Prognose der Zwangserkrankung
Zumindest für die unbehandelte Zwangserkrankung ist wohl von einem in der Regelchronifizierenden Verlauf auszugehen, auch wenn die Intensität der Symptome und der Beeinträchtigungsgrad durchaus schwanken können. Durch die kombinierte Behandlung mit geeigneten Medikamenten und psychotherapeutischen Methoden ist die Prognose häufig deutlich zu verbessern. Aber auch bei Ausschöpfung der vorhandenen therapeutischen Möglichkeiten ist eine vollständige und dauerhafte Remission der Zwangserkrankung eher die Seltenheit!
Die therapeutischen Bemühungen sollten daher v.a. auf eine Reduzierung des Leidensdruckes und eine verbesserte Kontrolle der Zwangssymptomatik abzielen. Häufig kann durch die Therapie eine verloren gegangene Arbeitsfähigkeit wieder hergestellt werden. Auch der Leidensdruck kann oft erheblich reduziert und dadurch eine erhebliche Besserung der Lebensqualität erreicht werden. Es gibt zum Teil recht unterschiedliche Studienergebnisse über den Langzeitverlauf. Deshalb seien an dieser Stelle einige Zahlen aus Kapfhammer (2000, S. 1235) zitiert:
- Verlaufsstudie von Goodwin et al. (1969):
- günstige Prognose bei milder Symptomausprägungauch bei schwerer Symptomatik noch Besserungsraten von 35%
- chronische Progredienz bei 5-10% der Erkrankten
Untersuchung von Black (1974):
- unveränderte Befunde oder chronifizierender Verlauf in 57% der Fällephasischer Verlauf in 13% der Fälle
- fluktuierender Verlauf in 30% der Fälle
- Steketee et al. (1997):
- zumindest 50% der Erkrankten erreicht eine bedeutende Teilremission
Deister (2001) stellt anhand von Studien-Ergebnissen dar, dass 75% der Patienten 7 Jahre nach Beginn Behandlung (!) einen sehr guten (10%) oder guten bis mittelmässigen (68%) Befindenszustand hatten, während sich die übrigen 22% auch nach dem langen Verlauf noch erheblich beeinträchtigt fühlten. (S. 133)Unabhängig von diesen divergierenden Zahlen herrscht Einigkeit darüber, dass Zwangssymptomegrundsätzlich eine Tendenz zur Ausbreitung haben und ohne Behandlung vom Betroffenen auch nach Jahren kaum zu beherrschen sind (Ausgenommen sind die oft spontan ausheilenden und nicht seltenen präpubertären zwangsneurotischen Episoden Jugendlicher). Die Aufnahme einer spezifischen Behandlung stellt somit einen entscheidenden prognostischen Faktor dar! Es besteht wohl auch einigung darüber, dass die Prognose davon mitbestimmt wird, wieviele und welche weiteren psychischen Erkrankungen mit welcher Ausprägung vorliegen. Symptomatisch zeichnet sich ein ungünstiger Verlauf durch fortschreitende Isolierung und sozialen Rückzug sowie teilweise auch durch diverse körperliche Folgeschäden durch einseitige intensive Belastungen (z.B. ekzematöse „Waschfrauenhände“ bei Waschzwang) aus. Gelingt es nicht, diese Prozesse therapeutisch zu stoppen oder zumindest teilweise zurückzubilden, dann besteht ein deutlich erhöhtes Suizidrisiko.
Ungünstige Behandlungs-Prädiktoren für eine Monotherapie mit einem serotonergen Antidepressivum(SSRI) sind nach Kapfhammer (2000, S. 1240f):
- begleitende schizotypische oder Borderline-Persönlichkeitsstörung
- komorbide soziale Phobie
- begleitende chronische Tic-Erkrankung
- diskrete neurologische Symptome
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