Komorbiditätsstrukturen bei Angststörungen Häufigkeit und mögliche Implikationen

  • Hans-Ulrich Wittchen
  • Antonia Vossen

Zusammenfassung

Allgemein beschreibt der Begriff Komorbidität den Umstand, daß viele Patienten mehr als eine Diagnose aufweisen. Akiskal (1990) wies kürzlich darauf hin, daß dieses Phänomen bereits seit der Antike gut bekannt ist (»Patients with anxiety of long standing are subject to melancholia«, Aristoteles, Epidemics III). Auch im klinischen Alltag finden wir in ausführlicheren Krankengeschichten und Verhaltensanalysen oft Hinweise wieder, die unter dem Phänomen der Komorbidität zusammengefaßt werden können, wie Angaben zu Haupt- und Nebendiagnosen, zu Persönlichkeitsstörungen sowie zu körperlichen Erkrankungen. Der Begriff Komorbidität wurde allerdings im englischen Sprachraum erst durch Feinstein (1970) populär, der Komorbidität definierte als »any distinct additional clinical entity that has existed and that may occur during the clinical course of a patient who has the index disease under study« (S. 456–457).

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Literatur

  1. Akiskal, H.S. (1990). Toward a clinical understanding of the relationship of anxiety and depressive disorders. In J.D. Maser, C.R. Cloninger (Eds.), Comorbidity of mood and anxiety disorders (pp. 597–610). Washington/DC: American Psychiatric Press.Google Scholar
  2. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington/DC: Author.Google Scholar
  3. Angst, J. & Dobler-Mikola, A. (1985). The Zurich study — V. Anxiety and phobia in young adults. European Archives of Psychiatry and Neurological Sciences, 234, 408–418.PubMedCrossRefGoogle Scholar
  4. Blazer, D.G., Hughes, D., George, L.K., Swartz, M. & Boyer, R. (1991). Generalized Anxiety Disorder. In L.N. Robins & D.A. Regier (Eds.), Psychiatric disorders in America. The epidemiologic catchment area study (pp. 180–203). New York: The Free Press.Google Scholar
  5. Boyd, J.F. (1986). Use of mental healt services for the treatment of panic disorder. American Journal of Psychiatry, 143, 1569–1574.PubMedGoogle Scholar
  6. Breier, A., Charney, D.S. & Heninger, G.R. (1986). Agoraphobia with panic attacks. Development, diagnostic stability, and course of illness. Archives of General Psychiatry, 43, 1029–1036.PubMedCrossRefGoogle Scholar
  7. Bronisch, T. & Hecht, H. (1990). Major depression with and without a coexisting anxiety disorder: Social dysfunction, social integration, and personality features. Journal of Affective Disorders, 20, 151–157.PubMedCrossRefGoogle Scholar
  8. Burke, J. D., Wittchen, H.-U., Regier, D.A. & Sartorius, N. (1990). Extracting information from diagnostic interviews on co-occurrence of symptoms of anxiety and depression. In J. D. Maser & C.R. Cloninger (Eds.), Comorbidity of mood and anxiety disorders (pp. 649–667). Washington/DC: American Psychiatric Press.Google Scholar
  9. Coryell, W., Noyes, R. & Clancy, J. (1982). Excess mortality in PD: a comparison with primary unipolar depression. Archives of General Psychiatry, 39, 701.PubMedCrossRefGoogle Scholar
  10. Eaton, W.W., Dryman, A. & Weissman, M.M. (1991). Panic and Phobia. In L.N. Robins & D.A. Regier (Eds.), Psychiatric disorders in America. The epidemiologic catchment area study (pp. 155–179). New York: The Free Press.Google Scholar
