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Kardiale und metabolische Risikofaktoren bei schweren psychischen Erkrankungen

Aufgaben eines Präventionsmanagers

Cardiac and metabolic risk factors in severe mental disorders

Task of a prevention manager

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Zusammenfassung

Menschen mit schweren psychischen Erkrankungen haben eine um 13 bis 30 Jahre kürzere Lebenserwartung als die Allgemeinbevölkerung. Die Ursache hierfür liegt in erster Linie in einer erhöhten Prävalenz kardialer und metabolischer Erkrankungen, allen voran koronare Herzkrankheit (KHK) und Typ-2-Diabetes. Diese lassen sich wiederum auf ein Muster gesundheitsrelevanten Verhaltens zurückführen, das von Rauchen, Bewegungsarmut und ungünstiger Ernährung geprägt ist. Mit diesem Verhalten ebenfalls häufig assoziierte Erkrankungen wie Adipositas, arterielle Hypertonie und Fettstoffwechselstörungen tragen weiter zu der Risikoerhöhung bei. Menschen mit schweren psychischen Erkrankungen zählen somit zu einer kardiometabolischen Hochrisikogruppe. Entsprechende präventive oder therapeutische Maßnahmen sind dringend indiziert, werden jedoch zu selten angewandt. Die vorliegende Arbeit stellt ein Konzept vor, wie dieses Defizit ausgeglichen werden kann. Eine zentrale Rolle spielt hierbei die Funktion eines Präventionsmanagers, bei dem die Koordinierung und Umsetzung dieser Maßnahmen liegt. Untersuchungen aus dem Bereich der Kardiologie und Diabetologie belegen den Nutzen dieser Bündelung. Durch diese Maßnahmen könnte die erhöhte Mortalität von Menschen mit schweren psychischen Erkrankungen reduziert werden.

Summary

People with severe mental disorders have a reduction in life expectancy of 13–30 % compared with the general population. This severe disadvantage is primarily due to an increased prevalence of cardiac and metabolic disorders, especially coronary heart disease (CHD) and type 2 diabetes mellitus and are the result of untoward health behavior characterized by smoking, low levels of physical activity and unhealthy dietary habits. Obesity, arterial hypertension and lipid disorders are also associated with this behavior and further increase the risk of CHD and type 2 diabetes. Thus, people with mental disorders constitute a population with a high risk of cardiovascular events. Appropriate measures for prevention and therapy are urgently indicated but rarely applied. This article presents new organizational structures to overcome this deficit with a prevention manager playing a central role in organizing and applying preventive and therapeutic care. Results from cardiology and diabetic medicine have shown the effectiveness of pooling this responsibility. The measure has the potential to reduce the increased mortality of people with severe mental disorders.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. F. Lederbogen, S. Häfner, U. Schweiger, M. Bohus und M. Deuschle geben an, dass kein Interessenkonflikt besteht. P. Schwarz gibt an, dass die Präventionsmanager-Ausbildung im Rahmen des IMAGE-Projektes (Development and Implementation of a European Guideline and Training Standards for Diabetes Prevention) durch die Europäische Union gefördert wurde. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Universität Heidelberg, Medizinische Fakultät Mannheim, J5, 68159, Mannheim, Deutschland

    F. Lederbogen & M. Deuschle

  2. Universitätsklinikum, Medizinische Klinik III, Abteilung Prävention und Versorgung des Typ 2 Diabetes, Medizinische Fakultät Carl Gustav Carus der TU Dresden, Dresden, Deutschland

    P. Schwarz

  3. Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen, Deutschland

    S. Häfner

  4. Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Lübeck, Deutschland

    U. Schweiger

  5. Zentralinstitut für Seelische Gesundheit, Klinik für Psychosomatik und Psychotherapeutische Medizin, Universität Heidelberg, Medizinische Fakultät Mannheim, Mannheim, Deutschland

    M. Bohus

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  1. F. Lederbogen
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  2. P. Schwarz
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  3. S. Häfner
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  4. U. Schweiger
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  5. M. Bohus
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  6. M. Deuschle
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Correspondence to F. Lederbogen.

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Lederbogen, F., Schwarz, P., Häfner, S. et al. Kardiale und metabolische Risikofaktoren bei schweren psychischen Erkrankungen. Nervenarzt 86, 866–871 (2015). https://doi.org/10.1007/s00115-014-4232-2

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