Der Begriff der „multifaktoriellen Ätiopathogenese affektiver Störungen“

Es gibt nicht die Ursache affektiver Störungen. Es gilt stattdessen als gesichert, dass die Störungen des Gemüts durch eine Vielzahl von Faktoren mitbedingt und ausgelöst werden kann. Das gilt auch für die einfache Manie und für die manisch-depressive Erkrankung, auch bipolare Störung genannt. Im Fachjargon spricht man von der „multifaktoriellen Ätiopathogenese„, d.h. von einer Krankheits-Entstehung durch viele Ursachen.

Bei der Ursache, Auslösung und Unterhaltung bipolarer (und anderer affektiver) Störungen handelt es sich um ein komplexes Wechselspiel verschiedener Faktoren:

  • genetische
  • biologische und
  • psychosoziale Faktoren

Studienergebnisse führen zu der Annahme, dass unipolare Erkrankungen, also die reine Manie oder die reine Depression, sich bedeutsam von bipolaren Erkrankungen unterscheiden. Bipolare Störungen scheinen eine grössere genetische Disposition aufzuweisen und verlaufen weniger beeinflussbar durch äussere Faktoren.

Für das Wechselspiel zwischen Genetik und Umweltfaktoren, die dann zur Manifestation der Krankheit führen, werden verschiedene Modelle diskutiert:

  • unspezifisch veränderte Gene + spezifische Umweltfaktoren führen zur Krankheitsmanifestation
  • spezifische bipolare Gene + unspezifische Umweltfaktoren führen zur Manifestation einer bestimmten bipolaren Krankheit (z. B. Bipolar-I oder Zyklothymie)
  • es herrscht ein polygenetisches Kontinuum: erst eine gewisse Anzahl disponierender Polygene ermöglicht das Überschreiten der Schwelle zur Krankheitsmanifestation, je mehr Polygene vorhanden sind, umso schwerer die Störung
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