Bei der Therapie der Zwangserkrankung zum Einsatz kommen sinnvollerweise Kombinationen von einem serotonergen Antidepressivum (SSRI) (z.B. Clomipramin, Fluvoxamin, Fluoxetin, Sertralin, Paroxetin) mit Psychotherapie. Nur der Einsatz von Antidepressiva oder Psychotherapie hat weit weniger Erfolg als die Kombination von Beidem. Bei der Psychotherapie scheint sich ein deutlicher therapeutischer Vorsprung der Verhaltenstherapie und der kognitiven Therapie gegenüberpsychodynamisch orientierter Therapie abzuzeichnen. Psychodynamische Aspekte treten jedoch gerade bei der Zwangserkrankung infolge von z.T. heftigen Übertragunen und Gegenübertragunen auf, wodurch sie zu einem entscheidenden Therapiehindernis führen können, wenn sie nicht erkannt und angegangen werden. Es ist also unbedingt von Nutzen, auch bei der Behandlung von Zwangskranken über psychodynamische Kenntnisse und Erfahrungen zu verfügen, wenngleich deren Stellenwert gegenüber den verhaltenstherapeutischen und kognitiven Therapieelementen vorwiegend im diagnostischen und differentialdiagnostischen interaktiven Bereich zu sehen ist.

Wichtig bei der Psychopharmako-Therapie der Zwangserkrankung ist eine ausreichend hohe Dosierung und eine ausreichend lange Behandlungsdauer. Veränderungen sind hier, anders als bei Depressionen und Angststörungen, meist erst nach 12 Wochen aufwärts festzustellen .Die Patienten sind also auf eine geduldige Erwartungshaltung einzustimmen.Zusätzliche andere psychische Störungen aus anderen Störungskategorien werden symptomatisch mitbehandelt. So gibt man bei zusätzlichen ausgeprägteren Ängsten zusätzlich Buspiron, bei zusätzlichen Tics oder psychotischen Symptomen (Wahn, Halluzinationen) oder Vorliegen einer schizotypen Persönlichkeitsstörung zusätzlich Haloperidol oder Pimozid.Bei der Verhaltenstherapie kommen die Methoden der Exposition mit inneren Zwängen bei gleichzeitiger Unterbindung der zwanghaften Reaktionen zum Einsatz. Süllwold und Herrlich (2001)betonen:

„Das aussschliessliche Unterbinden der Ausführung von Zwängen (…) genügt nicht. Um die Selbstkontrolle über das eigene Verhalten wiederzugewinnen, muss die Wahrnehmung der relevanten Reize eingeübt werden, die üblicherweise das Ingangsetzen einer Handlung oder deren Abschluss bewirken. …Das automatisierte Verhalten soll wieder durch Einsicht und rationale Kriterien steuerbar und der Situation angemessen werden.“ (S. 72f)

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