H.-P. Kapfhammer

Auswirkung von Stalking auf Psychiater, Psychotherapeuten und Psychologen

ZusammenfassungStalking im psychiatrischen Sprachgebrauch beschreibt pathologische Verhaltensweisen, die durch wiederholtes Verfolgen, Belästigen, Bedrohen oder Attackieren einer Person gekennzeichnet sind, wodurch sich diese in ihrer Sicherheit gefährdet fühlt. Durch die Assoziation von Stalking und psychischen Störungen gehören Psychiater, Psychotherapeuten und Psychologen zu den exponierten Berufsgruppen. Werden sie im Rahmen ihrer Berufsausübung zu Opfern, können psychische Beeinträchtigungen bis hin zur posttraumatischen Belastungsstörung die Folge sein. 117 Grazer Psychiater, Psychotherapeuten oder Psychologen nahmen an einer anonymen Befragung teil. Um mögliche Erfahrungen mit Stalking definierenden Verhaltensweisen zu erfassen, wurde eine modifizierte Version des Fragebogens nach Kamleiter verwendet. Zur Bestimmung von Prävalenz und Schweregrad posttraumatischer Belastungssymptome diente der Selbstbeurteilungsfragebogen nach Horowitz. Die Untersuchung ergab eine Häufigkeit von Stalking von 38,5%, wobei der Anteil weiblicher Stalker mit 60% sehr hoch war. Rein verbales bedrohendes und belästigendes Verhalten waren mit 68,9% am häufigsten. Die Frage nach der Diagnose des betreffenden Patienten nach ICD-10 zeigte eine hohe Repräsentanz der Schizophrenie, schizotypen und wahnhaften Störungen (F2) mit 41,9% sowie der Persönlichkeits- und Verhaltensstörungen (F6) mit 30,2%. 44,4% der Opfer entwickelten – vorwiegend leicht ausgeprägt – posttraumatische Belastungssymptome. Somit stellt Stalking innerhalb des psychiatrischen Tätigkeitsfelds ein häufiges und ernst zu nehmendes Phänomen dar, und es müssen Strategien zu Prävention und zum Schutz potenziell betroffener Berufsgruppen entwickelt werden.SummaryStalking in the psychiatric context describes a pathological behaviour which is characterized by repeated persecution, harassment, or menacing of or assault on a person. Because of the association between stalking and mental disorders, psychiatrists, psychologists and psychotherapists belong to particularly exposed professions. If they fall victim to stalking during their career, disruptive impacts up to posttraumatic stress disorder (PTSD) can be the consequence. A total of 117 psychiatrists, psychologists or psychotherapists in Graz participated in an anonymous interview. To register possible experiences with stalking defined behaviour, a modified version of the questionnaire of Kamleiter was used. The prevalence and severity of posttraumatic stress symptoms were determined using the Impact of Event Scale of Horowitz. The study showed an incidence of stalking of 38.5%. The rate of female stalkers (60%) was extraordinary high. Most victims (68.9%) experienced non-violent threats. Most of the offenders (41.9%) were diagnosed as suffering from schizophrenia, schizotype and delusional disorders (F2) followed by disorders of adult personality and behaviour (F6) (30.2%). Some 44.4% of the victims developed symptoms of PTSD, which were usually only slight. The analyses suggest that stalking, in the psychiatric field of activity, is a common and serious phenomenon, and that strategies for the prevention and protection of potentially affected professions have to be developed.

Psychopharmakotherapeutische Ansätze bei somatoformen Störungen und funktionellen Körpersyndromen

