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Fortschr Neurol Psychiatr 2009; 77(12): 720-737
DOI: 10.1055/s-0028-1109456
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© Georg Thieme Verlag KG Stuttgart · New York

Körperliche Erkrankungen bei psychiatrischen Patienten – Teil I[*]

Epidemiologie, häufige ErkrankungenMedical Disorders in Psychiatric Patients – Part IEpidemiology, Common DiseasesW. Hewer1 , H. S. Füeßl2
  • 1Vinzenz-von-Paul-Hospital, Rottweil
  • 2Isar-Amper Klinikum Haar
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Publication History

Publication Date:
16 June 2009 (online)

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Vermittlung des aktuellen Kenntnisstands zur Häufigkeit und klinischen Bedeutung wichtiger körperlicher Begleiterkrankungen bei allgemeinpsychiatrischen Patienten. Der Beitrag befasst sich schwerpunktmäßig mit gesundheitlichen Beeinträchtigungen von Patienten mit schweren psychischen Erkrankungen („severe mental illness”– SMI). Anhand einer Übersicht zu aktuellen Mortalitätsstudien soll deutlich werden, dass Menschen mit SMI einer signifikanten Verkürzung ihrer Lebenserwartung unterliegen. Die Übersterblichkeit wird neben einer erhöhten Wahrscheinlichkeit unnatürlicher Todesfälle in einem mindestens genauso starken Umfang durch eine Häufung natürlicher Todesursachen determiniert. Ausgewählte diagnostische und therapeutische Aspekte häufiger körperlicher Begleiterkrankungen bei psychiatrischen Patienten werden besprochen. Diese betreffen Herz-Kreislauf-, Atemwegs- und Lungen- sowie metabolische Erkrankungen. Spezifische Risikokonstellationen im Kontext der psychiatrischen Behandlung – z. B. in Verbindung mit der Anwendung von Psychopharmaka – stehen dabei im Fokus.

