Download PDF
Fortschr Neurol Psychiatr 2005; 73(4): 206-217
DOI: 10.1055/s-2004-830108
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Posttraumatische Belastungsstörungen bei somatischen Erkrankungen

PTSD in Somatic DiseaseT.  Krauseneck1 , H.-B.  Rothenhäusler2 , G.  Schelling3 , H.-P.  Kapfhammer2
  • 1Psychiatrische Klinik und Poliklinik der Ludwig-Maximilians-Universität München (Direktor: Prof. Dr. H.-J. Möller)
  • 2Universitätsklinik für Psychiatrie der Karl-Franzens-Universität Graz (Vorstand: Prof. Dr. Dr. H.-P. Kapfhammer)
  • 3Klinik für Anästhesiologie der Ludwig-Maximilians-Universität München (Direktor: Prof. Dr. Dr. h.c. K. Peter)
Further Information

Publication History

Publication Date:
15 December 2004 (online)

    Permissions and Reprints

Zusammenfassung

Die Arbeit gibt einen Überblick über das Auftreten der posttraumatischen Belastungsstörung (PTSD) im Kontext somatischer Erkrankungen. Die Forschung konzentrierte sich nach der Aufnahme dieser Diagnose in das Diagnostic Statistic Manual (DSM-III 1980) zunächst vorwiegend auf psychopathologische Reaktionen nach psychischen Traumata, insbesondere nach militärischen Fronteinsätzen, nach tätlichen Angriffen oder Vergewaltigungen. Zu Beginn der 90er Jahre wurde PTSD dann auch nach zivilen Traumata wie z. B. Verkehrsunfällen häufiger diagnostiziert. Auch schwerwiegende somatische Erkrankungen können zu einer PTSD gemäß DSM-IV führen. Es wurden Arbeiten über PTSD nach ungenügender Sedierung bei Allgemeinanästhesien, langwierigen Behandlungen auf der Intensivstation bei Lungenversagen (ARDS), septischem Schock, Verbrennungen, erfolgreicher Reanimation bei Kreislaufstillstand, koronarer Herzkrankheit, Organtransplantationen und Malignomen veröffentlicht. Eine PTSD trat bei den beschriebenen somatischen Erkrankungen mit einer Gesamtprävalenz von circa 5 - 10 % auf und ist damit eine wichtige Komorbidität, deren Diagnose und Behandlung in somatischen Therapiekonzepten zum heutigen Zeitpunkt zu wenig Beachtung findet. Generell kann sie bei jeder lebensbedrohlichen Erkrankung, aber möglicherweise auch bei weniger schweren Krankheiten auftreten, wenn die Erkrankung oder deren Verlauf vom Individuum mit intensiver Angst erlebt wird. Dies ist insofern von klinischer Bedeutung, als eine PTSD, speziell das Auftreten quälender Symptome wie zum Beispiel Intrusionen und Vermeidungsverhalten, das Leben der betroffenen Patienten im Verlauf zum Teil stärker beeinträchtigen kann als die zu Grunde liegende somatische Krankheit. Dies gilt auch für subsyndromale Verlaufsformen. Um gefährdete Patienten korrekt zu diagnostizieren und einer adäquaten Therapie zuzuführen, ist für die Zukunft eine enge Zusammenarbeit zwischen somatisch und psychiatrisch tätigen Ärzten vonnöten.

Abstract

This review describes the incidence of posttraumatic stress disorder (PTSD) in physically ill patients. At the beginning, research in the field of PTSD was primarily focused on war veterans and victims of bodily assault or rape. Starting in the early 90 s, PTSD after civilian traumas such as motor vehicle accidents was diagnosed increasingly more often. Recent publications showed that PTSD can also follow serious somatic diseases. Hence, awareness during anaesthesia, prolonged ICU treatment (ARDS, septic shock), burns, successful resuscitation after cardiac arrest, coronary artery bypass surgery, organ transplantation and cancer were all linked to the development of PTSD. Prevalence of PTSD in these medical conditions lies around 5 - 10 %, and it is therefore considered an important comorbidity. Unfortunately, the diagnosis and treatment of PTSD are not well enough established yet and thus do receive too little attention in the treatment regime of somatic illness. Generally, PTSD can occur with every life-threatening disease, but possibly also with less severe diseases if the patient experiences intense fear. PTSD symptoms, especially intrusive recollections, avoidance and hyperarousal can impair the patients' quality of life more than the primary disease. This seems to be also true for subsyndromal PTSD. To adequately diagnose and treat patients at risk of developing PTSD, close collaboration between physicians of all subspecialties and psychiatrists will be necessary.