Somatoform disorders and functional body syndromes define a major, diagnostically heterogeneous group of patients with medically unexplained physical symptoms. Psychopharmacological approaches can be derived from the conceptualization of somatoform symptoms and syndromes within a biopsychosocial model. The survey presented focuses on randomized, double-blind and placebo-controlled studies. Antidepressants show a statistically and clinically relevant impact on many somatoform symptoms. In special reference to pain symptoms serotonergic and noradrenergic antidepressants seem to mediate a more favorable effect than selective serotonin reuptake inhibitors. For some functional body syndromes, e.g. irritable bowel syndrome and fibromyalgia, a major analgesic effect of antidepressants can be underlined as well. The empirical data for fibromyalgia, however, seem to be more convincing than for irritable bowel syndrome. Pregabalin holds an empirically well established position in the treatment of fibromyalgia. As yet there is no convincing psychopharmacological strategy for chronic fatigue syndrome. Probably due to the inherent relationships to anxiety, obsessive-compulsive and depressive disorders, both hypochondria and body dysmorphic disorder can be positively treated by serotonergic antidepressants as well.ZusammenfassungSomatoforme Störungen und funktionelle Körpersyndrome definieren eine große, aber diagnostisch sehr heterogene Gruppe von Patienten mit medizinisch unerklärten Körpersymptomen. In einem biopsychosozialen Modell lassen sich auch pharmakotherapeutische Ansätze begründen. Eine Übersicht über vorrangig randomisierte, doppelblinde und placebokontrollierte Studien zeigt, dass Antidepressiva statistisch bedeutsame und klinisch relevante Wirkungen auf somatoforme Symptome erzielen. Im Hinblick auf Schmerzsymptome scheinen dual wirksame Antidepressiva einen günstigeren Effekt zu besitzen als selektive serotonerge Substanzen. Für eine Reihe funktioneller Körpersyndrome wie Colon irritabile und Fibromyalgie kann ebenfalls ein primärer antinozizeptiver Effekt der Antidepressiva nachgewiesen werden, der weitgehend unabhängig von antidepressiven und/oder anxiolytischen Wirkungen ist. Bei der Fibromyalgie ist auch Pregabalin eine gute Therapieoption. Bisherige Studien konnten noch keine überzeugenden Wirkbelege von Psychopharmaka beim chronischen Müdigkeitssyndrom aufzeigen. Hypochondrische und körperdysmorphe Störungen unterstreichen aufgrund einer inhärenten Nähe zu Angst-, Zwangs- und depressiven Störungen ebenfalls den Stellenwert serotonerger Antidepressiva.SummarySomatoform disorders and functional body syndromes define a major, diagnostically heterogeneous group of patients with medically unexplained physical symptoms. Psychopharmacological approaches can be derived from the conceptualization of somatoform symptoms and syndromes within a biopsychosocial model. The survey presented focuses on randomized, double-blind and placebo-controlled studies. Antidepressants show a statistically and clinically relevant impact on many somatoform symptoms. In special reference to pain symptoms serotonergic and noradrenergic antidepressants seem to mediate a more favorable effect than selective serotonin reuptake inhibitors. For some functional body syndromes, e.g. irritable bowel syndrome and fibromyalgia, a major analgesic effect of antidepressants can be underlined as well. The empirical data for fibromyalgia, however, seem to be more convincing than for irritable bowel syndrome. Pregabalin holds an empirically well established position in the treatment of fibromyalgia. As yet there is no convincing psychopharmacological strategy for chronic fatigue syndrome. Probably due to the inherent relationships to anxiety, obsessive-compulsive and depressive disorders, both hypochondria and body dysmorphic disorder can be positively treated by serotonergic antidepressants as well.

