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psychoneuro 2004; 30(1): 42-48
DOI: 10.1055/s-2004-818808
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© Georg Thieme Verlag Stuttgart · New York

Epidemiologische und ätiologische Aspekte von Depression und Angst - Psychische Komorbidität bei alkoholbezogenen Störungen

Thomas Hintz1 , Alexander Diehl1 , Bernhard Croissant1
  • 1Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit Mannheim, Universität Heidelberg
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Publication History

Publication Date:
09 February 2004 (online)

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Zusammenfassung

Das gemeinsame Auftreten von Alkoholabhängigkeit oder -missbrauch mit weiteren psychischen Störungen erfuhr in den letzten Jahrzehnten immer breitere Beachtung. In epidemiologischen Studien konnten hohe Prävalenzraten ermittelt werden. Am häufigsten zeigen alkoholabhängige Personen Angststörungen oder affektive Störungen (insbesondere Frauen) und Persönlichkeitsstörungen, vorwiegend aus Cluster B (narzisstische, histrionische und/oder antisoziale Persönlichkeitsstörung) (insbesondere Männer). Trotz teilweise sehr unterschiedlicher Prävalenzzahlen (überwiegend ein methodologisches Problem) liegen konsistente Befunde vor, welche die klinische Relevanz des Bereichs „Komorbidität” unterstreichen. Der Verlauf einer alkoholbezogenen Störung ist oftmals schwerer und die Behandlungsergebnisse weniger erfolgreich, wenn zusätzlich weitere psychische Störungen vorliegen. In diesem Zusammenhang stellt insbesondere Suizidalität ein nicht zu vernachlässigendes Problem dar. Ätiologische Hypothesen lassen sich grob in zwei Kategorien unterteilen: a) kausale Zusammenhänge zwischen Alkoholkonsum und psychischer Störung, b) gemeinsame ätiologische Faktoren tragen zur Genese beider Störungsbereiche bei. Im Fall von Angststörungen waren lange Zeit Selbstmedikationshypothesen sehr dominierend, die vor allem für Phobien relevant zu sein scheinen. Erst in letzter Zeit verschob sich der Aufmerksamkeitsfokus hin zu angstauslösenden Effekten des Alkoholkonsums. Bei affektiven Störungen spielen Annahmen einiger möglicher gemeinsamer ätiologischer Faktoren (Depressions-Spektrum-Erkrankung) neben depressions-fördernden Wirkungen des Alkohols eine entscheidende Rolle.

Summary

Increasing attention has been given to the association between alcoholism and other mental disorders over the last decades. Epidemiological studies revealed high prevalence rates of other mental disorders in persons with alcohol use disorders. Most persons suffer from anxiety or mood disorders (predominantly women) or cluster B personality disorders (predominantly men). Despite varying prevalence rates (due to methodological problems), research findings underline the clinical relevance of comorbidity. The course of alcohol use disorders often seems to be less favourable with poor treatment outcomes, given the presence of a comorbid disorder. Suicidality is one of the critical issues in this context. Aetiological hypotheses can roughly be divided into two categories: a) causal relationships between alcohol consumption and other mental disorders, b) shared aetiological factors contribute to the pathogenesis of both disorders. In cases of anxiety disorders self-medication hypotheses were dominant for a long period of time, which especially seemed to be relevant for phobias. Recently the focus of attention rather switched to anxiety-eliciting effects of alcohol consumption. In cases of mood diseases the assumption of some possibly shared aetiological factors plays an important role (depression-spectrum-disease) beside the depression supporting effects of alcohol.

Key words

comorbidity - alcoholism - anxiety - mood disorders

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Korrespondenzadresse:

Dipl.-Psych. Thomas Hintz

Zentralinstitut für Seelische Gesundheit, Klinik für Abhängiges Verhalten und Suchtmedizin

J5, 68159 Mannheim

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