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Chronisch entzündliche Darmerkrankungen (Colitis ulcerosa und Morbus Crohn) aus der Perspektive der Konsiliar-/Liaison-Psychosomatik und -Psychiatrie

Inflammatory bowel disease (ulcerative colitis and Crohn's disease) from a consultation liaison psychosomatic and psychiatric perspective

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Psychosomatik und Konsiliarpsychiatrie

Abstract

The concept inflammatory bowel diseases (IBD, CED) includes ulcerative colitis (UC) and Crohn's disease (CD). Both diseases are chronic with remissions and relapses over years. Symptoms include abdominal cramps and pain, diarrhea, weight loss and bleeding from the intestines. CD usually causes ulcers in the ileocoecal area, but any part of the gut may be affected. Some have fistula to the skin or surrounding organs. In ulcerative colitis diffuse ulcerations in the rectum are typical, but also to a variable degree more proximal sites may be affected. The aetiology is unknown. Type of drug treatment depends on disease activity. Commonly used drugs include 5-ASA drugs, corticosteroids and immune inhibiting drugs (e. g. azathioprin, methotrexat, ciclosporin, infliximab). Both steroids and infliximab may provoke psychiatric symptoms, most often anxiety or depression. Methotrexat may increase lithium concentration, but pharmacodynamic interactions with other psychotropics are not frequently seen.

Perceived life stress may influence the course of IBD negatively, and the prevalence of mental disorders is slightly above the frequency reported in population studies. However, there is no empirical evidence supporting the view that IBD is a psychosomatic disorder in the traditional meaning of the word. Patients with IBD should be evaluated with regard to the presence of perceived major life stress and mental disorders. Psychiatric treatment should follow regular guidelines. There is no evidence to support a view that patients with IBD should routinely receive psychotherapy.

Zusammenfassung

Zu den chronisch entzündlichen Darmerkrankungen (CED) gehören die Colitis ulcerosa (UC) und der Morbus Crohn (CD). Kennzeichen dieser entzündlichen Erkrankungen des Intestinaltraktes bisher unbekannter Ursache ist ein chronischer, meist rezidivierender Verlauf. Zu den Symptomen gehören Bauchschmerzen und -krämpfe, Durchfälle, Gewichtsabnahme und Blutverlust aus dem Darm. Beim Morbus Crohn, der alle Abschnitte des Gastrointestinaltraktes befallen kann, finden sich häufig Ulzera am Übergang zwischen Dünn- und Dickdarm. Bei einigen Patienten entstehen Fisteln zwischen Darmabschnitten, zu nahe liegenden Organen oder zur Haut. Bei der Colitis ulcerosa, die meist im Rektum beginnt und sich variierend nach proximal ausbreitet, entstehen diffuse und kontinuierliche Schleimhautulzerationen. Die somatische Behandlung ist abhängig von der Krankheitsaktivität und beinhaltet 5-Aminosalicylate (5-ASA), Kortikosteroide und Immunsuppressiva (Azathioprin, Methotrexat, Ciclosporin, Infliximab). Sowohl die Glukokortikoide als auch Tumornekrosefaktor-Alpha-Antikörper (Infliximab) können zu psychischen und psychiatrischen Nebenwirkungen führen, am häufigsten Angst und Depressionen bzw. Manie. Außer der Erhöhung der Lithiumkonzentration durch Methotrexat sind ernsthafte Interaktionen mit Psychopharmaka selten.

Es gibt Anhaltspunkte für eine negative Auswirkung auf den Krankheitsverlauf durch subjektiv erlebten Stress und für ein etwas häufigeres Vorkommen psychischer Störungen als in der Normalbevölkerung. Gesicherte Nachweise für die Zuordnung der chronisch entzündlichen Darmerkrankungen zu psychosomatischen Erkrankungen im traditionellen Verständnis sind nicht gegeben. Unter Experten besteht Konsens, Patienten mit diesen Erkrankungen bei Vorhandensein chronischer Stressbelastungen oder eventuellen psychischen Störungen eine Behandlung anzubieten. Die Therapie erfolgt nach den üblichen Behandlungsleitlinien. Alle Psychopharmaka können eingesetzt werden. Eine Lithiumbehandlung ist schwer zu kontrollieren. Demgegenüber gibt es keine ausreichenden Hinweise, routinemäßig den betroffenen Patienten eine psychodynamische oder andere Form von Psychotherapie anzubieten.

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Authors and Affiliations

  1. Psykiatrisk institutt Universitet i Oslo Norge og avdeling for nevropsykiatri og psykosomatisk medisin, Rikshospitalet-Radiumhospitalet HF, 0027, Oslo, Norge

    Birgitte Boye & Ulrik F. Malt

  2. Gastromedisinsk avdeling, Aker universitetssykehus HF, Aker universitetssykehus, 0531, Oslo, Norge

    Jørgen Jahnsen

  3. Dep. of Medicine, Rikshospitalet-Radiumhospitalet HF, 0027, Oslo, Norge

    Knut E. A. Lundin

  4. Institutt for indremedisin, Universitetet i Bergen og Medisinsk Klinikk, Haraldsplass Diakonale Sykehus, 5009, Bergen, Norge

    Ingvard Wilhelmsen

  5. Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Günter Jantschek

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  1. Birgitte Boye
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  2. Jørgen Jahnsen
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Correspondence to Günter Jantschek.

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Boye, B., Jahnsen, J., Lundin, K.E.A. et al. Chronisch entzündliche Darmerkrankungen (Colitis ulcerosa und Morbus Crohn) aus der Perspektive der Konsiliar-/Liaison-Psychosomatik und -Psychiatrie. Psychosom Konsiliarpsychiatr 1, 258–265 (2007). https://doi.org/10.1007/s11800-007-0026-8

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