Trauma- und stressorbezogene Störungen

The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) includes a distinct diagnostic group of trauma and stressor-related disorders that has been set apart from anxiety disorders. From a perspective of adult psychiatry this new disorder category includes posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and adjustment disorders. The PTSD is based on narrower trauma criteria that focus on acute life-threatening situations, serious injury, or sexual violence by way of direct confrontation, witnessing or indirect confrontation. Indirect confrontation, however, is reserved only for violent or accidental events that occurred to close family members or friends. The former A2 criterion of an intense emotional reaction to trauma has been removed. A deliberately broad approach to clinical PTSD phenomenology has created an empirically driven new cluster of persistent negative alterations in cognition and mood due to experiencing traumatic events. The ASD has been reconceptualized as an intense stress syndrome with a clear need of acute treatment during the early course after traumatic exposure. Adjustment disorders continue to emphasize maladaptive emotional and behavioral responses to unspecific, non-traumatic stressors in an intensity that is beyond social or cultural norms. Neither complex PTSD nor prolonged grief disorders have received an independent diagnostic status within DSM-5. With respect to stress-related disorders major divergences between DSM-5 and the future International Classification of Diseases 11 (ICD-11) are to be expected.ZusammenfassungDas DSM (Diagnostic and Statistical Manual of Mental Disorders) -5 berücksichtigt eine von der Gruppe der Angststörungen separate trauma- und stressorbezogene Störungsgruppe. Für den Versorgungsbereich der Erwachsenenpsychiatrie werden einerseits die posttraumatische Belastungsstörung (PTSD) und die akute Belastungsstörung (ASD), andererseits die Anpassungsstörungen aufgeführt. Eine strengere Fassung des Traumakriteriums fokussiert auf akute Lebensbedrohung, schwerwiegende körperliche Verletzung und sexuelle Gewalt. Direkte Konfrontation, Zeugenschaft und indirekte Konfrontation werden unterschieden, letztere aber auf gewaltsame oder unfallbedingte Traumata von nahen Familienmitgliedern oder Freunden eingeengt. Personen, die durch ihren speziellen professionellen Ersteinsatz mit den Folgen extremer Traumata indirekt konfrontiert sind, werden in ihrem speziellen PTSD-Risiko anerkannt. Das im DSM-IV enthaltene A2-Traumakriterium wird aufgegeben. Eine breite klinische PTSD-Phänomenologie enthält ein neues Cluster anhaltender Veränderungen in negativen Kognitionen und Emotionen infolge der Traumatisierung. Die ASD zielt nicht mehr darauf, eine spezielle Risikogruppe für ein späteres PTSD-Risiko zu identifizieren, sondern ein intensives Stresssyndrom mit hoher akuter Behandlungsbedürftigkeit zu definieren. Anpassungsstörungen zeichnen sich weiterhin durch eine im Vergleich zur sozialen und kulturellen Norm maladaptive Auseinandersetzung mit unspezifischen, nichttraumatischen Stressoren aus. Sowohl komplexe PTSD als auch anhaltende Trauerstörung besitzen im DSM-5 keinen eigenständigen diagnostischen Status. DSM-5 und künftige ICD-11 werden in der Konzeptualisierung stressbezogener Störungen große Unterschiede aufweisen.SummaryThe Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) includes a distinct diagnostic group of trauma and stressor-related disorders that has been set apart from anxiety disorders. From a perspective of adult psychiatry this new disorder category includes posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and adjustment disorders. The PTSD is based on narrower trauma criteria that focus on acute life-threatening situations, serious injury, or sexual violence by way of direct confrontation, witnessing or indirect confrontation. Indirect confrontation, however, is reserved only for violent or accidental events that occurred to close family members or friends. The former A2 criterion of an intense emotional reaction to trauma has been removed. A deliberately broad approach to clinical PTSD phenomenology has created an empirically driven new cluster of persistent negative alterations in cognition and mood due to experiencing traumatic events. The ASD has been reconceptualized as an intense stress syndrome with a clear need of acute treatment during the early course after traumatic exposure. Adjustment disorders continue to emphasize maladaptive emotional and behavioral responses to unspecific, non-traumatic stressors in an intensity that is beyond social or cultural norms. Neither complex PTSD nor prolonged grief disorders have received an independent diagnostic status within DSM-5. With respect to stress-related disorders major divergences between DSM-5 and the future International Classification of Diseases 11 (ICD-11) are to be expected.

Depressive, Angst- und posttraumatische Belastungsstörungen als Konsequenzen intensivmedizinischer Behandlung