  11. Eaton, W. W., Kessler, R.C., Wittchen, H.-U. & Magee, W.J. (1994). Panic and panic disorders in the United States. American Journal of Psychiatry, 151, 413–420.PubMedGoogle Scholar
  12. Faravelli, C. & Albanesi, G. (1987). Agoraphobia with panic attacks: 1 year prospective follow-up. Comprehensive Psychiatry, 28, 481–487.PubMedCrossRefGoogle Scholar
  13. Feinstein, A. R. (1970). The pre-therapeutic classification of co-morbidity in chronic disease. Journal of Chronic Diseases, 23, 455–468.CrossRefGoogle Scholar
  14. Fiester, S. J., Ellison, J.M., Dochert, J. P. (1990). Comorbidity of personality disorders: two for the price of three. In Treating personality — new direction for mental health (pp. 103–114). New York: Jossey-Bass.Google Scholar
  15. Hecht, H., Zerssen, D. von, Krieg, C., Pössl, J. & Wittchen, H.-U. (1989). Anxiety and depression: comorbidity, psychopathology and social functioning. Comprehensive Psychiatry, 30, 420–433.PubMedCrossRefGoogle Scholar
  16. Karno, M. & Golding, J.M. (1991). Obsessive-compulsive disorder. In L.N. Robins & D.A. Regier (Eds.). Psychiatric disorders in America. The epidemiologic catchment area study (pp. 204–219) New York: The Free Press.Google Scholar
  17. Kessler, R.C., McGonagle, K. A., Leaf, P. J., Frank, R., Zhao, S., Nelson, C.B., Hughes, M., Wittchen, H.-U., Kendler, K. S. & Edlung, M. (in press). Psychiatric disorders in the US: prevalence, impairment and frequency of treatment. New England Journal of Medicine. Google Scholar
  18. Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H.-U. & Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSMIII-R psychiatric disorders in the United States: Results from the national comorbidity survey. Archives of General Psychiatry, 51, 8–19.PubMedCrossRefGoogle Scholar
  19. Klein, D. F. (1981). Anxiety reconceptualized. In D. F. Klein & J. G. Rabkin (Eds.). Anxiety: New research and changing concepts. New York: Raven.Google Scholar
  20. Klerman, G.L. (1990). Approaches to the phenomena of comorbidity. In J. D. Maser & C.R. Clonbiger (Eds.), Comorbdity of mood and anxiety disorders (pp. 13–40). Washington/DC: American Psychiatric Press.Google Scholar
  21. Lepine, J.P., Wittchen, H.U. & Essau, C.A. (1993). Lifetime and current comorbidity of anxiety and depressive disorders: Results from the international WHO/ADAMHA CIDI field trials. International Journal of Methods in Psychiatric Research, 3, (2), 67–78.Google Scholar
  22. Lesser, I.M., Rubin, R. T., Pecknold, J.C., Rifkin, A., Swinson, R. P., Lydiard, R.B., Burrows, G.D., Noyes, R. Jr. & DuPont, R. L. Jr. (1988), Secondary depression in panic disorder and agoraphobia. Archives of General Psychiatry, 45, 437–443.PubMedCrossRefGoogle Scholar
  23. Liberthson, R., Sheehan, D. V., King, M.E. & Weyman, A.E. (1986). The prevalence of mitral valve prolapse in patients with panic disorders. American Journal of Psychiatry, 143, 511.PubMedGoogle Scholar
  24. Magee, W. J., Eaton, W. W., Wittchen, H.-U., McGonagle, K. A. & Kessler, R.C. (in press) Agoraphobia, simple phobia, and social phobia in the national comorbidity survey. Archives of General Psychiatry. Google Scholar
  25. Margraf, J. & Ehlers, A. (1988). Panic attacks in non-clinical subjects. In I. Hand & H.-U. Wittchen (Eds.), Panic and phobias. Heidelberg: Springer.Google Scholar
  26. Markowitz, J. S., Weissman, M. M., Quellette, R., Lish, J. & Klerman, G.L. (1989). Quality of life in panic disorder. Archives of General Psychiatry, 46, 984–992.PubMedCrossRefGoogle Scholar
  27. Maser, J. D. & Cloninger, C. R. (Eds.). (1990). Comorbidity of mood and anxiety disorders. Washington/DC: American Psychiatric Press.Google Scholar
  28. Mavissakalian, M. & Hamann, M. S. (1987). DSM-III personality disorder in agoraphobia II. changes to treatment. Comprehensive Psychiatry, 28, 356–361.PubMedCrossRefGoogle Scholar
  29. Medalie, J. H. & Goldbourt, U. (1976). Angina pectoris among io.000 men. II Psychosocial and other risk factors as evidenced by a multivariate analysis of a five year incidence study. American Journal of Medicine, 60, 910.PubMedCrossRefGoogle Scholar
  30. Merikangas, K., Angst, J., Eaton, W., Canino, G., Rubio-Stipec, M., Wacker, H. Wittchen, H.-U., Andrade, L., Essau, C.A., Kraemer, H., Robins, L. & Kupfer, D. (in press) Comorbidity and boundaries of affective disorders with anxiety disorders and substance abuse: results of an international task force. British Journal of Psychiatry. Google Scholar
  31. Merikangas, K.R. & Angst, J. (1990). Depression and migraine. In M. Sandler & G. Collins (Eds.), Migraine: a spectrum of ideas (pp. 248–258). New York: Oxford University Press.CrossRefGoogle Scholar
  32. Murphy, J. M., Olivier, D. C. Sobol, A. M. Monson, R. R. & Leighton, A.H. (1986). Diagnosis and outcome: depression and anxiety in a general population. Psychological Medicine, 16, 117–126.PubMedCrossRefGoogle Scholar
  33. Noyes, R. (1990). The comorbidity and mortality of panic disorder. Psychiatric Medicine, 8, 41–66.PubMedGoogle Scholar
  34. Noyes, R., Clancy, J., Crowe, R. R. & Slyman, D. (1978). The familial prevalence of anxiety neurosis. Archives of General Psychiatry, 135, 555–560.Google Scholar
  35. Noyes, R., Reich, J., Christiansen, J, Suelzer, M., Pfohl, B. & Coryell, W.A. (1990). Outcome of panic disorder: Relationship to diagnostic subtypes and comorbidity. Archives of General Psychiatry, 47, 809–818.PubMedCrossRefGoogle Scholar
  36. Nutzinger, D. O. & Zapototczy, H.G. (1985). The influence of depression on the outcome of cardiac phobia (panic disorder). Psychopathology, 18, 155–162.PubMedCrossRefGoogle Scholar
  37. Renneberg, B. (1991). Personality disorders and interactional behaviour of agoraphobic outpatients. Dissertation, Philipps-Universität, Marburg.Google Scholar
  38. Robins, L.N. & Regier, D.A. (Eds.) (1991). Psychiatric disorders in America. The epidemiologic catchment area study. New York: Maxwell Macmillan InternationalGoogle Scholar
  39. Rouillon, F. & Chignon, J.M. (1992). Psychiatric comorbidity of anxiety disorders. In J. A.E. Costa & L.A. Silva (Eds.), Anxiety disorders in the year 2000. Controversies and perspectives (pp. 26–33). Proceedings of the meeting held in Paris, 9 June 1992. Chester: Adis International.Google Scholar
  40. Shear, M.K., Kligfield, P., Harshfield, G. Devereux, R.B., Polan, J. J. Mann, J. J., Pickering, T. & Frances, A. J. (1987). Cardiac rate and rhythm in panic patients. American Journal of Psychiatry144:633–637.PubMedGoogle Scholar
  41. Stewart, W. F., Schechter, A. & Liberman, J. (1992). Physician consultation for headache pain and history of panic: results from a population based study. American Journal of Medicine, 92 (1A), 1A-355.CrossRefGoogle Scholar
