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Originalia

Psychische Störungen und individuelle Lebensqualität bei der chronisch progredient-terminalen Erkrankung „Amyotrophe Lateralsklerose (ALS)”

Published Online:April 23, 2013https://doi.org/10.1026/1616-3443/a000186

Abstract

Theoretischer Hintergrund: Die Krankheitsbewältigung spielt eine wichtige Rolle für die psychische Gesundheit und das Wohlbefinden von Patienten mit amyotropher Lateralsklerose (ALS). Fragestellung: Die vorliegende Studie untersuchte Angst, Depression und individuelle Lebensqualität sowie assoziierte Faktoren bei ALS. Methode: Die Stichprobe umfasste 39 ALS-Patienten (20 Frauen, Durchschnittsalter 58 Jahre, Durchschnitts-Erkrankungsdauer 2.4 Jahre). Eingesetzt wurden die Sektionen A, D, F und teilweise J des SKID-I, das ALS-Depressionsinventar (ADI-12), der Schedule for the Evaluation of Individual Quality of Life–Direct Weigthening (SEIQoL-DW) und die Liste zur Erfassung von Verstärkern (LEV). Ergebnisse: Auftretenshäufigkeiten für eine Major Depression Episode: 10 %, für depressive Störungen insgesamt: 23 %, für Angststörungen: 21 %. Die Erstmanifestation einer Major Depression lag bei 4 von 9 Patienten vor der ALS-Diagnose. Nur die Hälfte der Patienten mit der Depressions-Lebenszeitdiagnose erlebte nach der ALS-Diagnose eine weitere Episode. Depressionen waren assoziiert mit weiblichem Geschlecht, einem geringeren Bildungsniveau, geringerer Lebensqualität und einer geringeren Anzahl positiv verstärkender Aktivitäten. Die individuelle Lebensqualität (iLQ) lag bei 72 von 100. Depressive Patienten zeigten dabei eine stärkere Orientierung auf die Gesundheit als nicht depressive Patienten. Schlussfolgerung: Trotz hoher individueller Lebensqualität traten Depressionen und Angststörungen gehäuft auf. Psychotherapeutische Unterstützung ist angezeigt, vor allem im Sinne einer Einstellungs- und Werteveränderung, beim Aufbau oder Erhalt von Verstärkern sowie als kognitive Therapie bei erlebtem Kontrollverlust.


Mental health and individual quality of life in patients with a chronic, progressive and fatal disease: amyotrophic lateral sclerosis (ALS)

Background. Patients with amyotrophic lateral sclerosis (ALS) are challenged to cope with a progressive and fatal disease and how to maintain mental health and individual quality of life. Objectives: The purpose of this study was to examine depression, anxiety, and individual quality of life as well as associated factors in ALS patients. Methods: A sample of 39 ALS patients (20 women, average age 58 years, average disease duration 2.4 years) completed the following questionnaires/interviews: SCID-I Section A, D, F, and partially J; ALS depression inventory (ADI-12); Schedule for the Evaluation of Individual Quality of Life–Direct Weighting (SEIQoL-DW); Schedule of Reinforcement (LEV). Results: Prevalence for a major depression episode was 10 %, prevalence of any depression disorder was 23 %, prevalence for anxiety disorders was 21 %. In 4 of 9 patients onset of the major depression episode was prior to ALS diagnosis. Only 50 % of patients with a major depression lifetime diagnosis experienced another major depression episode after being diagnosed with ALS. There was an association between more symptoms of depression and female gender, lower level of education, poorer quality of life, and lower number of reinforcing activities. With an average score of 72 (of 100) individual quality of life was high. Depressed ALS patients stated health as a more important factor for individual quality of life than did non-depressed patients. Conclusions: Despite high individual quality of life the prevalence of depression and anxiety disorders was increased. Psychological support or psychotherapy is required, most notably to change attitudes and intrinsic values, to extend or sustain reinforcing activities, and for cognitive restructuring when experiencing loss of control.

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