4 Herrn Dr. med. Hans Werner Schied in dankbarer Verbundenheit gewidmet.

Literatur

  • 1 Arolt V, Rothermundt M. Depressive Störungen bei körperlich Kranken.  Nervenarzt. 2003;  74 1033-1052
    Search in Google Scholar
  • 2 Felker B, Yazel J J, Short D. Mortality and medical comorbidity among psychiatric patients: a review.  Psychiatr Serv. 1996;  47 1356-1363
    Search in Google Scholar
  • 3 Hewer W. Psychische Störungen und internistische Erkrankungen. Helmchen H et al Psychiatrie der Gegenwart. 4. Aufl., Band 4: Psychische Störungen bei somatischen Erkrankungen. Berlin Heidelberg New York; Springer 1999: 289-317
    Search in Google Scholar
  • 4 Fleischhacker W W, Cetkovich-Bakmas M, De Hert M. et al . Comorbid somatic illnesses in patients with severe mental disorders: clinical, policy, and research challenges.  J Clin Psychiatry. 2008;  69 514-519
    Search in Google Scholar
  • 5 Iacovides A, Siamouli M. Comorbid mental and somatic disorders: an epidemiological perspective.  Curr Opin Psychiatry. 2008;  21 417-421
    Search in Google Scholar
  • 6 Dalmau A, Bergman B, Brismar B. Somatic morbidity in schizophrenia – a case control study.  Public Health. 1997;  111 393-397
    Search in Google Scholar
  • 7 Mäkikyrö T, Karvonen J T, Hakko H. et al . Comorbidity of hospital-treated psychiatric and physical disorders with special reference to schizophrenia: a 28 year follow-up of the 1966 northern Finland general population birth cohort.  Public Health. 1998;  112 221-228
    Search in Google Scholar
  • 8 Goldman L S. Medical illness in patients with schizophrenia.  J Clin Psychiatry. 1999;  60 (Suppl 21) 10-15
    Search in Google Scholar
  • 9 Carney C P, Jones L, Woolson R F. Medical comorbidity in women and men with schizophrenia: a population-based controlled study.  J Gen Intern Med. 2006;  21 1133-1137
    Search in Google Scholar
  • 10 Leucht S, Burkard T, Henderson J. et al . Physical illness and schizophrenia: a review of the literature.  Acta Psychiatr Scand. 2007;  116 317-333
    Search in Google Scholar
  • 11 Carney C P, Jones L E. Medical comorbidity in women and men with bipolar disorders: a population-based controlled study.  Psychosom Med. 2006;  68 684-691
    Search in Google Scholar
  • 12 McIntyre R S, Soczynska J K, Beyer J L. et al . Medical comorbidity in bipolar disorder: re-prioritizing unmet needs.  Curr Opin Psychiatry. 2007;  20 406-416
    Search in Google Scholar
  • 13 Glassman A. Depression and cardiovascular disease.  Pharmacopsychiatry. 2008;  41 221-225
    Search in Google Scholar
  • 14 Batki S L, Meszaros Z S, Strutynski K. et al . Medical comorbidity in patients with schizophrenia and alcohol dependence.  Schizophr Res. 2008;  DOI: 10.1016 /j.schres.2008.10.016
    Search in Google Scholar
  • 15 Frankenburg F R, Zanarini M C. Personality disorders and medical comorbidity.  Curr Opin Psychiatry. 2006;  19 428-431
    Search in Google Scholar
  • 16 Jeste D V, Gladsjo J A, Lindamer L A. et al . Medical comorbidity in schizophrenia.  Schiz Bull. 1996;  22 413-430
    Search in Google Scholar
  • 17 Koran L M, Sox H C, Marton K I. et al . Medical evaluation of psychiatric patients.  Arch Gen Psychiat. 1989;  46 733-740
    Search in Google Scholar
  • 18 Koranyi E K. Morbidity and rate of undiagnosed physical illnesses in a psychiatric clinic population.  Arch Gen Psychiat. 1979;  36 414-419
    Search in Google Scholar
  • 19 Reeves R R, Pendarvis E J, Kimble R. Unrecognized medical emergencies admitted to psychiatric units.  Am J Emerg Med. 2000;  18 390-393
    Search in Google Scholar
  • 20 Harris C E, Barraclough B. Excess mortality of mental disorder.  Brit J Psychiat. 1998;  173 11-53
    Search in Google Scholar
  • 21 Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia. Is the differential mortality gap worsening over time?.  Arch Gen Psychiatry. 2007;  64 1123-1131
    Search in Google Scholar