Literatur

  • 1 American Psychiatric Association .Diagnostic and statistical Manual of mental Disorders, 4th ed. (DSM-IV). Washington: APA 1994
    Google Scholar
  • 2 Kessler R C, Sonnega A, Bromet E, Hughes M, Nelson C B. Posttraumatic stress disorder in the national comorbidity survey.  Arch Gen Psych. 1995;  52 1048-1060
    Google Scholar
  • 3 Breslau N, Davis G C, Andreski P, Peterson E. Traumatic events and posttraumatic stress disorders in an urban population of young adults.  Arch Gen Psych. 1991;  48 216-222
    Google Scholar
  • 4 Breslau N, Kessler R C, Chilcoat H D, Schultz L R, Davis G C, Andreski P. Trauma and posttraumatic stress disorders in the community. The 1996 Detroit area survey of trauma.  Arch Gen Psych. 1998;  55 626-632
    Google Scholar
  • 5 Perkonigg A, Kessler R C, Storz S, Wittchen H U. Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity.  Acta Psychiatr Scand. Jan 2000;  101 (1) 46-59
    CrossrefPubMedGoogle Scholar
  • 6 Wagner D, Heinrichs M, Ehlert U. Prevalence of symptoms of posttraumatic stress disorder in German professional firefighters.  Am J Psychiatry. Dec 1998;  155 (12) 1727-1732
    PubMedGoogle Scholar
  • 7 Solomon S D, Davidson J RT. Trauma: prevalence, impairment, service use and cost.  J Clin Psychiatry. 1997;  58 (suppl. 9) 5-11
    PubMedGoogle Scholar
  • 8 Friedman M J. Posttraumatic stress disorder.  J Clin Psych. 1997;  58 (suppl. 9) 33-36
    PubMedGoogle Scholar
  • 9 Deykin E Y, Keane T M, Kaloupek D, Fincke G, Rothendler J, Siegfried M, Creamer K. Posttraumatic stress disorder and the use of health services.  Psychosom Med. 2001;  63 835-841
    PubMedGoogle Scholar
  • 10 Bronisch T. Posttraumatic stress disorder - Posttraumatische Belastungsstörung. Neuere Forschungsergebnisse.  Fortschr Neurol Psychiat. 1997;  65 195-207
    PubMedGoogle Scholar
  • 11 Zatzick D F, Kang S M, Müller H G, Russo J E, Rivara F P, Katon W, Jurkovich G J, Roy-Byrne P. Predicting posttraumatic distress in hospitalized trauma survivors with acute injuries.  Am J Psych. 2002;  159 (6) 941-946
    PubMedGoogle Scholar
  • 12 Schützwohl M. Frühinterventionen nach traumatisierenden Erfahrungen.  Fortschr Neurol Psychiat. 2000;  68 423-432
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Mayou R A, Smith K A. Post traumatic symptoms following medical illness and treatment.  J Psychosom Res. 1997;  Vol. 43 No. 2 121-123
    CrossrefPubMedGoogle Scholar
  • 14 Kjaer Fuglsang A, Moergeli H, Hepp-Beg S, Schnyder U. Who develops acute stress disorder after accidental injuries?.  Psychother Psychosom. Jul-Aug 2002;  71 (4) 214-222
    PubMedGoogle Scholar
  • 15 Classen C, Koopman C, Hales R, Spiegel D. Acute stress disorder as a predictor of posttraumatic stress symptoms.  Am J Psychiatry. May 1998;  155 (5) 620-624
    PubMedGoogle Scholar
  • 16 Fein J A, Kassam-Adams N, Vu T, Datner E M. Emergency department evaluation of acute stress disorder symptoms in violently injured youths.  Ann Emerg Med. Oct 2001;  38 (4) 391-396
    PubMedGoogle Scholar
