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Neuropsychologische und psychosoziale Folgen von Schädel-Hirn-Traumen

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Zusammenfassung

Schädel-Hirn-Traumen (SHT) stehen als Todesursache in der Altersgruppe bis zu 45 Lebensjahren an erster Stelle [35, 45, 83]. Männer sind 3-mal häufiger von einem SHT betroffen als Frauen. In den Vereinigten Staaten von Amerika bilden SHT mit einem Anteil von 40% die häufigste Ursache von Todesfällen infolge von akuten Verletzungen. Pro Jahr werden ca. 200 000 Patienten stationär in den USA wegen eines schweren SHT behandelt und viele der Überlebenden bleiben permanent behindert [54]. Zusätzlich sind ca. 1,74 Mio. Amerikaner von einem leichten SHT betroffen, das zumindest die einmalige Konsultation eines Arztes erforderlich macht [83]. In Deutschland erleiden jährlich ca. 650 000 Menschen ein SHT, das bei ca. 150000 Patienten eine stationäre Behandlung erfordert, von denen wiederum ca. 30000 versterben [22]. Alter, Geschlecht und sozioökonomischer Status beeinflussen die Inzidenz des SHT in der Allgemeinbevölkerung. So findet sich eine höhere Inzidenz in der Altersklasse zwischen 15 und 24 Jahren, bei Personen männlichen Geschlechts oder bei Menschen mit einem niedrigen sozioökonomischen Status [45, 76]. Die häufigsten Ursachen von Schädel-Hirn-Verletzungen sind Verkehrsunfälle, Stürze und körperliche Gewalteinwirkungen [45, 76, 83]. Die Tatsache, dass die meisten Opfer eines SHT mit einem Alter von 15-24 Jahren [76] sehr jung sind und zu Beginn ihres produktiven Lebens stehen, verdeutlicht besonders die dahinter stehende psychosoziale und ökonomische Problematik. Zwar sinkt durch Verbesserungen im akutmedizinischen Management seit einiger Zeit die Mortalität nach einem SHT [22, 54], doch steigt auf der anderen Seite hierdurch der Anteil an permanent behinderten Überlebenden. Vor diesem Hintergrund forderte bereits 1989 Ridley einen Paradigmenwechsel weg von der grundlagenwissenschaftlichen Analyse der kognitiven Beeinträchtigungen in dieser Patientengruppe hin zu der Untersuchung der psychosozialen Folgen und ihrer psychologischen Verarbeitung [66]. Jacobson vertrat die noch weitergehende Ansicht, dass die subjektiven Beschwerden nach einem SHT nicht allein durch ein organisches Modell erklärt werden können, sondern dass neben kognitiv-behavioralen Faktoren auch die Krankheitsverarbeitung berücksichtigt werden muss [36].

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Authors
  1. B. O. Hütter
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  2. J. M. Gilsbach
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Editors and Affiliations

  1. Klinik u. Poliklinik f. Psychiatrie u. Psychotherapie, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Str. 11, 48129, Münster, Deutschland

    Volker Arolt

  2. Abteilung Psychiatrie und Psychotherapie, Ev. Krankenhaus Königin Elisabeth Herzberge, Herzbergstraße 79, 10362, Berlin, Deutschland

    Albert Diefenbacher

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Hütter, B.O., Gilsbach, J.M. (2004). Neuropsychologische und psychosoziale Folgen von Schädel-Hirn-Traumen. In: Arolt, V., Diefenbacher, A. (eds) Psychiatrie in der klinischen Medizin. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-662-12845-9_27

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