  • 22 Ösby U, Brandt L, Correia N. et al . Excess mortality in bipolar and unipolar disorder in Sweden.  Arch Gen Psychiat. 2001;  58 844-850
    Search in Google Scholar
  • 23 Bartels S J. Caring for the whole person: integrated health care for older adults with severe mental illness and medical comorbidity.  J Am Geriatr Soc. 2004;  52 S249-S257
    Search in Google Scholar
  • 24 Hennekens C H, Hennekens A R, Hollar D. et al . Schizophrenia and increased risks of cardiovascular disease.  Am Heart J. 2005;  150 1115-1121
    Search in Google Scholar
  • 25 Lambert T J, Velakoulis D, Pantelis C. Medical comorbidity in schizophrenia.  Med J Austr. 2003;  178 S67-S70
    Search in Google Scholar
  • 26 Allebeck P. Schizophrenia: a life-shortening disease.  Schizophr Bull. 1989;  15 81-89
    Search in Google Scholar
  • 27 Casey D E, Hansen T E. Excessive mortality and morbidity associated with schizophrenia. Meyer JM, Nasrallah HA Medical illness in schizophrenia Washington DC & London; American Psychiatric Publishing 2003: 13-34
    Search in Google Scholar
  • 28 Lawrence D, Holman C D, Jablensky A V. et al . Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980 – 1998.  Brit J Psychiat. 2003;  182 31-36
    Search in Google Scholar
  • 29 Rasanen S, Hakko H, Viilo K. et al . Excess mortality among long-stay psychiatric patients in Northern Finland.  Soc Psychiatry Psychiatr Epidemiol. 2003;  38 297-304
    Search in Google Scholar
  • 30 Osborn D PJ, Levy G, Nazareth I. et al . Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom’s general practice research database.  Arch Gen Psychiatry. 2007;  64 242-249
    Search in Google Scholar
  • 31 Ösby U, Correia N, Brandt L. et al . Mortality and causes of death in schizophrenia in Stockholm county, Sweden.  Schizophr Res. 2000;  45 21-28
    Search in Google Scholar
  • 32 Antretter E, Dunkel D, Haring C. Cause-specific excess mortality in suicidal patients: gender differences in mortality patterns.  Gen Hosp Psychiatry. 2009;  31 67-74
    Search in Google Scholar
  • 33 Carter G, Reith D M, Whyte I M. et al . Non-suicidal deaths following hospital-treated self-poisoning.  Aust NZ J Psychiatry. 2005;  39 101-107
    Search in Google Scholar
  • 34 Hamer M, Stamatakis E, Steptoe A. Psychiatric hospital admissions, behavioral risk factors, and all-cause mortality: the Scottish health survey.  Arch Intern Med. 2008;  168 2474-2479
    Search in Google Scholar
  • 35 Hewer W, Rössler W, Jung E. et al . Somatische Erkrankungen bei stationär behandelten psychiatrischen Patienten.  Psychiat Prax. 1991;  18 133-138
    Search in Google Scholar
  • 36 Wolff H P, Weihrauch T R. Internistische Therapie 2008 / 2009. München; Elsevier 2008 17. Aufl
    Search in Google Scholar
  • 37 Curkendall S M, Mo J, Glasser D B. et al . Cardiovascular disease in patients with schizophrenia in Saskatchewan, Canada.  J Clin Psychiatry. 2004;  65 715-720
    Search in Google Scholar
  • 38 Mitchell A J, Malone D. Physical health and schizophrenia.  Curr Opin Psychiatry. 2006;  19 432-437
    Search in Google Scholar
  • 39 Ruschena D, Mullen P E, Burgess P. et al . Sudden death in psychiatric patients.  Br J Psychiatry. 1998;  172 331-336
    Search in Google Scholar
  • 40 Schneeweiss S, Avorn J. Antipsychotic agents and sudden cardiac death – how should we manage the risk?.  N Engl J Med. 2009;  360 294-296
    Search in Google Scholar
  • 41 Ray W A, Chung C P, Murray K T. et al . Atypical antipsychotic drugs and the risk of sudden cardiac death.  N Engl J Med. 2009;  360 225-235
    Search in Google Scholar
  • 42 Haverkamp W, Deuschle M. Antipsychotikainduzierte QT-Verlängerung.  Nervenarzt. 2006;  77 276-288
    Search in Google Scholar
  • 43 Reilly J G, Ayis S A, Ferrier I N. QTc-interval abnormalities and psychotropic drug therapy in psychiatric patients.  Lancet. 2000;  355 1048-1052
    Search in Google Scholar
  • 44 Benkert O, Hippius H. Kompendium der Psychiatrischen Pharmakotherapie. Heidelberg–Berlin; Springer 2009 7. Aufl