  • 17 Blanchard E B, Hickling E J, Mitnick N, Taylor A E, Loos W R, Buckley T C. The impact of severity of physical injury and perception of life threat in the development of post-traumatic stress disorder in motor vehicle accident.  Behav Res Ther. 1995;  Vol. 33 No. 5 529-534
    PubMedGoogle Scholar
  • 18 Schnyder U, Moergeli H, Klafhofer R, Buddeberg C. Incidence and prediction of posttraumatic stress disorder symptoms in severely injured accident victims.  Am J Psych. 2001;  158 (4) 594-599
    CrossrefPubMedGoogle Scholar
  • 19 Meyer C, Steil R. Die posttraumatische Belastungsstörung nach Verkehrsunfällen.  Unfallchirurg. 1998;  101 878-893
    CrossrefPubMedGoogle Scholar
  • 20 Mayou R, Bryant B, Ehlers A. Prediction of psychological outcomes one year after a motor vehicle accident.  Am J Psych. 2001;  158 (8) 1231-1238
    CrossrefPubMedGoogle Scholar
  • 21 Ursano R J, Fullerton C S, Epstein R S, Crowley B, Kao T C, Vance K, Craig K J, Dougall A L, Baum A. Acute and Chronic Posttraumatic Stress Disorder in Motor Vehicle Accident Victims.  Am J Psychiatry. April 1999;  156 589-595
    PubMedGoogle Scholar
  • 22 Fullerton C S, Ursano R J, Epstein R S, Crowley B, Vance K, Kao T C, Dougall A, Baum A. Gender Differences in Posttraumatic Stress Disorder After Motor Vehicle Accidents.  Am J Psychiatry. September 2001;  158 1486-1491
    CrossrefPubMedGoogle Scholar
  • 23 Brady K T, Killeen T K, Brewerton T, Lucerini S. Comorbidity of psychiatric disorders and posttraumatic stress disorder.  J Clin Psychiatry. 2000;  61 (suppl. 7) 22-31
    PubMedGoogle Scholar
  • 24 Murray J, Ehlers A, Mayou R A. Dissociation and posttraumatic stress disorder: two prospective studies of road traffic accident survivors.  Br J Psych. 2002;  180 363-368
    PubMedGoogle Scholar
  • 25 Dougall A L, Ursano R J, Posluszny D M, Fullerton C S, Baum A. predictors of posttraumatic stress disorder among victims of motor vehicle accidents.  Psychosom Med. 2001;  63 402-411
    PubMedGoogle Scholar
  • 26 Shalev A Y, Sahar T, Freedman S, Peri T, Glick N, Brandes D, Orr S P, Pitman R K. A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder.  Arch Gen Psych. June 1998;  Vol. 55 553-559
    PubMedGoogle Scholar
  • 27 Delahanty D L, Raimonde A J, Spoonster E. Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims.  Biol Psych. 2000;  48 940-947
    PubMedGoogle Scholar
  • 28 Anisman H, Griffiths J, Matheson K, Ravindran A V, Merali Z. Posttraumatic stress symptoms and salivary cortisol levels.  Am J Psych. 2000;  158 (9) 1509-1511
    PubMedGoogle Scholar
  • 29 Yehuda R, Resnick H S, Schmeidler J, Yang R K, Pitman R K. Predictors of cortisol and 3-methoxy-4-hydroxy-phenylglykol responses in the acute aftermath of rape.  Biol Psych. 1998;  43 855-859
    PubMedGoogle Scholar
  • 30 Perry S, Difede J, Musngi G, Frances A J, Jacobsberg L. Predictors of posttraumatic stress disorder after burn injury.  Am J Psych. 1992;  149 (7) 931-935
    PubMedGoogle Scholar
  • 31 Madianos M G, Papaghelis M, Ionvanovich J, Dafni R. Psychiatric disorders in burn patients: A follow-up-study.  Psychother Psychosom. 2001;  70 30-37
    CrossrefPubMedGoogle Scholar
  • 32 Winterbottom E H. Insufficient anaesthesia (Correspondence).  Br Med J. 1950;  1 247
