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Angst und Depression bei Kopfschmerzpatienten

Das Beispiel der Integrierten Versorgung chronischer Kopfschmerzpatienten in Bayern

Anxiety and depression in headache patients

The example of managed care of chronic headache patients in Bavaria

Der Schmerz volume 23, pages 33–39 (2009)Cite this article

Zusammenfassung

Hintergrund

Es wurde die Häufigkeit von Angst und Depressionen sowie der Einfluss der Kopfschmerzschwere auf diese Erkrankungen bei den Patienten der „Integrierten Versorgung (IV) Kopfschmerz in Bayern“ untersucht.

Material und Methoden

Die deutsche Version der Hospital Anxiety and Depression Scale (HADS-D) zum Screening von Angst und Depressionen sowie den Migraine Disability Assessment Questionnaire (MIDAS) zur Erfassung der Schwere der Kopfschmerzen bearbeiteten 181 Patienten mit Kopfschmerzen. Neben rein deskriptiven Auswertungen wurden Korrelationskoeffizienten nach Spearman berechnet.

Ergebnisse

Beim Depressions- bzw. Angstscreening erreichten 22,7 bzw. 44,7% der Patienten grenzwertige oder auffällige Ergebnisse; 19,3% hatten grenzwertige oder auffällige Werte in beiden Bereichen. Es zeigten sich für Angst sowie Depressivität signifikante Zusammenhänge zur Schwere der Kopfschmerzen.

Schlussfolgerungen

Die Ergebnisse bestätigen die Notwendigkeit eines interdisziplinären Vorgehens bei Patienten mit Kopfschmerzen, um eine erfolgreiche Therapie durchführen zu können. Mit dem Konzept der Integrierten Versorgung wird eine derartige Behandlung verwirklicht.

Abstract

Background

The prevalence of anxiety and depression and the influence of headache severity on these illnesses were examined in patients who were part of the managed care of headache in Bavaria.

Patients and methods

A total of 181 patients with headache were screened for anxiety and depression with the German version of the Hospital Anxiety and Depression Scale (HADS-D). Headache severity was evaluated using the Migraine Disability Assessment Questionnaire (MIDAS). Apart from purely descriptive evaluations, Spearman’s coefficients of correlation were calculated.

Results

Of the patients 22.7% and 44.7% obtained results at or above the limit of the normal range of depression and anxiety, respectively and 19.3% had results at or above the limit of the normal range for both illnesses. There were significant coefficients of correlation between the severity of headache and both anxiety and depression.

Conclusion

The results confirm the necessity for an interdisciplinary procedure in treating headache patients in order to achieve a successful therapy. Such a treatment can be realised with the concept of managed care.

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Literatur

  1. Arnold LM, Crofford LJ, Martin SA et al. (2007) The effect of anxiety and depression on improvements in pain in a randomized, controlled trial of pregabalin for treatment of fibromyalgia. Pain Med 8(8): 633–638

    PubMed  Article  Google Scholar 

  2. Bair MJ, Robinson RL, Katon W, Kroenke K (2003) Depression and pain comorbidity: a literature preview. Arch Intern Med 163: 2433–2445

    PubMed  Article  Google Scholar 

  3. Baskin SM (2007) Managing the „difficult“ headache patient. Neurol Sci 28: 78–83

    Article  Google Scholar 

  4. Baskin SM, Lipchick GL, Smitherman TA (2006) Mood and anxiety disorders in chronic headache. Headache 46 [suppl 3]: 76–87

  5. Blumer D, Heilbronn M (1982) Chronic pain as a variant of depressive disease: the pain-prone disorder. J Nerv Ment Dis 170: 381–406

    PubMed  CAS  Article  Google Scholar 

  6. Breslau N (1998) Psychiatric comorbidity in migraine. Cephalalgia 18 [suppl 22]: 56–61

  7. Breslau N, Merikangas K, Bowden CL (1994) Comorbidity of migraine and major affective disorders. Neurology 44 [suppl 7]: 17–22

  8. Breslau N, Schultz LR, Stewart WF et al. (2001) Headache types and panic disorder. Directionality and specificity. Neurology 56: 350–354

    PubMed  CAS  Google Scholar 

  9. Brown GK (1990) A causal analysis of chronic pain and depression. J Abnorm Psychol 99(2): 127–137

    PubMed  Article  CAS  Google Scholar 

  10. Chau Mok L, Fung-Kam Lee I (2008) Anxiety, depression and pain intensity in patients with low back pain who are admitted to acute care hospitals. J Clin Nurs 17: 1471–1480

    Article  Google Scholar 

  11. Cornwal A, Doncleri DC (1988) The effect of experimental induced anxiety on the experience of pressure pain. Pain 35: 105–113

    Article  Google Scholar 

  12. Devlen J (1994) Anxiety and depression in migraine. J R Soc Med 87: 338–341

    PubMed  CAS  Google Scholar 

  13. Gamsa A (1990) Is emotional disturbances a precipitator or a consequence of chronic pain? Pain 42: 183–195

    PubMed  Article  CAS  Google Scholar 

  14. Guidetti V, Galli F, Fabrizi P et al. (1998) Headache and psychiatric comorbidity: clinical aspects and outcome in a 8-year follow-up study. Cephalalgia 18: 455–462

