Zusammenfassung
Depressive Symptomatik stellt eine schwerwiegende Begleitproblematik der Borderline-Persönlichkeitsstörung (BPS) dar, doch wird ihre Ernsthaftigkeit leicht unterschätzt, da die Symptome bei diesen Patienten wechselnd und damit transient erscheinen können. Die hohe Krisenhäufigkeit bei der BPS erfordert jedoch eine besonders rasche und effektive Therapie, um das erhöhte Risiko der vitalen Gefährdung, Chronifizierung und langfristigen psychosozialen Beeinträchtigung zu reduzieren. Eine effiziente Krisenintervention ist wesentliche Voraussetzung für den Erhalt einer Kontinuität der durchgängigen krankheitsspezifischen, muldimodalen Therapie der BPS und damit essenziell für eine nachhaltige Remission sowie die soziale Rehabilitation. Insbesondere vor dem Hintergrund, dass viele Patienten mit BPS auf eine antidepressive Pharmakotherapie schlecht oder gar nicht respondieren, stellt die Elektrokrampftherapie (EKT) ein wichtiges symptomspezifisches Therapieinstrument dar. Ihre Effektivität zur Behandlung der therapieresistenten Major Depression (MD) ist bereits weitreichend gezeigt worden, doch gibt es trotz hoher Relevanz nur wenige Studien zur EKT der MD bei komorbider BPS. Anhand der Darstellung der bisherigen Studien mit Originaldaten zur EKT der MD bei komorbider BPS diskutiert diese Arbeit kritisch den Wert und möglichen Beitrag sowie die Grenzen der EKT für die Behandlung der MD bei BPS. Diese differenzierte Beleuchtung soll zu einer zielbewussten Indikationsstellung und damit zu einem erfolgreichen Einsatz der EKT bei der BPS beitragen.
Abstract
Depressive disorder is a serious and frequent complication in borderline personality disorder (BPD), however, its severity tends to be neglected particularly if symptoms are short-lived or inconsistent as is common in patients with BPD. Yet the high frequency in these patients requires especially rapid and effective therapy to reduce the risks of vital endangerment, chronification and psychosocial impairment. Efficient crisis intervention is essential for continuity of the disease-specific multimodal therapy enabling lasting remission and social and vocational rehabilitation in BPD. In particular with regard to the high incidence of poor or failed pharmacological responses in patients with BPD, electroconvulsive therapy (ECT) is of significant relevance among antidepressant treatment options. Despite the wide consensus on its efficacy, there are only few selected trials on ECT for major depression (MD) in BPD. This review summarises the published original studies on this issue, and critically scrutinises indication, benefits and risks of ECT for MD in BPD. It contributes to a focused, discriminating view on ECT and thus enables an optimised patient-oriented, efficient indication for MD in BPD.
Schlüsselwörter
Elektrokrampftherapie (EKT) - Borderline-Persönlichkeitsstörung - schwere Depression - therapieresistente Depression - Suizidalität
Keywords
electroconvulsive therapy (ECT) - borderline personality disorder - major depressive disorder - therapy-resistant depression - suicide tendency
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Dr. Dorothee Maria Gescher
LVR-Klinikum Düsseldorf Klinik und Poliklinik für Psychiatrie und Psychotherapie Heinrich-Heine Universität Medizinische Fakultät
Bergische Landstr. 2
40629 Düsseldorf
Email: dorothee.gescher@lvr.de
