Der Nervenarzt

, Volume 83, Issue 9, pp 1128–1141 | Cite as

Psychopharmakotherapeutische Ansätze bei somatoformen Störungen und funktionellen Körpersyndromen

Leitthema

Zusammenfassung

Somatoforme Störungen und funktionelle Körpersyndrome definieren eine große, aber diagnostisch sehr heterogene Gruppe von Patienten mit medizinisch unerklärten Körpersymptomen. In einem biopsychosozialen Modell lassen sich auch pharmakotherapeutische Ansätze begründen. Eine Übersicht über vorrangig randomisierte, doppelblinde und placebokontrollierte Studien zeigt, dass Antidepressiva statistisch bedeutsame und klinisch relevante Wirkungen auf somatoforme Symptome erzielen. Im Hinblick auf Schmerzsymptome scheinen dual wirksame Antidepressiva einen günstigeren Effekt zu besitzen als selektive serotonerge Substanzen. Für eine Reihe funktioneller Körpersyndrome wie Colon irritabile und Fibromyalgie kann ebenfalls ein primärer antinozizeptiver Effekt der Antidepressiva nachgewiesen werden, der weitgehend unabhängig von antidepressiven und/oder anxiolytischen Wirkungen ist. Bei der Fibromyalgie ist auch Pregabalin eine gute Therapieoption. Bisherige Studien konnten noch keine überzeugenden Wirkbelege von Psychopharmaka beim chronischen Müdigkeitssyndrom aufzeigen. Hypochondrische und körperdysmorphe Störungen unterstreichen aufgrund einer inhärenten Nähe zu Angst-, Zwangs- und depressiven Störungen ebenfalls den Stellenwert serotonerger Antidepressiva.

Schlüsselwörter

Somatoforme Störungen Funktionelle Körpersyndrome Psychopharmologie Antidepressiva Pregabalin 

Psychopharmacological treatment in patients with somatoform disorders and functional body syndromes

Summary

Somatoform disorders and functional body syndromes define a major, diagnostically heterogeneous group of patients with medically unexplained physical symptoms. Psychopharmacological approaches can be derived from the conceptualization of somatoform symptoms and syndromes within a biopsychosocial model. The survey presented focuses on randomized, double-blind and placebo-controlled studies. Antidepressants show a statistically and clinically relevant impact on many somatoform symptoms. In special reference to pain symptoms serotonergic and noradrenergic antidepressants seem to mediate a more favorable effect than selective serotonin reuptake inhibitors. For some functional body syndromes, e.g. irritable bowel syndrome and fibromyalgia, a major analgesic effect of antidepressants can be underlined as well. The empirical data for fibromyalgia, however, seem to be more convincing than for irritable bowel syndrome. Pregabalin holds an empirically well established position in the treatment of fibromyalgia. As yet there is no convincing psychopharmacological strategy for chronic fatigue syndrome. Probably due to the inherent relationships to anxiety, obsessive-compulsive and depressive disorders, both hypochondria and body dysmorphic disorder can be positively treated by serotonergic antidepressants as well.

Keywords

Somatoform disorders Functional body syndromes Psychopharmacology Antidepressants Pregabalin 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenskonflikt besteht.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Klinik für PsychiatrieMedizinische Universität GrazGrazÖsterreich

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