    Search in Google Scholar
  • 45 Agelink M W, Kornischka J, Cordes J. et al . Allgemeinmedizinische Aspekte der Therapie mit Antipsychotika der zweiten Generation.  Dtsch Ärztebl. 2006;  103 2802-2808
    Search in Google Scholar
  • 46 Hewer W, Grohmann R. Akut- und Notfallsituationen durch unerwünschte Arzneimittelwirkungen (UAW). Hewer W, Rössler W Akute psychische Erkrankungen München; Elsevier 2007 2. Aufl: 467-499
    Search in Google Scholar
  • 47 Blaschke D, Parwani A S, Huerner M. et al . Torsade de pointes during combined treatment with risperidone and citalopram.  Pharmacopsychiatry. 2007;  40 294-295
    Search in Google Scholar
  • 48 Deutsche Hochdruckliga – Deutsche Hypertonie Gesellschaft .Leitlinien zur Behandlung der arteriellen Hypertonie. 2008 http://leitlinien.net/
    Search in Google Scholar
  • 49 Goff D C, Sullivan L M, McEvoy J P. et al . A comparison of ten-year cardiac risk estimates in schizophrenia patients from the CATIE study and matched controls.  Schizophrenia Research. 2005;  80 45-53
    Search in Google Scholar
  • 50 Hägg S, Spigset O. Antipsychotic-induced venous thromboembolism: a review of the evidence.  CNS Drugs. 2002;  16 765-776
    Search in Google Scholar
  • 51 Maly R, Masopust J, Hosak L. et al . Assessment of the risk of venous thrombembolism and its possible prevention in psychiatric patients.  Psychiatry Clin Neurosci. 2008;  62 3-8
    Search in Google Scholar
  • 52 Lacut K, Le Gal G, Couturaud F. et al . Association between antipsychotic drugs, antidepressant drugs and venous thrombembolism: results from the EDITH case-control study.  Fundam Clin Pharmacol. 2007;  21 643-650
    Search in Google Scholar
  • 53 Hach-Wunderle V. Diagnostik und Therapie der venösen Thrombose.  Hämostaseologie. 2008;  28 376-386
    Search in Google Scholar
  • 54 Konstantinides S. Venöse Thrombembolie.  Dtsch Med Wschr. 2006;  131 1389-1400
    Search in Google Scholar
  • 55 Goff D C, Heckers S, Freudenreich O. Schizophrenia.  Med Clin North Am. 2001;  85 663-689
    Search in Google Scholar
  • 56 Programm für Nationale Versorgungs-Leitlinien. Nationale VersorgungsLeitlinie COPD Kurzfassung. 2006 http://leitlinien.net/
    Search in Google Scholar
  • 57 AWMF-Leitlinie Nr.082 / 001. Epidemiologie, Diagnostik, antimikrobielle Therapie und Management von erwachsenen Patienten mit ambulant erworbenen tiefen Atemwegsinfektionen (akute Bronchitis, akute Exazerbation einer chronischen Bronchitis, Influenza und andere respiratorische Virusinfektionen) sowie ambulant erworbener Pneumonie. 2005 http://leitlinien.net/
    Search in Google Scholar
  • 58 Fioritti A, Giacotto L, Melega V. Choking incidents among psychiatric patients: retrospective analysis of thirty-one cases from the West Bologna psychiatric wards.  Can J Psychiatry. 1997;  42 515-520
    Search in Google Scholar
  • 59 Schmitt M F, Hewer W. Lebensbedrohliche Situationen durch Bolusaspiration bei stationär behandelten psychisch Kranken – Klinik, Risikofaktoren, Prophylaxe, Therapie.  Fortschr Neurol Psychiat. 1993;  61 313-318
    Search in Google Scholar
  • 60 Mortensen P B, Juel K. Mortality and causes of death in schizophrenic patients in Denmark.  Acta Psychiatr Scand. 1990;  81 372-377
    Search in Google Scholar
  • 61 Ruschena D, Mullen P E, Palmer S. et al . Choking death: the role of antipsychotic drugs.  Br J Psychiatry. 2003;  183 446-450
    Search in Google Scholar
  • 62 Winkelman J W. Schizophrenia, obesity, and obstructive sleep apnea.  J Clin Psychiatry. 2001;  62 8-11
    Search in Google Scholar
  • 63 Catts V S, Catts S V, O`Toole B I. et al . Cancer incidence in patients with schizophrenia and their first-degree relatives – a meta-analysis.  Acta Psychiatr Scand. 2008;  117 323-336
    Search in Google Scholar
  • 64 Lawrence D, Holman C D, Jablensky A V. et al . Excess cancer mortality in Western Australian psychiatric patients due to higher case fatality rates.  Acta Psychiatr Scand. 2000;  101 382-388
