Die Depression gilt als eine der größten Volkskrankheiten, an der in Deutschland etwa acht Millionen Menschen einmal oder mehrmals in ihrem Leben erkranken. Kognitive Störungen sind ein wesentliches Merkmal depressiver Erkrankungen, die nicht nur das alltägliche Leben der Betroffenen beeinträchtigen, sondern auch zu erheblichen Einschränkungen der Arbeitsfähigkeit führen können. Darüber hinaus ist die Reversibilität kognitiver Beeinträchtigungen trotz Besserung der depressiven Symptomatik oft unvollständig.
Simone Reppermund untersucht das kognitive Leistungsniveau depressiver Patienten mit dem Ziel einer detaillierten Charakterisierung kognitiver Beeinträchtigungen und deren Bedeutung für den weiteren Verlauf der Erkrankung. In einem längsschnittlichen Design werden kurz nach der stationären Aufnahme in die psychiatrische Klinik, kurz vor der Entlassung aus der stationären Therapie sowie sechs Monate nach der Entlassung umfangreiche neuropsychologische Untersuchungen durchgeführt, welche die Bereiche Gedächtnis, Aufmerksamkeit und exekutive Funktionen beinhalten. Die Ergebnisse verdeutlichen umfassende kognitive Beeinträchtigungen, die unabhängig von der Remission der Depression weiterbestehen können und heben die Relevanz kognitiver Rehabilitationsmaßnahmen hervor.
Die Autorin: Jahrgang 1977; Studium der Psychologie mit Schwerpunkt Neuropsychologie an der Ruhr-Universität in Bochum. 2007 Promotion an der Ludwig-Maximilians-Universität in München. Simone Reppermund lebt in München und arbeitet als wissenschaftliche Mitarbeiterin in der Arbeitsgruppe ›Molekulare Psychologie‹ am Max-Planck-Institut für Psychiatrie.

Vorwort

Ich möchte mich sehr herzlich bei allen bedanken, die zum Entstehen und Gelingen dieser Arbeit beigetragen haben.
Ganz herzlich danke ich meinem Betreuer, Prof. Dr. Josef Zihl für die Unterstützung, die hilfreichen Gespräche und Anregungen und für die absolute Zuverlässigkeit.
Besonderer Dank gilt Dr. Marcus Ising, der mich von Beginn an mit großem Engagement und scheinbar unerschöpfbarem Wissen unterstützt hat und mir mit viel Geduld und Zeit wertvolle Einblicke in die Welt der Statistik gab.
Die vorliegende Arbeit entstand während meiner Tätigkeit am Max-Planck Institut für Psychiatrie in München. Vielen Dank an den Direktor des Instituts Prof. Dr. Dr. Florian Holsboer für die Möglichkeit zur Durchführung dieser Dissertation.
Herzlichen Dank auch an die Kolleginnen und Kollegen der Arbeitsgruppe "Genetik der Depression" und an Anna Wendl für die gute Zusammenarbeit und für die Hilfe bei der Datenerhebung und -eingabe.
Weiterhin möchte ich mich bei allen Kolleginnen der Arbeitsgruppe "Molekulare Psychologie" für die tolle Arbeitsatmosphäre sowie für die menschliche und fachliche Unterstützung bedanken. Anna-Maria Pröbstl sei darüber hinaus auch für das Korrekturlesen gedankt.
Mit dieser Arbeit sollte ein kleiner Beitrag zur weiteren Erforschung der Depression geleistet werden. Ich danke allen Patientinnen und Patienten, die an dieser Studie teilgenommen haben.

