;  135 1079-1081
• 34 Loosen PT, Dew BW, Prange AJ. Long-term predictors of outcome in abstinent alcoholic men.  Am J Psychiatry. 1990;  147 1662-1666
• 35 Maier W, Lichtermann D, Minges J. The relationship of alcoholism and unipolar depression: a controlled family study.  J Psychiatr Res. 1994;  28 303-317
• 36 Maier W, Merikangas KR. Co-occurrence and cotransmission of affective disorders and alcoholism in families.  Br J Psychiatry. 1996;  30 93-100
• 37 Maier W, Minges J, Lichtermann D. Alcoholism and panic disorder: co-occurrence and co-transmission in families.  Eur Arch Psychiatry Clin Neurosci. 1993;  243 205-211
• 38 Mann K, Hintz T, Jung M. Does psychiatric comorbidity in alcohol-dependent patients affect treatment outcome?.  Eur Arch Psychiatry Clin Neurosci; in press.
• 39 Merikangas K, Risch N, Weissman M. Comorbidity and co-transmission of alcoholism, anxiety, and depression.  Psychol Med. 1994;  24 69-80
• 40 Merikangas KR, Stevens DE, Fenton B, Stolar M, O'Malley S, Woods SW, Risch N. Comorbidity and familial aggregation of alcoholism and anxiety disorders.  Psychol Med. 1998;  28 773-788
• 41 Meyer C, Rumpf HJ, Hapke U, Dilling H, John U. Lebenszeitprävalenz psychischer Störungen in der erwachsenen Bevölkerung. Ergebnisse der TACOS-Studie.  Nervenarzt. 2000;  71 535-542
• 42 O'Sullivan K, Rynne C, Miller J, OŽSullivan S, Fitzpatrick V, Hux M, Cooney J, Clare A. A follow-up study on alcoholics with and without co-existing affective disorders.  Br J Psychiatry. 1988;  152 813-819
• 43 Pitts FN, Winokur G. Affective disorders - VII: Alcoholism and affective disorders.  J Psychiatr Res. 1966;  4 37-50
• 44 Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the epidemiologic catchment area study (ECA).  JAMA. 1990;  264 2511-2518
• 45 Rommelspacher H, Schmidt LG. Pathobiochemische und pharmakologische Aspekte der Abhängigkeit.  In: Tretter F, Busello-Spieth S, Bender W (Hrsg.). Therapie von Entzugssyndromen.  Berlin, Springer. 1994;  28-46
• 46 Rounsaville BJ, Dolinsky CS, Babor TF, Meyer RE. Psychopathology as a predictor of treatment outcome in alcoholics.  Arch Gen Psychiatry. 1987;  44 505-513
• 47 Roy A. Aetiology of secondary depression in male alcoholics.  Br J Psychiatry. 1996;  169 753-757
• 48 Schuckit MA, Hesselbrock VM. Alcohol dependency and anxiety disorders: what is the relationship?.  Am J Psychiatry. 1994;  151 1723-1734
• 49 Schuckit MA, Tipp JE, Bergman M, Reich W, Hesselbrock V, Smith TL. Comparison of induced and independent major depressive disorders in 2945 alcoholics.  Am J Psychiatry. 1997;  154 948-957
• 50 Schuckit MA, Tipp JE, Bucholz KK, Nurnberger JI, Hesselbrock VM, Crowe RR, Kramer J. The life-time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls.  Addiction. 1997;  92 1289-1304
• 51 Schutte KK, Moos RH, Brennan PL. Depression and drinking behavior among women and men: A three-way longitudinal study of older adults.  J Cons Clin Psychol. 1995;  63 810-822
• 52 Sexton H, Lipton RI, Nilssen O. Relating alcohol use and mood: Results from the Tromsø Study.  J Stud Alcohol. 1999;  60 111-119
• 53 Sher KJ. Stress response dampening.  In: Blane HT, Leonard KE (Hrsg.). Psychological theories of drinking and alcoholism.  New York, Guilford Press. 1987;  227-271
• 54 Stockwell T, Smail P, Hodgson R, Canter S. Alcohol dependence and phobic anxiety states. II: a retrospective study.  Br J Psychiatry. 1984;  144 53-57
• 55 Swedsen JD, Merikangas KR, Canino GJ, Kessler RC, Rubio-Stipec M, Angst J. The comorbidity of alcoholism with anxiety and depressive disorders in four geographic communities.  Compr Psychiatry. 1998;  39 176-184
• 56 Tomasson K, Vaglum P. The role of psychiatric comorbidity in the prediction of readmission for detoxification.  Compr Psychiatry. 1998;  39 129-136
• 57 Torgensen S. Childhood and family characteristics in panic and generalized anxiety disorders.  Am J Psychiatry. 1986;  143 630-632
• 58 Vaillant GE. Natural history of male psychological health: VIII. Antecedents of alcoholism and „orality”.  Am J Psychiatry. 1980;  137 181-186
• 59 Waller SJ, Lyons JS, Constantini-Ferrando MF. Impact of comorbid affective and alcohol use disorders on suicidal ideation and attempts.  J Clin Psychol. 1999;  55 585-595
• 60 Wilson GT. Alcohol and anxiety.  Behav Res Ther. 1988;  26 369-381
• 61 Winokur G, Coryell W, Akiskal HS, Maser JD, Keller MB, Endicott J, Mueller T. Alcoholism in manic-depressive (bipolar) illness: familial illness, course of illness, and the primary-secondary distinction.  Am J Psychiatry. 1995;  152 365-372
• 62 Winokur G, Reich T, Rimmler J, Pitts FN. Alcoholism III. Diagnosis and familial psychiatric illness in 259 alcoholic probands.  Arch Gen Psychiatry. 1970;  23 104-111
• 63 Wittchen HU, Essau CA, Zerssen v D, Krieg JC, Zaudig M. Lifetime and 6-months prevalence of mental disorders in the Munich Follow-up Study.  Eur Arch Psychiatry Clin Neurosci. 1992;  241 247-258
• 64 Wittchen HU, Perkonigg A, Reed V. Comorbidity of mental disorders and substance use disorders.  Eur Addict Res. 1996;  2 36-47

Korrespondenzadresse: