Summary
Symptoms of acute distress are often present in cancer patients. Prevalence rates of psychiatric disorders are reported between 30%–60%. Rates of psychopharmacologic treatment are not very well documented and depend much on factors like locally established treatment procedures and structure of treatment settings. Psychosocial needs including psychiatric and psychotherapeutic treatment of cancer patients are often not addressed sufficiently. During the last ten years the use of anxiolytic and antidepressant medication has increased continuously in cancer patients. Nevertheless evidence based data deriving from randomised controlled trials are still not very many available. The main indication for anxiolytic drugs is short term treatment of acute distress symptoms. Antidepressants are mainly used for depression spectrum syndromes and anxiety syndromes which are the two most often reported psychiatric disorders in cancer patients. Psychopharmacologic medication is also used to achieve a better control of somatic symptoms either due the disease itself or due to cancer therapy. Pain, emesis, nausea, hot flashes and pruritus are some of the symptoms which can be improved by additional psychopharmacologic therapy. Antipsychotics are primarily used for treating delirium symptoms in oncological patients. Although psychopharmacologic medication appears to be beneficial in the treatment of psychiatric syndromes in cancer patients, more research needs to be done to support current clinical practices and to develop new therapeutic procedures to better address psychiatric symptoms and syndromes in cancer patients.
Zusammenfassung
Bei Krebspatienten finden sich häufig Symptome von akuter psychischer Belastung. Die Prävalenzraten von psychiatrischen Erkrankungen werden mit 30–60 % angegeben. Die Verwendungshäufigkeit von Psychopharmaka bei onkologischen Patienten ist nicht gut erfasst, weist regional große Unterschiede auf und ist sehr von lokalen Behandlungsgepflogenheiten und Behandlungssettings abhängig. Onkologische Patienten sehen sich nicht selten mit Behandlungsabläufen konfrontiert, bei denen ihre psychosozialen Bedürfnisse inklusive psychiatrisch-psychotherapeutischer Therapieangebote zu wenig Berücksichtigung finden. In den letzten 10 Jahren fanden anxiolytische und antidepressive Substanzen bei onkologischen Patienten zunehmend mehr Verwendung. Trotz dieser Entwicklung sind kaum Evidenz-basierende Daten aus randomisierten, kontrollierten Studien verfügbar. Die Hauptindikation für eine anxiolytische Therapie stellen kurzfristige Behandlungen von akutem Distressbeschwerden dar. Syndrome aus dem depressiven Spektrum sowie Angstsyndrome sind die zwei häufigsten psychiatrischen Diagnosen bei Krebspatienten. Die adäquate Therapiestrategie dafür stellen in erster Linie Antidepressiva dar. Ein weiterer Indikationsbereich für Psychopharmaka in der Onkologie ist die Verbesserung von somatischen Symptomen, die entweder durch die Krebserkrankung selbst oder durch onkologische Therapien verursacht sein können. Die psychopharmakologische Therapie stellt dabei eine ergänzende Strategie dar und kann gerade bei chronischen Schmerzsyndromen, bei Übelkeit und Erbrechen, bei Hitzewallungen und Juckreiz zu einer Symptomlinderung führen. Antipsychotika werden hauptsächlich zur Behandlung von deliranten Symptomen bei onkologischen Patienten eingesetzt. Obwohl der Einsatz psychopharmakologischer Medikation zur Behandlung psychiatrischer Symptome bei Krebspatienten im klinischen Alltag durchwegs erfolgreich ist, liegt ein großer Bedarf an weiterer Forschungsarbeit vor. Dadurch soll die momentane klinische Praxis auf eine bessere wissenschaftliche Basis gestellt werden, um so neue therapeutische Abläufe zu entwickeln und die Behandlung von psychiatrischen Symptomen und Syndromen bei Krebspatienten auch besser gewährleisten zu können.
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Sperner-Unterweger, B. Psychopharmakatherapie bei Patienten mit onkologischen Erkrankungen. Psychiatrie 3, 86–95 (2007). https://doi.org/10.1007/s11326-007-0046-1
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DOI: https://doi.org/10.1007/s11326-007-0046-1