Die Posttraumatische Belastungsstörung - Teil 2: Kosten, Komorbiditäten und Therapie

Zusammenfassung

Die Posttraumatische Belastungsstörung (PTBS) hat aufgrund ihres häufigen Vorkommens neben der medizinischen auch eine große soziale und wirtschaftliche Bedeutung. Nicht nur die medizinische Behandlungsnotwendigkeit, sondern auch volkswirtschaftliche Gesichtspunkte verlangen nach einer effizienten Therapie der Betroffenen. Schätzungen von direkten und indirekten Folgekosten der PTBS in den USA, bewegen sich, nicht zuletzt als Folge der Ereignisse vom 11. Sept. 2001, im mehrstelligen Milliarden-Dollar-Bereich. Die Behandlung der PTBS gestaltet sich aufgrund von häufigen komorbid auftretenden Erkrankungen schwierig. Die Begleiterkrankungen sind mannigfaltig und decken den gesamten Bereich psychischer Erkrankungen ab. Die nosologische Eigenständigkeit der PTBS wird durch vielfältige organische Befunde aus der Elektrophysiologie und der funktionellen Bildgebung belegt. Ein sich mittlerweile aus vielen Richtungen abzeichnendes organisches Korrelat und eine Vielzahl von Verhaltensauffälligkeiten stellen weitere Ansatzpunkte für eine adäquate Therapie dar, die auf das Individuum abgestimmt und in einem integrativen Ansatz sowohl aus pharmakologischen als auch aus psychotherapeutischen Komponenten bestehen sollte.

Abstract

Besides a huge impact on psychiatric burden of disease, post-traumatic stress disorder (PTSD) is of immense socioeconomic importance. Not only medical, but also economical aspects demand an effective treatment of PTSD: direct and indirect costs of PTSD in the United States of America are estimated several billion dollars. Due to frequent co-morbidities, PTSD therapy proves to be complex and difficult. Co-morbid diseases are numerous and cover almost the whole field of psychiatry. The delineation of PTSD as a distinct nosological entity is however meanwhile substantiated by various findings generated by the means of multimodal neuroimaging, e. g. electrophysiological or functional imaging techniques. Converging lines of evidence, arguing for an organic correlate of PTSD, and widespread behavioural disturbances provide a further rationale for an adequate treatment of PTSD. This should be individually tailored for every patient and include both pharmacological as well as cognitive-behavioural methods to provide a modern, integrative approach to meet the requirements of this complex disease.

Schlüsselwörter

Posttraumatische Belastungsstörung - PTBS - PTSD - Therapie - Kosten - Ökonomie - Komorbide Erkrankungen - Pharmakotherapie - Kognitiv-behaviorale Therapie - Debriefing - Psychotherapie

Key words

Posttraumatic stress disorder - PTSD - therapy - costs - economy - co-morbid disorders - pharmacotherapy - cognitive-behavioural therapy - debriefing - psychotherapy

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