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, Volume 80, Issue 12, pp 1440–1451 | Cite as

Emotional-affektive, Angst- und Persönlichkeitsstörungen bei Epilepsien

  • E. PauliEmail author
  • H. Stefan
Übersichten

Zusammenfassung

Das Spektrum komorbider psychischer Störungen bei Epilepsien umfasst Angststörungen, affektive Störungen, Persönlichkeitsstörungen und Psychosen. Während die Prävalenz psychischer Störungen in der allgemeinen Epilepsiepopulation mit ca. 6% angegeben wird, werden für fokale Epilepsien, insbesondere für Temporallappenepilepsien (TLE), in der Literatur deutlich erhöhte Erkrankungsraten zwischen 20–70% angegeben, wobei Angsterkrankungen und Depressionen die häufigsten Störungen darstellen.

Entsprechend dem Diathese-Stress-Modell sind für die Entwicklung psychischer Störungen bei Epilepsiepatienten vorbestehende Vulnerabilitätsfaktoren, neurobiologische Faktoren, iatrogene Einflüsse und psychosoziale Stressoren in individuell unterschiedlichem Ausmaß bedeutsam. Sowohl gelernte psychologische Reaktionen auf die vielfältigen Belastungsfaktoren der chronischen Erkrankung als auch strukturelle und funktionelle Störungen in den für die Regulation affektiven, emotionalen und sozialen Verhaltens zuständigen neuronalen Netzwerken des limbischen Systems stellen wichtige Einflussfaktoren dar. Aber auch therapeutische Maßnahmen können zur Entstehung psychischer Störungen beitragen. Eine Reihe von Antiepileptika (AE) hat sich in der psychiatrischen Behandlung affektiver Störungen bewährt, AE können aber auch psychisch negative Effekte bis hin zu psychiatrischen Nebenwirkungen hervorrufen.

Zur Therapie fokaler Epilepsien, insbesondere der TLE konnte sich die Epilepsiechirurgie als effiziente Behandlung etablieren. Häufig werden postoperativ positive Effekte über das gesamte Spektrum der komorbiden psychischen Störungen hinweg beobachtet, seltener werden auch negative psychische Auswirkungen berichtet.

Schlüsselwörter

Angst Affektive Störung Persönlichkeitsstörung Depression Epilepsie 

Emotional and affective disorders, anxiety and personality disorders in epilepsies

Summary

The wide spectrum of comorbid mental disorders in epilepsy includes anxiety, affective as well as personality disorders and psychosis. While the prevalence of mental disorders in the general epilepsy population is reported to be 6%, for focal epilepsies, especially temporal lobe epilepsy, this rate is considerably higher and the numbers given in the literature range from 20 to 70%, of which anxiety and depression have the highest share.

According to the diathesis-stress model pre-existing vulnerability factors, neurobiological factors, iatrogenic effects and psychosocial stress factors are individually of different significance in the development of mental disorders in epilepsy. Learned reactions in answer to psychosocial stress as well as structural and functional disturbances in the neuronal limbic networks for the regulation of affective, emotional and social behaviour are fundamental driving factors. Furthermore, therapeutic measures may add to the development of mental health problems. Several antiepileptic drugs (AE) have proven their value in the psychiatric treatment of mental disorders; however, AE may also cause psychiatric side effects.

Similarly, although established as a successful treatment option in focal epilepsies, surgery is also reported to have an influence on mental health. Newly diagnosed mental problems are rarely reported after surgery; more often positive changes are observed across the entire spectrum of mental disorders associated with epilepsy.

Keywords

Anxiety Affective disturbances Depression Manic symptoms Epilepsies 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Epilepsiezentrum - Neurologische KlinikUniversitätsklinikumErlangenDeutschland

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