München, im April 2007
Simone Reppermund

Inhaltsverzeichnis

Vorwort
Inhaltsverzeichnis
Abbildungsverzeichnis
Tabellenverzeichnis
Abkürzungsverzeichnis
1 Einleitung
2 Theoretischer Hintergrund und Stand der Forschung
2.1 Definition und Diagnose depressiver Erkrankungen
2.2 Der Verlauf der Depression
2.3 Die Ätiologie der Depression
2.3.1 Neurotransmittertheorien
2.3.2 Genetische Einflüsse auf die Entstehung der Depression
2.3.3 Psychologische Theorien
2.3.4 Neurobiologische und neuroanatomische Auffälligkeiten der Depression
2.3.4.1 Die Stresshormonachse
2.3.4.2 Erkenntnisse aus Bildgebungsstudien
2.4 Veränderungen kognitiver Funktionen bei der Depression
2.4.1 Aufmerksamkeit
2.4.1.1 Aufmerksamkeit bei der Depression
2.4.2 Lernen und Gedächtnis
2.4.2.1 Das Arbeitsgedächtnis
2.4.2.2 Gedächtnisdefizite bei der Depression
2.4.3 Exekutive Funktionen
2.4.3.1 Exekutive Funktionen bei der Depression
2.4.3.2 Exkurs: Die zentralnervöse Basis exekutiver Funktionen
2.5 Kognitive Veränderungen im Verlauf der Depression
2.6 Zusammenfassung
2.7 Fragestellungen und Hypothesen
2.7.1 Herleitung der Fragestellungen
2.7.2 Hypothesen
3 Methodik
3.1 Untersuchungsdesign
3.2 Testverfahren zur Erfassung kognitiver Funktionen
3.2.1 Gedächtnis
3.2.1.1 Zahlenspanne vorwärts
3.2.1.2 Blockspanne vorwärts
3.2.1.3 Logisches Gedächtnis
3.2.2 Aufmerksamkeit
3.2.2.1 Aufmerksamkeits-Belastungs-Test (Test d2)
3.2.2.2 Zahlen-Verbindungs-Test
3.2.2.3 Alertness
3.2.2.4 Geteilte Aufmerksamkeit
3.2.3 Exekutive Funktionen
3.2.3.1 Arbeitsgedächtnis
3.2.3.1.1 CANTAB: Spatial Working Memory (SWM)
3.2.3.1.2 CANTAB: Delayed Matching to Sample (DMS)
3.2.3.1.3 Zahlenspanne rückwärts
3.2.3.1.4 Blockspanne rückwärts
3.2.3.2 Kognitive Flexibilität
3.2.3.2.1 CANTAB: Intradimensional / Extradimensional Attentional Set Shifting (ID/ED)
3.2.3.2.2 Regensburger Wortflüssigkeits-Test (RWT)
3.2.3.3 Visuelles Problemlösen
3.2.3.3.1 Standard Progressive Matrices (SPM)
3.3 Verfahren zur Erfassung der Psychopathologie
3.3.1 Beck Depression Inventory (BDI)
3.3.2 Hamilton-Depression-Rating-Scale (HDRS)
3.3.3 Strukturiertes Klinisches Interview für DSM-IV (SKID)
3.3.4 Münchener-Composite International Diagnostic Interview (M-CIDI)
3.4 Statistische Analyse
4 Ergebnisse
4.1 Beschreibung der Stichproben
4.1.1 Diagnosen und Psychopathologie
4.2 Kognitive Leistungen und Psychopathologie bei Aufnahme und Entlassung
4.2.1 Gedächtnis
4.2.2 Aufmerksamkeit
4.2.3 Exekutive Funktionen
4.2.3.1 Arbeitsgedächtnis
4.2.3.2 Kognitive Flexibilität
4.2.3.3 Visuelles Problemlösen
4.2.4 Übungseffekte
4.2.5 Kognitive Leistungen und Remission
4.3 Kognitive Leistungen und Psychopathologie bei der Nachuntersuchung
4.3.1 Gedächtnis
4.3.2 Aufmerksamkeit
4.3.3 Exekutive Funktionen
4.3.3.1 Arbeitsgedächtnis
4.3.3.2 Kognitive Flexibilität
4.3.4 Kognitive Leistungen und Rückfall
5 Diskussion
6 Zusammenfassung
Anhang

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