Zusammenfassung
Psychische Störungen bei somatischen Krankheiten definieren einen Kernsektor der psychosomatischen Medizin . Kognitive wie affektive Veränderungen können gleichermaßen als mögliche komorbide psychopathologische Syndrome im Kontext körperlicher Erkrankungen auftreten. In einer pathogenetischen Perspektive sind sowohl psychosomatische als auch somatopsychische Prozesse zu beachten. Unter den kognitiven Syndromen imponieren in erster Linie Delire. Sie werden zusammen mit weiteren organisch bedingten psychischen Störungen andernorts näher ausgeführt (► Kap. 46, 48) und hier nur kurz skizziert. Depressiv-ängstliche Störungen stellen die wichtigsten komorbiden affektiven Störungen bei körperlichen Krankheiten dar. Sie sind nicht nur als psychologische Reaktionen auf die Situation der jeweiligen Erkrankung zu verstehen, sondern in ein komplexes psychosomatisches bzw. somatopsychisches Bedingungsgefüge eingebettet. Sie sind besonders häufig bei Erkrankungen des Zentralnervensystems oder endokriner Systeme, die unmittelbar die Regulation von Affekten und Stimmung betreffen. Es besteht ein enger Zusammenhang zur Chronizität, Schwere und Prognose der Erkrankung. Eigenständige Effekte von diversen pharmakologischen Substanzgruppen sind wahrscheinlich. Beim Verlauf somatischer Erkrankungen sind negative Auswirkungen koexistenter depressiv-ängstlicher Störungen auf die psychosoziale Adaptation, das medizinische Inanspruchnahmeverhalt en, die Morbidität und Mortalität zu beachten. Psychotherapeutische Verfahren besitzen einen wichtigen Stellenwert im Gesamtbehandlungs plan. Differenzierte psychopharmakologische Strategien sind für die einzelnen somatischen Erkrankungen unter Kenntnis wichtiger Nebenwirkungen, der Interaktionen mit Internistika und der pathophysiologischen Grundbedingungen der somatischen Erkrankung verfügbar. Kontrollierte empirische Studien zur Wirksamkeit psychotherapeutischer und psychopharmakologischer Behandlungen depressiv-ängstlicher Syndrome bei somatischen Erkrankungen sowie zu Effekten auf den weiteren Krankheitsverlauf erlauben eine erste Orientierung.
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Kapfhammer, HP. (2011). Psychische Störungen bei somatischen Krankheiten. In: Möller, HJ., Laux, G., Kapfhammer, HP. (eds) Psychiatrie, Psychosomatik, Psychotherapie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-03637-8_76
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