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Differenzialdiagnose dissoziativer Anfälle

Differential diagnosis of dissociative seizures

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Zusammenfassung

Anamnese und Semiologie geben oft wegweisende Hinweise auf das Vorliegen dissoziativer Anfälle. Offenheit und Wachsamkeit des behandelnden Arztes, an dissoziative Anfälle frühzeitig zu denken, sind essenziell. Eine Video-Elektroenzephalographie-basierte Analyse der Ereignisse ist in der Regel entscheidend zur korrekten Diagnosestellung, insbesondere bei komplexeren Fällen. Der Beziehungsgestaltung ist bereits im diagnostischen Prozess ein hoher Stellenwert zuzuordnen, um Patienten für eine psychotherapeutische Behandlung zu gewinnen. Psychische Komorbidität und weitere somatische Beschwerden müssen im Diagnoseprozess erfasst werden. Aktuelle Änderungen in den gängigen Diagnosemanualen, einschließlich der ICD-11, spiegeln das lebhafte Interesse und die kontroverse Diskussion um die lange bekannte Krankheitsentität wider.

Abstract

Patient history taking and semiology provide seminal clues to the diagnosis of dissociative seizures. Openness and alertness of the treating physician are essential. Video-electroencephalogram(EEG)-based analyses of the events are crucial to establish the correct diagnosis, particularly in complex cases. The patient-doctor relationship is of particular importance in order to successfully motivate the patient for psychotherapeutic treatment. Coexisting psychiatric morbidity as well as other functional somatic symptoms must be actively explored. Current changes in the established diagnostic manuals, including ICD-11, reflect the ongoing vivid interest and controversial discussions in the field of dissociative disorders.

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Authors and Affiliations

  1. Zentrum für Psychische Erkrankungen, Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hauptstraße 8, 79104, Freiburg, Deutschland

    A. Joos, K. Baumann, C. E. Scheidt, C. Lahmann & R. König

  2. Kliniken Schmieder, Psychotherapeutische Neurologie, Gailingen, Deutschland

    A. Joos

  3. Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland

    H.-J. Busch

  4. Epilepsiezentrum, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland

    A. Schulze-Bonhage

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  1. A. Joos
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  2. K. Baumann
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  3. C. E. Scheidt
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  4. C. Lahmann
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  5. R. König
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  7. A. Schulze-Bonhage
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Correspondence to A. Joos.

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Interessenkonflikt

A. Joos, K. Baumann, C. E. Scheidt, C. Lahmann, R. König, H.-J. Busch und A. Schulze-Bonhage geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Joos, A., Baumann, K., Scheidt, C.E. et al. Differenzialdiagnose dissoziativer Anfälle. Nervenarzt 88, 1147–1152 (2017). https://doi.org/10.1007/s00115-017-0401-4

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