  42. Tyrer, P., Casey, P. & Gall, J. (1983). Relationship between neurosis and personality disorder. British Journal of Psychiatry, 142, 404–408.PubMedCrossRefGoogle Scholar
  43. Üstün, T.B. & Sartorius, N. (1995). An international study of psychosocial disorders in 14 countries: standardized assessment of ill-defined problems in primary care: the background and rationale of the WHO collaborative project on »Psychological Problems in General Health Care«. In J. Miranda, A. Hohmann, C. Atkinson & D. Larson (Eds.) Mental disorders in primary health care. San Francisco: Jossey-Bass.Google Scholar
  44. Valkenburg, C. van, Akiskal, H. S., Puzantian, V. & Rosenthal, T. (1984). Anxious depressions: Clinical, family history, and naturalistic outcome — comparisons with panic and major depressive disorders. Journal of Affective Disorders, 6, 67–82.CrossRefGoogle Scholar
  45. Vollrath, M., Koch, R., Angst, J. (1990). The Zurich study. IX. Panic disorder and sporadic panic: symptoms, diagnosis, prevalence, and overlap with depression. European Archives of Psychiatry and Neurological Sciences, 239 (4), 221–230.PubMedCrossRefGoogle Scholar
  46. Korff, M. von, Eaton, W. & Keyl, P. (1983). The epidemiology of panic attacks and panic disorder: results of three community surveys. American Journal of Epidemiology, 122, 970–981.Google Scholar
  47. Wacker, H. R. (1991). Angst und Depression: Deskriptoren, Prädiktoren: Eine Querschnitts- und Verlaufsuntersuchung [Schweizer Nationalfonds. Schlußbericht. GesuchNr. 32–9373 (3.995–0.87)].Google Scholar
  48. Walker, R.E., Roy-Byrne, P. P., Katon, W.J., Li, L., Ames, D. & Jiranek, G. (1990). Psychiatric illness and irritable bowel syndrome: a comparison with inflammatory bowel disease. American Journal of Psychiatry, 147, 1656.PubMedGoogle Scholar
  49. Weissman, M.M. (1990). Epidemiology of panic disorder and agoraphobia. Psychiatric Medicine8, 3–13.PubMedGoogle Scholar
  50. Weissman, M.M. (1991). Panic disorder: Impact on quality of life. Journal of Clinical Psychiatry, 52 (2), 6–8.PubMedGoogle Scholar
  51. Weissman, M.M., Bland, R., Canino, G., Faravelli, C., Greenwald, S., Hwu, H.-G., Joyce, P.R., Karam, E.G. , Lee, C.K., Lellouch, J., Lepine, J.-P., Newman, S., Rubio-Stipec, M., Wells, J.E., Wickrammaratne, P., Wittchen, H.-U. & Yeh, E.-K. (in press). Cross national aspects of major depression and bipolar disorder. Depression. Google Scholar
  52. Wittchen, H.-U. (1986). Epidemiology of panic attacks and panic disorders. In I. Hand & H.-U. Wittchen (Eds.), Panic and phobias — Empirical evidence of theoretical models and longterm effects of behavioral treatments (pp. 18–28). Berlin: Springer.Google Scholar
  53. Wittchen, H.-U. (1988). Natural course and spontaneous remissions of untreated anxiety disorders — Results of the Munich follow-up study (MFS). In I. Hand & H.-U. Wittchen (Eds.), Panic and Phobias 2. Treatments and variables affecting course and outcome (pp. 3–17). Berlin: Springer.Google Scholar
  54. Wittchen, H.-U. (1991). Der Langzeitverlauf unbehandelter Angststörungen: Wie häufig sind Spontanremissionen? Verhaltenstherapie, 1 (4), 273–282.CrossRefGoogle Scholar
  55. Wittchen, H.-U. (1994). Reliability and validity studies of the WHO-composite international diagnostic interview (CIDI): A critical review. Journal of Psychiatric Research, 28 (1), 57–84.PubMedCrossRefGoogle Scholar