    PubMedGoogle Scholar
  • 33 Schwender D, Daunderer D, Kunze-Kronawitter H, Klasing S, Pöppl E, Peter K. Awareness during general anaesthesia - incidence, clinical relevance and monitoring.  Acta Anaesthesiol Scand Suppl. 1997;  111 313-314
    PubMedGoogle Scholar
  • 34 Meyer M C, Blacher R S. A traumatic neurotic reaction induced by succinylcholine chloride.  N Y State J Med. 1961;  61 1255-1261
    PubMedGoogle Scholar
  • 35 Blacher R S. On awakening paralysed during surgery.  JAMA. 1975;  234 67-68
    CrossrefPubMedGoogle Scholar
  • 36 Goldman L, Shah M V, Hebden M W. Memory of cardiac anaesthesia.  Anaesthesia. 1987;  42 596-603
    PubMedGoogle Scholar
  • 37 MacLeod A D, Maycock E. Awareness during anaesthesia and posttraumatic stress disorder.  Anaesthesia and Int Care. 1992;  Vol. 20 No. 3 378-382
    PubMedGoogle Scholar
  • 38 Osterman J E, Hopper J, Heran W J, Keane T M, Kolk B A van der. Awareness under anaesthesia and the development of posttraumatic stress disorder.  Gen Hosp Psych. 2001;  23 198-204
    PubMedGoogle Scholar
  • 39 Osterman J E, Kolk B A van der. Awareness during anaesthesia and posttraumatic stress disorder.  Gen Hosp Psych. 1998;  20 274-281
    PubMedGoogle Scholar
  • 40 Sandin R H, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study.  Lancet. 2000 Feb 26;  355 (9205) 707-711
    CrossrefPubMedGoogle Scholar
  • 41 Lennmarken C, Bildfors K, Enlund G, Samuelsson P, Sandin R. Victims of awareness.  Acta Anaesthesiol Scand. 2002 Mar;  46 (3) 229-231
    CrossrefPubMedGoogle Scholar
  • 42 Stoll C, Schelling G, Goetz A E, Kilger E, Bayer A, Kapfhammer H P, Rothenhausler H B, Kreuzer E, Reichart B, Peter K. Health-related quality of life and post-traumatic stress disorder in patients after cardiac surgery and intensive care treatment.  J Thorac Cardiovasc Surg. 2000 Sep;  120 (3) 505-512
    CrossrefPubMedGoogle Scholar
  • 43 Stoll C, Kapfhammer H P, Rothenhäusler H B, Haller M, Briegel J, Schmidt M, Krauseneck T, Durst K, Schelling G. Sensitivity and Specifity of a screening test to document traumatic experiences and to diagnose Post-Traumatic Stress Disorder in patients after intensive care treatment.  Int Care Med. 1999;  25 697-704
    CrossrefPubMedGoogle Scholar
  • 44 Schelling G, Richter M, Roozendaal B, Rothenhäusler H B, Nollert G, Schmidt M, Kapfhammer H P. Effects of stress hormones on traumatic memories, post-traumatic stress disorder and health-related quality of life outcomes in patients after cardiac surgery.  Critical Care Medicine. 2003;  31 1971-1980
    CrossrefPubMedGoogle Scholar
  • 45 Coursin D R, Coursin D B. Survivors, beware of posttraumatic stress disorder: What shall we tell the men in black?.  Crit Care Med. 1998;  Editorial Vol. 26 No.4 634-635
    CrossrefPubMedGoogle Scholar
  • 46 Hayden W R. Life and near - death in the intensive care unit. A personal experience.  Crit Care Clin. 1994;  Vol. 10 No. 4 651-657
    PubMedGoogle Scholar
  • 47 Kapfhammer H P, Rothenhäusler H B, Krauseneck T, Stoll C, Schelling G. Posttraumatic stress dis-order in long-term survivors of ARDS: Results of a psychiatric follow-up study and psychological tests.  Am J Psychiatry. 2004;  161 45-52