Modern intensive care medicine has led to increased survival rates even after severe life-threatening medical conditions. In self-critical and multidimensional outcome research, however, it must be considered that beyond survival rates treatment on intensive care units (ICU) can also be associated with high long-term rates of depressive, anxiety and posttraumatic stress disorders. Significant correlations with increased somatic morbidity and mortality, persisting cognitive impairments and significant deficits in health-related quality of life must also be taken into consideration. Empirical analysis of the risk factors reveals that a history of premorbid depression, sociodemographic and socioeconomic variables, age, female sex, personality traits, the underlying pathophysiological condition requiring ICU treatment, mode of sedation and analgesia, life support measures, such as mechanical ventilation, manifold traumatic experiences and memories during the stay in the ICU are all of particular pathogenetic importance. In order to reduce principally modifiable risk factors several strategies are illustrated, including well-reflected intensive care sedation and analgesia, special prophylactic medication regarding the major risk of traumatic memories and posttraumatic stress disorder (PTSD), psychological and psychotherapeutic interventions in states of increased acute stress symptoms and aids for personal memories and reorientation.ZusammenfassungDie moderne Intensivmedizin zeichnet sich durch gestiegene Überlebensraten selbst bei schwersten somatischen Krankheiten aus. In einer selbstkritischen und multidimensionalen Outcomeforschung sind aber zusätzliche stärker patientenorientierte Variablen mit zu berücksichtigen. Das Überleben einer intensivpflichtigen Krankheit ist im Langzeitverlauf mit hohen Raten von depressiven, Angst- und posttraumatischen Belastungsstörungen (PTSD) assoziiert. Bedeutsame Zusammenhänge mit einer erhöhten somatischen Morbidität und Mortalität, mit persistierenden kognitiven Defiziten sowie mit Einbußen in der gesundheitsbezogenen Lebensqualität sind hierbei zu beachten. In einer empirischen Analyse der Risikofaktoren kommt affektiven Vorerkrankungen, soziodemographischen und -ökonomischen Variablen, typischen pathophysiologischen Grundkonstellationen der intensivpflichtigen Erkrankung, dem Modus der Sedierung und Analgesie, lebensunterstützenden Maßnahmen wie z.u2009B. mechanische Respiration und mannigfaltigen traumatischen Erfahrungen und Erinnerungen eine besondere pathogenetische Bedeutung zu. Eine hierauf überlegt bezogene intensivmedizinische Therapie, spezielle prophylaktische psychopharmakologische Medikationen zur Reduktion des erhöhten PTSD-Risikos, klinisch-psychologische, psychotherapeutische und interpersonal reorientierende Interventionen zur Reduktion früh sich manifestierender akuter Belastungssymptome werden dargestellt.AbstractModern intensive care medicine has led to increased survival rates even after severe life-threatening medical conditions. In self-critical and multidimensional outcome research, however, it must be considered that beyond survival rates treatment on intensive care units (ICU) can also be associated with high long-term rates of depressive, anxiety and posttraumatic stress disorders. Significant correlations with increased somatic morbidity and mortality, persisting cognitive impairments and significant deficits in health-related quality of life must also be taken into consideration. Empirical analysis of the risk factors reveals that a history of premorbid depression, sociodemographic and socioeconomic variables, age, female sex, personality traits, the underlying pathophysiological condition requiring ICU treatment, mode of sedation and analgesia, life support measures, such as mechanical ventilation, manifold traumatic experiences and memories during the stay in the ICU are all of particular pathogenetic importance. In order to reduce principally modifiable risk factors several strategies are illustrated, including well-reflected intensive care sedation and analgesia, special prophylactic medication regarding the major risk of traumatic memories and posttraumatic stress disorder (PTSD), psychological and psychotherapeutic interventions in states of increased acute stress symptoms and aids for personal memories and reorientation.

