Die Interaktion von Posttraumatischer Belastungsstörung und Organischem Psychosyndrom im Langzeitverlauf nach spontaner Subarachnoidalblutung

Spontaneous subarachnoid hemorrhages (SAH) occur without any specific warning symptoms. Because of the sudden danger to life the survivors of a SAH suffer from neurological and neuropsychological impairments as well as from posttraumatic stress disorders (PTSD). In this study the incidence of cognitive and affective disorders and of PTSD is explored on an average of four years after a SAH in a sample of 29 patients without neurological deficits. Psychiatric and psychological examinations recorded the premorbid intelligence, the current level of intelligence, mnestic function, and attention. Symptoms of depression, PTSD, somatic complaints, quality of life and level of psychosocial function were determined by questionnaires. Results: Four years after the SAH 41,1 % of the patients have no neuropsychological deficits, 27,6 % suffer from mild, and 31,0 % from severe cognitive impairments. Symptoms of depression (41,4 %) and anxiety of new hemorrhage (53,6 %) are frequent. Compared to a sample of patients examined 7 months after SAH (Mangold & Wallenfang, 2000), the neuropsychological functions improved, but depression, somatisation, and quality of life did not. One prominent factor is probably the persistence of a PTSD. Based on questionnaire data (Posttraumatic Diagnostic Scale ; Foa et al, 1996) 37,9 % of the patients developed a PTSD according to the DSM-IV-criteria. The patients suffer from an organic brain lesion and a psychic trauma. The DSM-IV-criteria for PTSD and for cerebro-organic lesions are corresponding in 7 of 17 symptoms (amnesia, apathy, affective instability, sleep disturbances, impulsivness, attention deficits and social and occupational impairment). So there is a high risk of false-positive PTSD-diagnosis in patients with brain lesions. When the organic features of the disorder (amnesia, attention deficits) are excluded, the frequency of PTSD-diagnosis is reduced to 27,6 %. Further research is necessary to differ PTSD-symptoms from symptoms of cerebro-organic lesions, also after stroke and cranio-cerebral trauma. An early identification of PTSD and affective disorders may prevent chronicity. After SAH for many patients the interventions have to change from neurosurgery to psychotherapy.