    CrossrefPubMedGoogle Scholar
  • 48 McCartney J R, Boland R J. Anxiety and delirium in the intensive care unit.  Crit Care Clin. 1994;  Vol. 10 No. 4 673-680
    PubMedGoogle Scholar
  • 49 Kutz I, Garb R, David D. Post-traumatic stress disorder following myocardial infarction.  Gen Hosp Psych. 1988;  10 169-176
    PubMedGoogle Scholar
  • 50 Kutz I, Shabtai H, Solomon Z, Neumann M, David D. Post-traumatic stress disorder in myocardial infarction patients: prevalence study.  Isr J Psychiatry Relat Sci. 1994;  31 (1) 48-56
    PubMedGoogle Scholar
  • 51 Doerfler L A, Pbert L, DeCosimo D. Symptoms of posttraumatic stress disorder following myocardial infarction and coronary artery bypass surgery.  Gen Hosp Psych. 1994;  16 193-199
    CrossrefPubMedGoogle Scholar
  • 52 Ladwig K H, Schoefinius A, Damman G, Danner R, Gürtler R, Herrmann R. Long-acting psychotraumatic properties of a cardiac arrest experience.  Am J Psych. 1999;  156 (6) 912-919
    PubMedGoogle Scholar
  • 53 Dew M A, Kormos R L, DiMartini A F, Switzer G E, Schulberg H C, Roth L H, Griffith B P. Prevalence and Risk of depression and anxiety - related disorders during the first three years after heart transplantation.  Psychosom. 2001;  42 300-313
    CrossrefPubMedGoogle Scholar
  • 54 Stukas A A, Dew M A, Switzer G E, DiMartini A, Kormos R L, Griffith B P. PTSD in heart transplant recipients and their primary family caregivers.  Psychosom. 1999;  40 (3) 212-221
    Google Scholar
  • 55 Zipfel S, Lowe B, Paschke T, Immel B, Lange R, Zimmermann R, Herzog W, Bergmann G. Psychological distress in patients awaiting heart transplantation.  J Psychosom Res. 1998 Nov;  45 (5) 465-470
    Google Scholar
  • 56 Rothenhäusler H B, Ehrentraut S, Lang C, Zachoval R, Bilzer M, Schelling G, Kapfhammer H P, Gerbes A L. Psychiatric and psychosocial outcome of orthotopic liver transplantation.  Psychother Psychosom. 2002;  71 285-297
    Google Scholar
  • 57 Kangas M, Henry J L, Bryant R A. Posttraumatic stress disorder following cancer. A conceptual and empirical review.  Clin Psychol Rev. 2002;  22 499-524
    CrossrefPubMedGoogle Scholar
  • 58 Holland J C, Rowland J H. Handbook of psychooncology: Psychological care of the patient with cancer. New York, Oxford: University press 1989
    Google Scholar
  • 59 Green B L, Rowland J H, Krupnick J L, Epstein S A, Stockton P, Stern N M, Spertus I L, Steakley R N. Prevalence of posttraumatic stress disorder in women with breast cancer.  Psychosom. 1998;  39 102-111
    PubMedGoogle Scholar
  • 60 Andrykowski M A, Cordova M J, Studts J L, Miller T W. Posttraumatic stress disorder after treatment for breast cancer : prevalence of diagnosis and use of the PTSD checklist - civilian version (PCL-C) as a screening instrument.  J Consul Clin Psychology. 1998;  Vol. 66 No. 3 586-590
    PubMedGoogle Scholar
  • 61 Mundy E A, Blanchard E B, Cirenza E, Gargiulo J, Maloy B, Blanchard C G. Posttraumatic stress disorder in breast cancer patients following autologous bone marrow transplantation or conventional cancer treatments.  Behav Res Ther. 2000 Oct;  38 (10) 1015-1027
