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PSYCH up2date 2013; 7(04): 233-250
DOI: 10.1055/s-0033-1343272
Affektive Störungen
© Georg Thieme Verlag KG Stuttgart · New York

Phasenprophylaxe bei bipolaren Störungen

Ute Lewitzka
,
Emanuel W. Severus
,
Michael Bauer
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Publication Date:
02 July 2013 (online)

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Kernaussagen

Bipolare Störungen sind sehr mannigfaltig und insbesondere zu Beginn der Erkrankung schwierig zu diagnostizieren. Entscheidend für die Langzeitprognose ist v. a. die Rezidivprophylaxe. Eine frühzeitige Diagnostik und adäquate Therapieeinleitung ist für eine günstige Beeinflussung der bipolaren Störung sehr wichtig. Nach dem Abklingen der akuten Symptomatik wird neben der Fortführung der antidepressiven/antimanischen Medikation bereits die Entscheidung getroffen, ob und in welcher Form eine Rezidivprophylaxe eingeleitet werden sollte. Die ideale Phasenprophylaxe bipolarer Störungen strebt ein völliges Fehlen von depressiven, manischen und gemischten Episoden bzw. allenfalls eine minimale interepisodische Symptomatik an. Damit wird eine Voraussetzung für eine unbeeinträchtigte Teilhabe am Leben geschaffen. Trotz der Kombination verschiedener Verfahren (Pharmakotherapie, Psychotherapie, Soziotherapie) wird dieses Ziel nicht immer vollständig erreicht. Als Teilerfolg ist auch zu sehen, wenn es zu selteneren, kürzeren und/oder schwächer ausgeprägten Krankheitsepisoden kommt bzw. eine verringerte interepisodische Symptomatik auftritt. Bezüglich der pharmakologischen Behandlung ist Lithium weiterhin als Goldstandard der Phasenprophylaxe anzusehen. Innerhalb der psychotherapeutischen Verfahren haben sich insbesondere die interaktive Gruppenpsychoedukation sowie die kognitive Verhaltenstherapie bewährt.

 

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