    Search in Google Scholar
  • 65 Marder S R, Essock S M, Miller A L. et al . Physical health monitoring of patients with schizophrenia.  Am J Psychiatry. 2004;  161 1334-1349
    Search in Google Scholar
  • 66 Hauner H, Buchholz G, Hamann A. et al .Evidenzbasierte Leitlinie. Prävention und Therapie der Adipositas. 2007 http://leitlinien.net/
    Search in Google Scholar
  • 67 Executive summary of the Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III).  JAMA. 2001;  285 2486-2497
    Search in Google Scholar
  • 68 Alberti K G, Zimmet P, Shaw J. et al . The metabolic syndrome – a new worldwide definition.  Lancet. 2005;  366 1059-1062
    Search in Google Scholar
  • 69 Hummer M, Kemmler G, Kurz M. et al . Weight gain induced by clozapine.  Eur Neuropsychopharmacol. 1995;  5 437-440
    Search in Google Scholar
  • 70 American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity . Consensus development conference on antipsychotic drugs and obesity and diabetes.  Diabetes Care. 2004;  27 596-601
    Search in Google Scholar
  • 71 Kopf D. Diabetes mellitus bei psychiatrischen Erkrankungen. Schatz H Diabetologie kompakt Stuttgart; Georg-Thieme-Verlag 2006 4. Aufl: 320-325
    Search in Google Scholar
  • 72 Smith M, Hopkins D, Peveler R C. et al . First- v. Second-generation antipsychotics and risk for diabetes in schizophrenia: systematic review and metaanalysis.  Br J Psychiatry. 2008;  192 406-411
    Search in Google Scholar
  • 73 Holt R IG, Peveler R C, Byrne C D. Schizophenia, the metabolic syndrome and diabetes.  Diabet Med. 2004;  21 515-523
    Search in Google Scholar
  • 74 Kerner W, Brückel J. Definition, Klassifikation und Diagnostik des Diabetes mellitus.  Diabetologie. 2008;  3 Suppl 2 S131-S133
    Search in Google Scholar
  • 75 Von Hayek D, Hüttl V, Reiss J. et al . Hyperglykämie und Ketoazidose unter Olanzapin.  Nervenarzt. 1999;  70 836-837
    Search in Google Scholar
  • 76 Hummer M, Malik P, Gasser R W. et al . Osteoporosis in patients with schizophrenia.  Am J Psychiatry. 2005;  162 162-167
    Search in Google Scholar
  • 77 Siegel A J. Hyponatremia in psychiatric patients: update on evaluation and management.  Harv Rev Psychiatry. 2008;  16 13-24
    Search in Google Scholar
  • 78 Scholze A, Tepel M. Hyponatriämie.  Med Klin. 2009;  104 137-149
    Search in Google Scholar
  • 79 Brookes G, Ahmed AG. Pharmacologic treatments for psychosis-related polydipsia.  Cochrane Database Syst Rev. 2006;  CD003544
    Search in Google Scholar
  • 80 Dundas B, Harris M, Narasimhan M. Psychogenic polydipsia review: etiology, differential, and treatment.  Curr Psychiatry Rep. 2007;  9 236-241
    Search in Google Scholar
  • 81 Hewer W. Körperliche Erkrankungen bei psychiatrischen Patienten. Arolt V, Diefenbacher A Psychiatrie in der klinischen Medizin Darmstadt; Steinkopff 2004: 241-258
    Search in Google Scholar
  • 82 Grohmann R, Müller-Oerlinghausen B, Rüther E. et al . 25 years of drug surveillance in psychiatry.  Pharmacopsychiatry. 2004;  37 Suppl 1
    Search in Google Scholar
  • 83 Brown S. Excess mortality of schizophrenia: a meta-analysis.  Brit J Psychiat. 1997;  171 502-508
    Search in Google Scholar
  • 84 Weeke A, Juel K, Vaeth M. Cardiovascular death and manic-depressive psychosis.  J Affect Disord. 1987;  13 287-292
    Search in Google Scholar
  • 85 Ahrens B, Grof P, Möller H J. et al . Extended survival of patients on long-term lithium treatment.  Can J Psychiatry. 1995;  40 241-246
    Search in Google Scholar
  • 86 Tiihonen J, Wahlbeck K, Lönnqvist J. et al . Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study.  BMJ. 2006;  333 224-227
    Search in Google Scholar
  • 87 Eckermann G. Interaktionstabellen Psychopharmaka. Stuttgart; Schattauer 2006
    Search in Google Scholar

4 Herrn Dr. med. Hans Werner Schied in dankbarer Verbundenheit gewidmet.

Priv.-Doz. Dr. med. Walter Hewer

Vinzenz-von-Paul-Hospital

Schwenninger Str. 55

78628 Rottweil

Email: w.hewer@VvPH.de