    PubMed  Article  CAS  Google Scholar 

  15. Gureje O, von Korff M, Kola L et al. (2008) The relation between multiple pains and mental disorders: results from the world mental health surveys. Pain 135: 82–91

    PubMed  Article  Google Scholar 

  16. Hamelsky SW, Lipton RB (2006) Psychiatric comorbidity of migraine. Headache 46: 1327–1333

    PubMed  Google Scholar 

  17. Herrmann-Lingen C, Buss U, Snaith RP (1995) HADS-D: Hospital Anxiety and Depression Scale – Deutsche Version. Huber, Bern

  18. Juang KD, Wang SJ, Fuh JL et al. (2000) Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes. Headache 40: 818–823

    PubMed  Article  CAS  Google Scholar 

  19. Keeley P, Creed F, Tomenson B et al. (2008) Psychosocial predictors of health-related quality of life and health service utilisation in people with chronic low back pain. Pain 135: 142–150

    PubMed  Article  Google Scholar 

  20. Lake AE III, Rains JC, Penzien DB, Lipchik GL (2005) Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance. Headache 45: 493–506

    PubMed  Article  Google Scholar 

  21. Lipchik GL, Penzien DB (2004) Psychiatric comorbidities in patients with headache. Semin Pain Med 2: 93–105

    Article  Google Scholar 

  22. Maizels M, Smitherman TA, Penzien DB (2006) A review of screening tools for psychiatric comorbidity in headache patients. Headache 46 [suppl 3]: 98–109

  23. McWilliams LA, Cox BJ, Enns MW (2001) Self-reporting differentiation of anxiety and depression in a mood disorder sample. J Psychopathol Behav Assess 23(2): 125–131

    Article  Google Scholar 

  24. McWilliams LA, Goowin RD, Cox BJ (2004) Depression and anxiety associated with three pain conditions: results from a nationally representative sample. Pain 111: 77–83

    PubMed  Article  Google Scholar 

  25. Merikangas KR, Angst J, Isler H (1992) Migraine and psychopathology: epidemiologic and genetic aspects. Clin Neuropharmacol 15 [suppl 1 Pt A]: 275A–276A

  26. Radat F, Swenson J (2004) Psychiatric comorbidity of migraine. CNS Spectr 8: 433–444

    Google Scholar 

  27. Rains JC, Penzien DB, Lipchik GL (2006) Behavioral facilitation of medical treatment for headache – part I: review of headache treatment compliance. Headache 46: 1387–1394

    PubMed  Google Scholar 

  28. Scher AI, Bigal ME, Lipton RB (2005) Comorbidity of migraine. Curr Opin Neurol 18(3): 305–310

    PubMed  Article  Google Scholar 

  29. Stewart WF, Lipton RB, Kolonder K et al. (1999) Reliability of the migraine disability assessment score in a population-based sample of headache sufferers. Cephalalgia 19: 107–114

    PubMed  Article  CAS  Google Scholar 

  30. Tietjen GE, Herial NA, Hardgrove J et al. (2007) Migraine comorbidity constellations. Headache 47: 857–865

    PubMed  Article  Google Scholar 

  31. Verri A, Cecchini AP, Galli C et al. (1998) Psychiatric comorbidity in chronic daily headache. Cephalalgia 18 [suppl 21]: 45–49

    Google Scholar 

  32. Verspeelt J, De Locht P, Amery WK (1996) Postmarketing cohort study comparing the safety and efficacy of flunarizine and propranolol in the prophylaxis of migraine. Cephalalgia 16: 328–336

    PubMed  Article  CAS  Google Scholar 

  33. Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67: 361–370

    PubMed  Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Neurologische Klinik und Poliklinik, Klinikum Großhadern der Ludwig-Maximilians-Universität München , Marchioninistr. 15, 81377, München, Deutschland

    J. Felbinger, V.M. Reinisch, P. Sostak & A. Straube

  2. Kopfschmerzzentrum, Sankt-Gertrauden-Krankenhaus Berlin, Berlin, Deutschland

    T.M. Wallasch

  3. Neurologische Klinik und Westdeutsches Kopfschmerzzentrum, Universität Duisburg-Essen, Duisburg, Deutschland

    H.C. Diener

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  1. J. Felbinger
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  2. V.M. Reinisch
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  4. T.M. Wallasch
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  5. H.C. Diener
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  6. A. Straube
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Correspondence to J. Felbinger.

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Felbinger, J., Reinisch, V., Sostak, P. et al. Angst und Depression bei Kopfschmerzpatienten. Schmerz 23, 33–39 (2009). https://doi.org/10.1007/s00482-008-0735-8

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Schlüsselwörter

  • Kopfschmerz
  • Angst
  • Depression
  • Integrierte Versorgung

Keywords

  • Headache
  • Anxiety
  • Depression
  • Managed care