Depressive und Angststörungen bei Krebserkrankungen

Patients with cancer face a high risk of comorbid depressive and anxiety disorders that have to be paradigmatically considered within a complex biopsychosocial context. Several conceptual challenges have to be mastered in arriving at a correct clinical diagnosis. Coexistent affective and anxiety disorders in cancer patients include a more dramatic subjective suffering, reduced psychological coping, possible negative interference with somatic treatment and rehabilitation, impaired quality of life and higher grades of psychosocial disability. They may also lead to an overall increased risk of somatic morbidity, a more rapid progression of cancer and a higher cancer-related mortality in the course of the disease. Manifold psychological, psychosocial and existential, cancer and treatment-related stressors have to be considered with respect to common neurobiological, especially neuroendocrine and neuroinflammatory mechanisms. Complex psychosomatic, somatopsychic and somato-somatic effects must always be considered. Evidence-based approaches in psychotherapy and pharmacotherapy exist for the integrative treatment of comorbid depressive and anxiety disorders in cancer.ZusammenfassungPatienten mit Krebserkrankungen weisen eine hohe Rate an komorbiden depressiven und Angststörungen auf, die paradigmatisch in einen komplexen biopsychosozialen Kontext gestellt werden müssen. Bei der Diagnosestellung sind einige konzeptuelle Herausforderungen zu meistern. Die psychischen Komorbiditäten bedeuten nicht nur ein höheres subjektives Leiden, ein reduziertes Coping, mögliche negative Interferenzen mit somatischen Therapien und Rehabilitationen, eine stärker beeinträchtigte Lebensqualität sowie höhere Grade an psychosozialer Behinderung. Sie schließen auch ein höheres somatisches Morbiditäts- und Mortalitätsrisiko im weiteren Verlauf ein. Die vielfältigen psychologischen, psychosozialen, morbogenen und therapiebezogenen Stressoren müssen aufeinander bezogen und auf gemeinsame neurobiologische, v.xa0a. neuroendokrine, neuroinflammatorische Vermittlungsmechanismen hin reflektiert werden. Hierbei sind stets mehrfache psychosomatische, somatopsychische und somatosomatische Effekte zu beachten. Es existieren evidenzbasierte psychotherapeutische und psychopharmakologische Ansätze für eine integrative Behandlung der komorbiden depressiven und Angststörungen.SummaryPatients with cancer face a high risk of comorbid depressive and anxiety disorders that have to be paradigmatically considered within a complex biopsychosocial context. Several conceptual challenges have to be mastered in arriving at a correct clinical diagnosis. Coexistent affective and anxiety disorders in cancer patients include a more dramatic subjective suffering, reduced psychological coping, possible negative interference with somatic treatment and rehabilitation, impaired quality of life and higher grades of psychosocial disability. They may also lead to an overall increased risk of somatic morbidity, a more rapid progression of cancer and a higher cancer-related mortality in the course of the disease. Manifold psychological, psychosocial and existential, cancer and treatment-related stressors have to be considered with respect to common neurobiological, especially neuroendocrine and neuroinflammatory mechanisms. Complex psychosomatic, somatopsychic and somato-somatic effects must always be considered. Evidence-based approaches in psychotherapy and pharmacotherapy exist for the integrative treatment of comorbid depressive and anxiety disorders in cancer.

[The effects of stalking on psychiatrists, psychotherapists and psychologists. Prevalence of stalking and its emotional impact].

