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Nervenheilkunde 2019; 38(08): 565-569
DOI: 10.1055/a-0961-2589
Schwerpunkt
© Georg Thieme Verlag KG Stuttgart · New York

Angsterkrankungen und Therapieresistenz

Klinische Empfehlungen und PerspektivenAnxiety disorders and therapy resistance
Peter Zwanzger
1   Fachbereich Psychosomatik und Allgemeinpsychiatrie, kbo-Inn-Salzach-Klinikum, Therapieschwerpunkt Angst und Depression, Wasserburg am Inn
2   Klinik für Psychiatrie und Psychotherapie der Ludwig-Maximilians-Universität, München
,
Julia Diemer∗
1   Fachbereich Psychosomatik und Allgemeinpsychiatrie, kbo-Inn-Salzach-Klinikum, Therapieschwerpunkt Angst und Depression, Wasserburg am Inn
3   Fachbereich Psychologie, Ludwig-Maximilians-Universität, München
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Publication History

Publication Date:
01 August 2019 (online)

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ZUSAMMENFASSUNG

Epidemiologischen Studien zufolge gehören Angsterkrankungen zu den häufigsten seelischen Störungen. Dabei stellen insbesondere diejenigen Verläufe die größte Herausforderung dar, die anamnestisch bereits zahlreiche erfolglose Behandlungsversuche aufweisen. Die in Anlehnung an die Depressionsbehandlung als therapieresistente Angsterkrankungen bezeichnete Gruppe von Störungen ist im Hinblick auf therapeutische Ansätze weit weniger untersucht als die therapieresistente Depression. Im Rahmen der Übersicht werden Studien zur Behandlung therapieresistenter Angsterkrankungen referiert. Der Fokus liegt dabei auf der Panikstörung, der generalisierten Angststörung sowie der sozialen Phobie. Die Behandlungsansätze umfassen pharmakologische Ansätze mit atypischen Antipsychotika und Antikonvulsiva, Kombinationstherapien, den psychotherapeutischen Ansatz der Acceptance and Commitment Therapy (ACT) sowie den experimentell pharmakologischen Einsatz von D-Cycloserin (DCS). Auf die Problematik von Pseudotherapieresistenz und die Notwendigkeit einer sorgfältigen Diagnostik und Differenzialdiagnostik wird ebenso eingegangen.

ABSTRACT

According to epidemiological studies, anxiety disorders are among the most frequent psychiatric disorders. In particular, nonresponse and treatment resistance represent a relevant challenge in daily clinical practice. However, prevalence and clinical management of treatment resistant anxiety disorders are far less investigated in comparison to treatment resistant major depression.

Within the scope of this overview, studies on the treatment of therapy-resistant anxiety disorders are presented. The focus is on panic disorder, generalized anxiety disorder and social phobia. Potential treatment approaches include pharmacological approaches with atypical antipsychotics and anticonvulsants, combination therapies, the psychotherapeutic approach of acceptance and commitment therapy (ACT) and the experimental pharmacological use of D-cycloserine (DCS). The problem of pseudo-treatment-resistance, and the necessity of careful diagnostics and differential diagnostics are also discussed.

Schlüsselwörter

Angststörungen - Therapieresistenz - Pharmakotherapie - Psychotherapie

Key Words

Anxiety disorders - therapy resistance - pharmacotherapy - psychotherapy
 

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