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Anästhesiol Intensivmed Notfallmed Schmerzther 2012; 47(4): 214-223
DOI: 10.1055/s-0032-1310409
Fachwissen
Intensivmedizin
© Georg Thieme Verlag Stuttgart · New York

Psychische Störungen in der Intensivmedizin – Teil 2: Prävention und Therapie

Mental disorders in intensive care medicine – Part 2: Prevention and therapeutic approaches
Alexander Wolf
,
Frank-Gerald B Pajonk
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Publication History

Publication Date:
13 April 2012 (online)

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Zusammenfassung

Der zweiteilige Artikel ”Psychische Störungen in der Intensivmedizin“ stellt die häufigsten psychischen Störungen und Erkrankungen vor, mit denen der Intensivmediziner konfrontiert wird. Teil 1 befasst sich mit Grundlagen, Störungsbildern und der Diagnostik, Teil 2 mit der Prävention und Therapie dieser Erkrankungen.

Für die Therapie psychischer Störungen auf der Intensivstation liegen keine Empfehlungen vor, die höchsten Evidenzkriterien genügen. Dennoch gibt es eine Reihe von Therapieoptionen, die neben der Psychopharmakotherapie auch psycho-therapeutische Maßnahmen und die Gestaltung der Umgebungsbedingungen beinhalten. Prophylaktische und rationale therapeutische Maßnahmen können den Behandlungsverlauf ganz erheblich positiv beeinflussen.

Abstract

This two part article “Mental disorders in intensive care medicine” aims to give an understanding of the most frequent mental disorders in critical care medicine. Part 1 highlights the basics, disturbances and diagnostics, part 2 prevention and therapeutic approaches.

Kernaussagen

  • Viele psychische Störungen auf der Intensivstation lassen sich durch die Gestaltung der Umgebungsbedingungen positiv beeinflussen.

  • Die effektivste Therapie des Delirs ist die Prophylaxe.

  • Die nicht pharmakologische Prophylaxe des Delirs ist zum Teil mit sehr einfachen Mitteln zu erreichen (z. B. Hör- und Sehhilfen).

  • Die Dämpfung mit α2-Agonisten und die niedrigdosierte Gabe eines Antipsychotikums (z. B. Haloperidol) sind sinnvolle pharmakologische Maßnahmen zur Delirprophylaxe.

  • Für die Therapie des Delirs haben Antipsychotika die stärkste Evidenz.

  • Bei Depression zeigt Methylphenidat – wenngleich für diese Indikation nicht zugelassen – einen schnellen Wirkeintritt mit Besserung des Affekts.

  • Beim Einsatz von Antidepressiva sollten neuere Substanzen wie Citalopram oder Venlafaxin bevorzugt eingesetzt werden.

  • Die Beherrschung einfacher Grundregeln der (Psycho-)Pharmakotherapie ist angesichts der Häufigkeit psychischer Störungen auf der Intensivstation unverzichtbar.

Schlüsselwörter:

psychische Störungen - IST - Intensivmedizin - Prävention - Therapie

Key words:

mental disorders - psychic disorders - icu - critical care - prevention - therapy

Ergänzendes Material

 

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