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Fortschr Neurol Psychiatr 2016; 84(08): 499-510
DOI: 10.1055/s-0042-111913
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© Georg Thieme Verlag KG Stuttgart · New York

Differenzialdiagnose psychotischer Symptome[1]

Psychosis – clinical differential diagnosis
A. Röh
,
P. Falkai
,
A. Hasan
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Publication History

Publication Date:
29 August 2016 (online)

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Zusammenfassung

Hintergrund: Bei einer großen Vielzahl an psychiatrischen und organischen Erkrankungen können primäre oder sekundäre psychotische Symptome von den Patienten berichtet werden. In diesem Übersichtsartikel soll v.a. anhand der ICD-10-Klassifizierung ein Überblick über die möglichen zugrunde liegenden Erkrankungen und deren genaue Unterteilung gegeben werden. Ein Schwerpunkt wird dabei auf differenzialdiagnostische Überlegungen gelegt.

Ergebnis: Klinisch ist v.a. die Differenzialdiagnose der paranoiden Schizophrenie oder anderen psychotischen Erkrankungen gegenüber 3 Gruppen an Erkrankungen relevant: 1. Andere psychiatrische Erkrankungen, die nicht in den schizophrenen Formenkreis eingruppiert werden, 2. primäre und sekundäre organische Erkrankungen und 3. autoimmun vermittelte Erkrankungen. In der 1. Gruppe finden sich bspw. die drogeninduzierten Psychosen, affektive Erkrankungen, Persönlichkeitsstörungen. Zur 2. Gruppe zählen u.a. die verschiedenen Demenzformen, delirante Zustandsbilder oder metabolische Erkrankungen. In der neueren Entwicklung wird ein zunehmender Schwerpunkt auf die autoimmun vermittelten Erkrankungen, v. a. die Enzephalitiden gelegt.

Zusammenfassung: Mit einer ausführlichen Anamnese, einer körperlichen Untersuchung sowie organischer Diagnostik kann die korrekte Diagnose gestellt und die passende Therapie eingeleitet werden. Die differenzialdiagnostische Einteilung und das Erkennen organischer Ursachen ist dabei eine psychiatrische Kernkompetenz, die jedoch häufig eine gute Kooperation mit somatischen Fachrichtungen benötigt.

Abstract

Background: Many patients with psychiatric and organic disorders may present primary or secondary psychotic symptoms. Based on the ICD 10 classification, this article describes the possible underlying diseases and their subdivision. The main focus will be differential-diagnostic evaluations of psychotic syndromes.

Results: In the clinical setting, the differential diagnosis of the paranoid schizophrenia and other psychotic disorders into three main disease groups is important: 1. other psychiatric diseases, 2. primary and secondary organic diseases and 3. autoimmune diseases. The first group contains, for example, drug-induced psychoses, affective disorders, personality disorders. The second group includes forms of dementia, forms of deliria or metabolic diseases. Recently, another focus is set on autoimmune diseases, especially encephalitides.

Summary: A detailed medical history, a physical examination and organic diagnostic can lead to the correct diagnosis and therapy. The differential-diagnostic classification and the detection of organic causes is an important part of psychiatric care, but often a good cooperation with organic specialties is needed.

1 PSYCH up2date 2016; 10: 271 – 284.


 

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