Zusammenfassung
Die Arbeit gibt einen Überblick über das Auftreten der posttraumatischen Belastungsstörung (PTSD) im Kontext somatischer Erkrankungen. Die Forschung konzentrierte sich nach der Aufnahme dieser Diagnose in das Diagnostic Statistic Manual (DSM-III 1980) zunächst vorwiegend auf psychopathologische Reaktionen nach psychischen Traumata, insbesondere nach militärischen Fronteinsätzen, nach tätlichen Angriffen oder Vergewaltigungen. Zu Beginn der 90er Jahre wurde PTSD dann auch nach zivilen Traumata wie z. B. Verkehrsunfällen häufiger diagnostiziert. Auch schwerwiegende somatische Erkrankungen können zu einer PTSD gemäß DSM-IV führen. Es wurden Arbeiten über PTSD nach ungenügender Sedierung bei Allgemeinanästhesien, langwierigen Behandlungen auf der Intensivstation bei Lungenversagen (ARDS), septischem Schock, Verbrennungen, erfolgreicher Reanimation bei Kreislaufstillstand, koronarer Herzkrankheit, Organtransplantationen und Malignomen veröffentlicht. Eine PTSD trat bei den beschriebenen somatischen Erkrankungen mit einer Gesamtprävalenz von circa 5 - 10 % auf und ist damit eine wichtige Komorbidität, deren Diagnose und Behandlung in somatischen Therapiekonzepten zum heutigen Zeitpunkt zu wenig Beachtung findet. Generell kann sie bei jeder lebensbedrohlichen Erkrankung, aber möglicherweise auch bei weniger schweren Krankheiten auftreten, wenn die Erkrankung oder deren Verlauf vom Individuum mit intensiver Angst erlebt wird. Dies ist insofern von klinischer Bedeutung, als eine PTSD, speziell das Auftreten quälender Symptome wie zum Beispiel Intrusionen und Vermeidungsverhalten, das Leben der betroffenen Patienten im Verlauf zum Teil stärker beeinträchtigen kann als die zu Grunde liegende somatische Krankheit. Dies gilt auch für subsyndromale Verlaufsformen. Um gefährdete Patienten korrekt zu diagnostizieren und einer adäquaten Therapie zuzuführen, ist für die Zukunft eine enge Zusammenarbeit zwischen somatisch und psychiatrisch tätigen Ärzten vonnöten.
Abstract
This review describes the incidence of posttraumatic stress disorder (PTSD) in physically ill patients. At the beginning, research in the field of PTSD was primarily focused on war veterans and victims of bodily assault or rape. Starting in the early 90 s, PTSD after civilian traumas such as motor vehicle accidents was diagnosed increasingly more often. Recent publications showed that PTSD can also follow serious somatic diseases. Hence, awareness during anaesthesia, prolonged ICU treatment (ARDS, septic shock), burns, successful resuscitation after cardiac arrest, coronary artery bypass surgery, organ transplantation and cancer were all linked to the development of PTSD. Prevalence of PTSD in these medical conditions lies around 5 - 10 %, and it is therefore considered an important comorbidity. Unfortunately, the diagnosis and treatment of PTSD are not well enough established yet and thus do receive too little attention in the treatment regime of somatic illness. Generally, PTSD can occur with every life-threatening disease, but possibly also with less severe diseases if the patient experiences intense fear. PTSD symptoms, especially intrusive recollections, avoidance and hyperarousal can impair the patients' quality of life more than the primary disease. This seems to be also true for subsyndromal PTSD. To adequately diagnose and treat patients at risk of developing PTSD, close collaboration between physicians of all subspecialties and psychiatrists will be necessary.
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Dr. med. Till Krauseneck
Psychiatrische Klinik und Poliklinik der LMU München
Nußbaumstr. 7
80336 München
eMail: Till.Krauseneck@med.uni-muenchen.de