ZusammenfassungStalking im psychiatrischen Sprachgebrauch beschreibt pathologische Verhaltensweisen, die durch wiederholtes Verfolgen, Belästigen, Bedrohen oder Attackieren einer Person gekennzeichnet sind, wodurch sich diese in ihrer Sicherheit gefährdet fühlt. Durch die Assoziation von Stalking und psychischen Störungen gehören Psychiater, Psychotherapeuten und Psychologen zu den exponierten Berufsgruppen. Werden sie im Rahmen ihrer Berufsausübung zu Opfern, können psychische Beeinträchtigungen bis hin zur posttraumatischen Belastungsstörung die Folge sein. 117 Grazer Psychiater, Psychotherapeuten oder Psychologen nahmen an einer anonymen Befragung teil. Um mögliche Erfahrungen mit Stalking definierenden Verhaltensweisen zu erfassen, wurde eine modifizierte Version des Fragebogens nach Kamleiter verwendet. Zur Bestimmung von Prävalenz und Schweregrad posttraumatischer Belastungssymptome diente der Selbstbeurteilungsfragebogen nach Horowitz. Die Untersuchung ergab eine Häufigkeit von Stalking von 38,5%, wobei der Anteil weiblicher Stalker mit 60% sehr hoch war. Rein verbales bedrohendes und belästigendes Verhalten waren mit 68,9% am häufigsten. Die Frage nach der Diagnose des betreffenden Patienten nach ICD-10 zeigte eine hohe Repräsentanz der Schizophrenie, schizotypen und wahnhaften Störungen (F2) mit 41,9% sowie der Persönlichkeits- und Verhaltensstörungen (F6) mit 30,2%. 44,4% der Opfer entwickelten – vorwiegend leicht ausgeprägt – posttraumatische Belastungssymptome. Somit stellt Stalking innerhalb des psychiatrischen Tätigkeitsfelds ein häufiges und ernst zu nehmendes Phänomen dar, und es müssen Strategien zu Prävention und zum Schutz potenziell betroffener Berufsgruppen entwickelt werden.SummaryStalking in the psychiatric context describes a pathological behaviour which is characterized by repeated persecution, harassment, or menacing of or assault on a person. Because of the association between stalking and mental disorders, psychiatrists, psychologists and psychotherapists belong to particularly exposed professions. If they fall victim to stalking during their career, disruptive impacts up to posttraumatic stress disorder (PTSD) can be the consequence. A total of 117 psychiatrists, psychologists or psychotherapists in Graz participated in an anonymous interview. To register possible experiences with stalking defined behaviour, a modified version of the questionnaire of Kamleiter was used. The prevalence and severity of posttraumatic stress symptoms were determined using the Impact of Event Scale of Horowitz. The study showed an incidence of stalking of 38.5%. The rate of female stalkers (60%) was extraordinary high. Most victims (68.9%) experienced non-violent threats. Most of the offenders (41.9%) were diagnosed as suffering from schizophrenia, schizotype and delusional disorders (F2) followed by disorders of adult personality and behaviour (F6) (30.2%). Some 44.4% of the victims developed symptoms of PTSD, which were usually only slight. The analyses suggest that stalking, in the psychiatric field of activity, is a common and serious phenomenon, and that strategies for the prevention and protection of potentially affected professions have to be developed.

The role of tryptophan metabolism and food craving in the relationship between obesity and bipolar disorder

BACKGROUND & AIMSnIndividuals with bipolar disorder (BD) have a significantly increased risk of obesity-related conditions. The imbalance between food intake and energy expenditure is assumed to be a major risk factor for obesity in BD. This study analyzed food craving in relation to anthropometric, metabolic, and neurobiological parameters in a well-characterized cohort of euthymic individuals with BD.nnnMETHODSnOne-hundred-thirty-five patients completed the Food-Craving Inventory assessing four categories of food craving (fat, fast-food, sweets and carbohydrate craving). Additionally, clinical, metabolic and anthropometric parameters were assessed.nnnRESULTSnHigher levels of fat craving were observed in males, versus females, with BD. High levels of carbohydrate craving positively correlated with kynurenine and the kynurenine-to-tryptophan ratio. Higher serum nitrite and neopterin levels were related to fat craving. Parameters of fat metabolism (triglycerides, high-density lipoprotein) were associated with fat and fast-food craving. Anthropometric measures of obesity (e.g. body mass index, waist-to-hip-ratio) were not related to food craving.nnnCONCLUSIONSnOverweight/obese individuals with BD show an increased driving of tryptophan down the kynurenine pathways, as indicated by an increase in the serum kynurenine-to-tryptophan ratio. The driving of tryptophan down the kynurenine pathway is mediated by immune-inflammatory activity and stress. The correlation of increased kynurenine with food craving, especially carbohydrate craving, probably indicates a regulatory deficit in the maintenance of chronic inflammatory processes in obesity and BD. Food craving seems to be of clinical importance in the treatment of metabolic disturbances in BD, although not associated with anthropometric measures of obesity. Rather, food craving correlates with blood metabolic parameters and an increased activation of the kynurenine pathway, both of which are linked to higher affective symptomatology and the development of cardiovascular diseases.

Tizanidin-Absetzsymptome bei Stress-Kardiomyopathie

INTRODUCTIONnAn acute discontinuation of tizanidine, an alpha-2-agonistic muscle relaxant, is associated with reflex tachycardia, hypertension, tremor, hypertonicity and anxiety.nnnCASE REPORTnWe describe a 53-year-old patient with broken-heart syndrome, who developed serious tizanidine withdrawal symptoms after high-dosed long-term treatment within the framework of stress cardiomyopathy.nnnCONCLUSIONnCentral muscle relaxants like tizanidine might have an impact on the development of delirium. Tizanidine withdrawal should be considered in patients who manifest signs and symptoms of withdrawal from medications. The drug should be gradually reduced in dosage under observation by a psychiatrist. When prescribing tizanidine, the possible pharmacological side effects and interactions should be taken into careful account.