  56. Wittchen, H.-U. (1995). Implikationen von Komorbidität. Verhaltenstherapie, Praxis, Forschung, Perspektiven, 5 (3), 120–133.Google Scholar
  57. Wittchen, H.-U. & Essau, C.A. (1989). Comorbidity of anxiety disorders and depression: does it affect course and outcome? Journal of Psychiatry and Psychobiology, 4, 315–323.Google Scholar
  58. Wittchen, H.-U. & Essau, C. A. (1993 a). Comorbidity and mixed anxiety-depressive disorders: Is there epidemiological evidence? Journal of Clinical Psychiatry. Google Scholar
  59. Wittchen, H.-U. & Essau, C.A. (1993b). Epidemology of anxiety disorders. In R. Michels. (Ed), Psychiat (pp. 1–25). Philadelphia: J. B. Lippincott.Google Scholar
  60. Wittchen, H.-U. & Essau, C.A. (1993 c). Epidemiology of panic disorder: Progress and unresolved issues. Journal of Psychiatric Research, 27, (Suppl. 1), 47–68.PubMedCrossRefGoogle Scholar
  61. Wittchen, H.-U., Essau, C.A. & Krieg, J. C. (1991). Anxiety disorders: Similarities and differences of comorbidity in treated and untreated groups. British Journal of Psychiatry, 159 (Suppl. 12), 23–33.CrossRefGoogle Scholar
  62. Wittchen, H.-U., Schramm, E., Zaudig, M., Mombour, W. & Unland, H. (1993 a). SKID-II. Strukturiertes Klinisches Interview für- DSM-III-R, Achse-II (Persönlichkeitsstörungen): a) Interviewheft. Weinheim: Beltz Test.Google Scholar
  63. Wittchen, H.-U., Schramm, E., Zaudig, M., Mobour, W. & Unland, H. (1993b). SKID II. Strukturiertes Klinisches Interview für DSM-III-R, Achse II (Persönlichkeitsstörungen): b) Manual. Weinheim: Beltz Test.Google Scholar
  64. Wittchen, H.-U., Schramm, E., Zaudig, M. Mombour, W. & Unland, H. (1993c). SKID IL Strukturiertes Klinisches Interview für DSM-III-R, Achse II (Persönlichkeitsstörungen): c) Persönlichkeitsfragebogen. Weinheim: Beltz Test.Google Scholar
  65. Wittchen, H.-U., Essau, C.A., Rief, W. & Fichter, M.M. (1993d). Assessment of somatoform disorders and comorbidity pattern with the CIDI-findings in psychosomatic inpatients. International Journal of Methods in Psychiatric Research, 3 (2), 87–100.Google Scholar
  66. Wittchen, H.-U., Zhao, S., Kessler, R. & Eaton, W.W. (1994). DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Archives of General Psychiatry, 51, 355–364.PubMedCrossRefGoogle Scholar
  67. Wittchen, H.-U. & Zerssen, D. von (Hrsg.). (1987). Verläufe behandelter und unbehandelter Depressionen und Angststörungen. — Eine klinisch-psychiatrische und epidemiologische Verlaufsuntersuchung. Berlin: Springer.Google Scholar

Weiterführende Literatur

  1. Kessler, R.C., McGonagle, K.A., Zaho, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H.-U. & Kendler, K.S. (1994). Lifetime and 12-month prevalence of DSMIII-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry51, 8–19PubMedCrossRefGoogle Scholar
  2. Maser, J.D. & Cloninger C.R. (Eds.) (1990). Comorbidity of mood and anxiety disorders. Washington/DC. London: American Psychiatric Press.Google Scholar
  3. Wittchen, H.-U. (in press). What is comorbidity. Fact of artefact? (Editorial). British Journal of Psychiatry.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1996

Authors and Affiliations

  • Hans-Ulrich Wittchen
  • Antonia Vossen

There are no affiliations available

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