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Depressive und Angststörungen bei Krebserkrankungen

Comorbid depressive and anxiety disorders in patients with cancer

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Zusammenfassung

Patienten mit Krebserkrankungen weisen eine hohe Rate an komorbiden depressiven und Angststörungen auf, die paradigmatisch in einen komplexen biopsychosozialen Kontext gestellt werden müssen. Bei der Diagnosestellung sind einige konzeptuelle Herausforderungen zu meistern. Die psychischen Komorbiditäten bedeuten nicht nur ein höheres subjektives Leiden, ein reduziertes Coping, mögliche negative Interferenzen mit somatischen Therapien und Rehabilitationen, eine stärker beeinträchtigte Lebensqualität sowie höhere Grade an psychosozialer Behinderung. Sie schließen auch ein höheres somatisches Morbiditäts- und Mortalitätsrisiko im weiteren Verlauf ein. Die vielfältigen psychologischen, psychosozialen, morbogenen und therapiebezogenen Stressoren müssen aufeinander bezogen und auf gemeinsame neurobiologische, v. a. neuroendokrine, neuroinflammatorische Vermittlungsmechanismen hin reflektiert werden. Hierbei sind stets mehrfache psychosomatische, somatopsychische und somatosomatische Effekte zu beachten. Es existieren evidenzbasierte psychotherapeutische und psychopharmakologische Ansätze für eine integrative Behandlung der komorbiden depressiven und Angststörungen.

Summary

Patients with cancer face a high risk of comorbid depressive and anxiety disorders that have to be paradigmatically considered within a complex biopsychosocial context. Several conceptual challenges have to be mastered in arriving at a correct clinical diagnosis. Coexistent affective and anxiety disorders in cancer patients include a more dramatic subjective suffering, reduced psychological coping, possible negative interference with somatic treatment and rehabilitation, impaired quality of life and higher grades of psychosocial disability. They may also lead to an overall increased risk of somatic morbidity, a more rapid progression of cancer and a higher cancer-related mortality in the course of the disease. Manifold psychological, psychosocial and existential, cancer and treatment-related stressors have to be considered with respect to common neurobiological, especially neuroendocrine and neuroinflammatory mechanisms. Complex psychosomatic, somatopsychic and somato-somatic effects must always be considered. Evidence-based approaches in psychotherapy and pharmacotherapy exist for the integrative treatment of comorbid depressive and anxiety disorders in cancer.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. H.P. Kapfhammer gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, 8036, Graz, Österreich

    H.-P. Kapfhammer

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Kapfhammer, HP. Depressive und Angststörungen bei Krebserkrankungen. Nervenarzt 86, 291–301 (2015). https://doi.org/10.1007/s00115-014-4156-x

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