Stress bei bipolar affektiver Störung

The results of mortality studies have indicated that medical conditions, such as cardiovascular disease, obesity and diabetes are the most important causes of mortality among patients with bipolar disorder. The reasons for the increased incidence and mortality are not fully understood. Oxidative stress and an inadequate antioxidative system might be one missing link and could also help to further elucidate the pathophysiological basis of bipolar disorder. This article provides a comprehensive review of oxidative stress in general and about the existing data for bipolar disorder. In addition information is given about possible therapeutic strategies to reduce oxidative stress and the use in bipolar disorder.ZusammenfassungMenschen mit bipolarer affektiver Störung leiden vermehrt an somatischen Komorbiditäten wie kardiovaskuläre Erkrankungen, Adipositas und Diabetes und einer mit diesen verbundenen erhöhten Mortalität. Die Ursachen hierfür sind bislang nicht vollständig geklärt, ferner sind die pathophysiologischen Grundlagen der Erkrankung selbst noch weitgehend unklar. In dieser Übersicht werden die allgemeinen Grundlagen des anti-/oxidativen Systems und die mögliche Bedeutung in der bipolaren Störung zusammengefasst. Zudem werden Therapiestrategien beschrieben, die eine Reduktion der freien Radikale im Körper bewirken und damit auch im Rahmen der Behandlung der bipolaren Störung hilfreich sein könnten.SummaryThe results of mortality studies have indicated that medical conditions, such as cardiovascular disease, obesity and diabetes are the most important causes of mortality among patients with bipolar disorder. The reasons for the increased incidence and mortality are not fully understood. Oxidative stress and an inadequate antioxidative system might be one missing link and could also help to further elucidate the pathophysiological basis of bipolar disorder. This article provides a comprehensive review of oxidative stress in general and about the existing data for bipolar disorder. In addition information is given about possible therapeutic strategies to reduce oxidative stress and the use in bipolar disorder.

Oxidative stress in bipolar affective disorder

The results of mortality studies have indicated that medical conditions, such as cardiovascular disease, obesity and diabetes are the most important causes of mortality among patients with bipolar disorder. The reasons for the increased incidence and mortality are not fully understood. Oxidative stress and an inadequate antioxidative system might be one missing link and could also help to further elucidate the pathophysiological basis of bipolar disorder. This article provides a comprehensive review of oxidative stress in general and about the existing data for bipolar disorder. In addition information is given about possible therapeutic strategies to reduce oxidative stress and the use in bipolar disorder.ZusammenfassungMenschen mit bipolarer affektiver Störung leiden vermehrt an somatischen Komorbiditäten wie kardiovaskuläre Erkrankungen, Adipositas und Diabetes und einer mit diesen verbundenen erhöhten Mortalität. Die Ursachen hierfür sind bislang nicht vollständig geklärt, ferner sind die pathophysiologischen Grundlagen der Erkrankung selbst noch weitgehend unklar. In dieser Übersicht werden die allgemeinen Grundlagen des anti-/oxidativen Systems und die mögliche Bedeutung in der bipolaren Störung zusammengefasst. Zudem werden Therapiestrategien beschrieben, die eine Reduktion der freien Radikale im Körper bewirken und damit auch im Rahmen der Behandlung der bipolaren Störung hilfreich sein könnten.SummaryThe results of mortality studies have indicated that medical conditions, such as cardiovascular disease, obesity and diabetes are the most important causes of mortality among patients with bipolar disorder. The reasons for the increased incidence and mortality are not fully understood. Oxidative stress and an inadequate antioxidative system might be one missing link and could also help to further elucidate the pathophysiological basis of bipolar disorder. This article provides a comprehensive review of oxidative stress in general and about the existing data for bipolar disorder. In addition information is given about possible therapeutic strategies to reduce oxidative stress and the use in bipolar disorder.