Angststörungen neigen zur Chronifizierung, sie sind ausserdem häufig mit anderen psychischen Erkrankungen vergesellschaftet und führen nicht selten zur Invalidität. Deshalb haben sie eine grosse gesundheitspolitische und auch volkswirtschaftliche Bedeutung.
Panikattacken
Panikattacken können sich entweder zurückbilden oder aber zu einer chronischen Angststörung mit steigender Erwartungsangst werden. Um das weitere Auftreten von Panikattacken zu verhindern, kommt es im weiteren Verlauf nicht selten zu Vermeidungsreaktionen, worauf hin sich im Verlauf dann eine soziale Phobie entwickeln kann. Auch die Kombination mit einer Agoraphobie ist häufig. In den Fällen mit kombinierter Panikattacke und Agoraphobie werden meist besonders starke Erwartungsängste erlebt. Ob sich eine Panikstörung wieder zurückbildet oder weiter ausbreitet und chronifizert scheint wesentlich von der sonstigen seelischen „Gesundheit“ des Betroffenen abzuhängen. So ist die Heilungsrate besser bei ansonsten psychisch Gesunden als bei psychiatrisch Vorbelasteten und besser bei ambulanten Patienten als bei stationär Versorgten. Vorbestehende Persönlichkeitsstörungen sind ein besonders schlechter Prädiktor! Je schwerer die Anfangssymptomatik ist und je geringer die Ressourcen zur Krankheitsbewältigung bei dem Betroffenen und seinem sozialen Umfeld sind, umso schlechter ist auch die Prognose. Menschen mit Panikstörungen sind bei schwerem Verlauf suizidgefährdet!
Häufige Komorbiditäten (=Zusatzerkrankungen):
- Depression (30 – 70%)
- Alkohol- und Medikamentenmissbrauch (vorhergehend oder nachfolgend)
- Sexualstörungen
- Essstörungen
- Schlafstörunge
- Magengeschwür
Generalisierte Angststörung
Die sich schleichend und oft lange unbehandelt entwickelnde generalisierte Angststörung neigt häufiger zur Chronifizierung als Panikattacken. Sie verläuft meist ungünstiger und spricht weniger gut auf Behandlung an. Der Verlauf der generalisierten Angststörung ist dabei durchaus wechselhaft. Krisen und Symptomverschlechterungen sind häufig an belastende Lebensumstände oder Ereignisse gekoppelt, Stressentlastung bringt Symptomverbesserung. Menschen mit einer generalisierten Angststörung betreiben sehr häufig Alkohol- und Medikamentenmissbruach, um das Angstniveau zu senken und Entlastung herbeizuführen. Im Gegensatz zu der Panikstörung ist die Suizidrate bei der generalisierten Angststörung nicht messbar erhöht!
Häufige Komorbiditäten:
- Depression (sehr häufig)
- Alkoho- und/oder Medikamentenabhängigkeit (sehr häufig)
Soziale Phobie
Erste Symptome einer sozialen Phobie setzen bereits in der Kindheit ein, der Verlauf ist schleichend und chronifizierend. Später Krankheitsbeginn, ein hoher sozialer Status und sonstige psychische Gesundheit verbessern in der Regel die Prognose (Heilungserwartung) einer sozialen Phobie. Bei ungünstigen Verläufen ist die Suizidgefahr erhöht!
Häufige Komorbiditäten:
- Depression
- Alkohol- und Drogenprobleme
Spezifische Phobien
Die spezifischen Phobien können zu jedem Lebenszeitpunkt auftreten, sind aber im Mittel um das 15. Lebensjahr am häufigsten. Im Kindesalter sind Phobien häufig vorübergehend! Je später Phobien erworben werden, umso eher neigen sie zur Chronifizierung. Auch unbehandelte Phobien bleiben meist bestehen. Je eher eine spezifische Behandlung einsetzt, je mehr der Ausbruch der Phobie mit einem akuten Konflikt oder einer akut belastenden Lebenssituation zusammenhängt, je vollständiger die Ängste in dem phobischen Objekt gebunden werden können und je grösser die persönlichen und familiären Ressourcen zur Krankheitsbewältigung sind, umso besser ist auch die Prognose.
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