    CrossrefPubMedGoogle Scholar
  • 62 Pitman R K, Lanes D M, Williston S K, Guillaume J L, Metzger L J, Gehr G M, Orr S P. Psychophysiologic assessment of posttraumatic stress disorder in breast cancer patients.  Psychosom. 2001;  42 (2) 133-140
    CrossrefPubMedGoogle Scholar
  • 63 Alter C L, Pelcovitz D, Axelrod A, Goldenberg B, Harris H, Meyers B, Grobois B, Mandel F, Seprimus A, Kaplan S. Identification of PTSD in cancer survivors.  Psychosom. 1996;  37 137-143
    PubMedGoogle Scholar
  • 64 Harvey A G, Bryant R A. Memory for acute stress disorder symptoms. A two year prospective study.  J Nerv Ment Dis. 2000;  Vol. 188 No. 9 602-606
    CrossrefPubMedGoogle Scholar
  • 65 Widows M R, Jacobsen P B, Fields K K. Relation of psychological vulnerability factors to posttraumatic stress disorder symptomatology in bone marrow transplant recipients.  Psychosom Med. 2000;  62 873-882
    PubMedGoogle Scholar
  • 66 Kapfhammer H P. Anpassungsstörung, Akute und Posttraumatische Belastungsstörung. In: Möller HJ, Laux G, Kapfhammer HP (Hrsg.). Psychiatrie und Psychotherapie. 2. erweiterte Auflage. Berlin Heidelberg: Springer 2002: 1302-1341
    Google Scholar
  • 67 O'Donnell M L, Creamer M, Pattison P. Posttraumatic stress disorder and depression following trauma: Understanding comorbidity.  Am J Psychiatry. 2004;  161 1390-1396
    CrossrefPubMedGoogle Scholar
  • 68 Andreasen N. Acute and delayed posttraumatic stress disorders: A history and some issues.  Am J Psychiatry. 2004;  161 1321-1323
    CrossrefPubMedGoogle Scholar
  • 69 Schelling G, Stoll C, Kapfhammer H P, Rothenhäusler H B, Völkl G, Krauseneck T, Durst K, Haller M, Briegel J. The effect of stress doses of hydrocortisone during septic shock on post-traumatic stress disorder and health-related quality of life in survivors.  Critical Care Medicine. 1999;  27 2678-2683
    CrossrefPubMedGoogle Scholar
  • 70 Schelling G, Briegel J, Stoll C, Rothenhäusler H B, Jochum M, Roozendal B, Kapfhammer H P. The effect of serum cortisol levels and the norepinephrine dosage-cortisol ratio during septic shock on traumatic memories and post-traumatic stress disorder in survivors.  Biol Psychiatry. 2001;  50 978-985
    CrossrefPubMedGoogle Scholar
  • 71 Schelling G, Kilger E, Roozendaal B, de Quervain D, Briegel J, Dagge A, Rothenhäusler H B, Krauseneck T, Nollert G, Kapfhammer H P. Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: A randomized study.  Biol Psychiatry. 2004;  55 627-633
    CrossrefPubMedGoogle Scholar
  • 72 Mundy E, Baum A. Medical disorders as a cause of psychological trauma and posttraumatic disorder.  Curr Opin Psychiatry. 2004;  17 123-127
    PubMedGoogle Scholar
  • 73 Mayou R A, Ehlers A, Hobbs M. Psychological debriefing for road traffic accident victims. Three-year follow-up of a randomised controlled trial.  Br J Psychiatry 2000. Jun ;  176 589-593
    PubMedGoogle Scholar

Dr. med. Till Krauseneck

Psychiatrische Klinik und Poliklinik der LMU München

Nußbaumstr. 7

80336 München

Email: Till.Krauseneck@med.uni-muenchen.de

      >