Hypochondrie - Krankheitsangst: Eine Erhebung in sächsischen Hausarztpraxen
Year: 2016
Type: dissertation
Study design: Observational Study
Abstract: This paper reviews the prevalence, characteristics, comorbidity, and care of hypochondriac patients in primary care samples in Saxony. Patients with health anxieties don’t get much attention in terms of care and supply due to a lack of knowledge regarding treatment strategies of this health disorder, but also because it is perceived as innocuous in itself by family doctors. On the other hand these patients create high personal and communicative expenditures for the caregiver and high expenses for the healthcare system due to diagnosis and treatment seeking of those patients. The study was performed predominantly in the cities of Saxony at patients consulting their family doctors for any purpose on a randomly chosen testing day and revealed a rate of 10.5% hypochondriac patients. The demographic patient characterization matches the available literature, considering the two determining factors “screened population” and “diagnostic instrument”. There was no gender predominance noticeable; marital status did also not have any impact on the development of hypochondria. A higher age was the strongest associated demographic risk marker for developing health anxiety. A higher educational level is associated with lower levels of hypochondriasis with more impact than the current job situation. The high number of retired patients in the study limits the statistical power of job-associated variables. The most important and prominent comorbidity was depression, followed by panic disorders, matching also with available literature. The overall somatic morbidity of the patients was low. One positive finding of our study was a high stability of the physician-patient relationship over many years. Hypochondriac patients consult their doctors more often, get longer lasting visits, and require more specialist consultations than other patients. The majority of physicians diagnose the psychological disorders of a hypochondriac patient and recommend psychotherapy. Patient´s self-perception differs slightly from the physicians´ evaluation; they may understand the need of a therapy but don´t bring up enough motivation for realizing it. That’s where the dilemma for family doctors starts because they have no problems of diagnosing health anxieties but are not provided with professional tools for a time- and resource effective management of hypochondriac patients. The enormous time pressure in daily clinical practice provokes ignoring of hypochondriac patients and just an attempt of a reserved transfer practice to specialists, which the patients usually handle by transferring themselves. Considering the availability of more efficient screening tools and therapy strategies, practical aid for professional contact with hypochondria patients by family doctors would be desirable and needed. Those should on the one hand help evaluate patients at risk for depression, and also introduce them to therapy, and on the other hand help general practitioners with communication strategies for hypochondria patients to make them understand the need of therapy. Hypochondriasis in education- or advanced training curriculum for general practitioners is explained way too short. Especially requirements concerning the family doctors’ professional communication skills to deal with hypochondria patients are enormous and could eventually be improved by either specialized psychotherapists or through further training programs. This could save costs for multiple diagnostic screenings of patients on the long-term. The study illustrates the interest of family doctors for health anxiety disorders and the topic’s practical relevance. The appropriate medical societies are asked to create training programmes for family doctors and to improve the interface between family doctors and psychotherapists regarding the treatment of hypochondriasis. This work does not cover the impact of digital media on the prevalence of health anxieties. The internet provides a huge amount of unfiltered medical information and leaves patients alone processing with that knowledge. Physicians are challenged by the patients to put the information in a correct perspective to the patients’ individual medical situation. Scientific data about the impact of digital media