Psychische Störungen in der Intensivmedizin – Teil 1: Grundlagen, Störungsbilder und Diagnostik

Zusammenfassung

Der zweiteilige Artikel ”Psychische Störungen in der Intensivmedizin“ stellt die häufigsten psychischen Störungen und Erkrankungen dar, mit denen der Intensivmediziner konfrontiert ist. Teil 1 wird sich mit Grundlagen, Störungsbildern und Diagnostik befassen und Teil 2 mit der Prävention und Therapie dieser Erkrankungen. Die häufigsten psychischen Störungen auf der Intensivstation sind Delir, Substanzabusus bzw. -intoxikation, Suizidversuche, Angststörung, Depression oder Psychosen. Psychische Störungen können Grund für die Aufnahme sein oder sich im Rahmen der intensivmedizinischen Behandlung entwickeln, wie z.B. eine posttraumatische Belastungsstörung. Die Folge davon: eine erhöhte Morbidität, Mortalität und Liegedauer. Eine frühzeitige Einbindung eines Psychiaters in die Diagnostik ist empfehlenswert.

Abstract

This two-part article on mental disorders in intensive care medicine aims to provide an understanding of the most frequent mental disorders in critical care medicine. Part 1 highlights the basic principles, disturbances and diagnostics and part 2 deals with prevention and therapeutic approaches. The most frequent mental disorders in the intensive care unit are delirium, substance abuse or, respectively, intoxication, suicide attempts, anxiety disorders, depression or psychosis. Mental disorders may be the reason for admission or can develop in the course of intensive care treatment, such as, for example, a post-traumatic stress disorder. The consequences thereof include increased morbidity, mortality, and duration of hospitalization. The early participation of a psychiatrist in the diagnostic process is to be recommended.

Kernaussagen

• Die häufigsten psychischen Störungen auf der Intensivstation sind Delir, Substanzabusus bzw. -intoxikation, Suizidversuche, Angststörung oder Depression.

• Eine intensivmedizinische Behandlung stellt allein durch die Umgebungsbedingungen bereits für Gesunde einen erheblichen Stressor dar.

• Bis zu 80 % der ITS-Patienten erkranken an einem Delir.

• Risikofaktoren für ein Delir sind vor allem kognitive Einschränkung, höheres Lebensalter und die Einnahme psychotroper Substanzen.

• Die immer noch zu seltene Diagnose des Delirs hat gravierende Konsequenzen für Mortalität, Morbidität und Kosten.

• Depressionen treten vor allem nach kardialen Erkrankungen und nach Schlaganfällen auf und können das Weaning erheblich verzögern.

• Eine angstvermittelte Erhöhung des Sympathikotonus hat potenziell schwerwiegende Folgen für zahlreiche Organsysteme.

• Bei allen unklaren Intoxikationen und Polytraumata sollte auch an einen Suizidversuch gedacht werden und im Zweifelsfall ein Psychiater frühzeitig hinzugezogen werden.

Schlüsselwörter

psychische Störungen - ITS - Intensivmedizin - Diagnostik - Delir - Suizid - Angststörung - Depression - Substanzabusus

Key words

mental disorders - psychic disorders - ICU - critical care - delirium - suicide - anxiety disorder - depression - drug abuse

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