on the prevalence and course of health anxiety are missing. Research on this topic seems being complex due to the heterogeneity of the interacting internal and external factors. It can be assumed, that the influence of the plentiful medical “superficial knowledge” available from the internet will increasingly influence physicians´ and hypochondriac patients´ interaction. The need of a scientific evaluation of this subject, including the development of professional communication strategies for family doctors with hypochondriac patients has been addressed to the responsible psychological research facilities. Family doctors emphasized the particular need of an improved interface between primary care and specialized psychological treatment for hypochondriac patients. Quickly retrievable communication tools for strategical contact with those patients are demanded. May this study contribute to an increased awareness and an installation of research programmes dealing with this disorder.:1 Einleitung 9 2 Theoretischer Hintergrund 11 2.1 Definition hypochondrischer Ängste und Somatisierungsstörungen 11 2.1.1 ICD-10 Klassifizierung 11 2.1.2 DSM-5 Klassifizierung 19 2.1.3 Das Spektrum der Krankheitsangst 20 2.2 Epidemiologie hypochondrischer Ängste 21 2.3 Demografische Variablen 22 2.4 Komorbidität hypochondrischer Ängste 23 2.5 Inanspruchnahme des Gesundheitswesens 24 2.6 Diagnostische Verfahren 26 2.6.1 Diagnostische Interviews 26 2.6.2 Diagnostische Tests 27 2.7 Differenzialdiagnose 29 2.8 Therapieansätze und deren Problematik 31 2.8.1 Gesprächsführung 31 2.8.2 Psychotherapie 31 2.8.3 Pharmakotherapie 32 3 Fragestellungen 33 4 Methoden 34 4.1 Literaturrecherche 34 4.2 Studiendesign 34 4.3 Konstrukte und deren Operationalisierung 35 4.3.1 Patientenfragebögen 35 4.3.1.1 Soziodemographische und medizinische Variablen 36 4.3.1.2 Depressive Syndrome und Paniksyndrom - PHQ-D 36 4.3.1.3 Hypochondrische Ängste - Whiteley Index 38 4.3.2 Arztfragebögen 38 4.3.2.1 Demografische Arztangaben 39 4.3.2.2 Patientenspezifische Hausarztkennzahlen 40 4.3.2.3 Arzteinschätzung der psychischen Befindlichkeit 40 4.4 Datenerhebung 40 4.5 Dateneingabe 40 4.6 Statistische Auswertung 40 4.6.1 Statistische Methoden 40 5 Ergebnisse 42 5.1 Beschreibung der Stichprobe der Ärzte 42 5.2 Beschreibung der Stichprobe der Patienten 43 5.2.1 Demografische Patientencharakteristika 43 5.2.2 Patientenspezifische Hausarztkennzahlen 44 5.2.3 Komorbiditäten / Überweisungsfrequenz 45 5.2.4 Komorbide psychische Störungen 48 5.2.5 Arzteinschätzung der psychischen Befindlichkeit 49 5.2.6 Patienten - Selbsteinschätzung bezüglich Psychotherapie 51 5.3 Häufigkeit hypochondrischer Ängste 52 5.4 Zusammenhänge mit soziodemographischen Variablen 53 5.5 Zusammenhänge mit komorbiden psychischen Syndromen 60 5.6 Zusammenhänge mit hausärztlichen Kennwerten 62 5.6.1 Korrelation hausärztlicher Kontakte mit Hypochondrieverdacht im Whiteley-Index (WI) 62 5.6.2 Überweisungsfrequenz in Abhängigkeit vom WI .63 5.7 Korrelation Selbst- und Fremdeinschätzung bzgl. Psychotherapie 64 5.8 Zusammenhänge zwischen Hypochondrieneigung im WI und Selbst- bzw. Fremdeinschätzung bzgl. Psychotherapiemotivation und -inanspruchnahme 66 6 Diskussion 67 6.1 Diskussion der Methoden: Methodenkritik 67 6.1.1 Repräsentativität der Studienpopulation 67 6.1.2 Erhebungsinstrumente 68 6.2 Diskussion der Ergebnisse 70 6.2.1 Häufigkeit hypochondrischer Ängste in der Hausarztpraxis 70 6.2.2 Zusammenhänge mit soziodemografischen Variablen 71 6.2.3 Zusammenhänge mit komorbiden psychischen Syndromen 73 6.2.4 Zusammenhänge mit hausärztlichen Kennwerten 74 6.2.5 Übereinstimmung von Arzt- und Patientenselbsteinschätzung 75 7 Zusammenfassung der zentralen Ergebnisse und Schlussfolgerung 77 8 Summary 80 9 Literaturverzeichnis 82 10 Anhang 90 10.1 Erhebungsbögen Patienten 90 10.1.1 Soziodemografische Variablen 90 10.1.2 Gesundheitsfragebogen (Patient Health Questionnaire Deutschland PHQ-D) 91 10.1.3 Whiteley – Index (WI) für Hypochondrie 92 10.2 Erhebungsbögen Ärzte 93 10.2.1 Demografische Arztangaben 93 10.2.2 Patientenspezifische Hausarztkennzahlen 94 10.2.3 Arzteinschätzung der psychischen Befindlichkeit 95 10.3 Ausfüllanleitung 96 10.4 Aufklärungsbogen Patienten 96 10.5 Einverständniserklärung Patienten 97 10.6 Tabellen und Zahlen 98
Author: Schmidt-Göhrich, Uta Katharina
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7038459353