Früherkennung von Psychosen bei Kindern und Adoleszenten
Sind entwicklungsbezogene Besonderheiten ausreichend berücksichtigt?
Abstract
Die Früherkennung und Frühbehandlung von Personen mit erhöhtem Psychoserisiko gilt derzeit als vielversprechende Strategie, die weitreichenden negativen Konsequenzen psychotischer Störungen zu reduzieren. Die beiden derzeitigen Risikokriteriensätze, die «ultra-high risk» und die Basissymptom-Kriterien, wurden vorwiegend an Erwachsenenstichproben entwickelt. Erste Studien sprechen dafür, dass diese Kriterien nur eingeschränkt auf Kinder und Jugendliche übertragbar sein könnten. Für die «ultra-high risk»-Kriterien gibt es Hinweise, dass einige attenuierte psychotische Symptome im Jugendalter möglicherweise nicht ausreichend spezifisch und, wenn beobachtbare Verhaltenskorrelate fehlen, kurze intermittierende psychotische Symptome im Kindesalter schwer klassifizierbar sind. Auch für die Basissymptom-Kriterien liegen nur sehr vorläufige Hinweise auf ihre Eignung bei Kindern und Adoleszenten vor. Da entwicklungsbezogene Besonderheiten auch bei der Erhebung von Basissymptomen berücksichtigt werden sollten, wurde eine Kinder- und Jugendversion des Schizophrenia Proneness Instrument (SPI-CY) entwickelt, die in der vorgelegten Arbeit vorgestellt wird. Somit sind gezielte Studien zur Validierung und ggf. Adaptation der Risikokriterien für Kinder und Jugendliche dringend erforderlich, insbesondere wenn ein «Prodromal Risk Syndrome for Psychosis» oder «Attenuated Psychotic Symptoms Syndrome» in das DSM-5 aufgenommen wird. In diesem Fall müsste betont werden, dass die klinisch-prognostische Validität dieses Risikosyndroms für Kinder und Jugendliche noch unzureichend geklärt ist.
The early detection and treatment of persons at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. The two current favored at-risk approaches, i.e., the «ultra high risk» and the «basic symptom» criteria, were developed mainly using adult samples. Initial evidence suggests, however, that they cannot simply be applied to children and adolescents. For «ultra-high risk» criteria, there is indication of some attenuated psychotic symptoms being potentially nonspecific in adolescents, and of brief limited intermittent symptoms being difficult to clinically classify in children when observable behavioral correlates are missing. For basic symptoms, too, only a preliminary indication of their usefulness in children and adolescents exists. Since developmental peculiarities in the assessment of basic symptoms should be considered, a child and youth version of the Schizophrenia Proneness Instrument (SPI-CY) was developed. In conclusion, research on the clinical-prognostic validity of the at-risk criteria and their potential adaption to the special needs of children and adolescents is needed. If a «Prodromal Risk Syndrome for Psychosis» or «Attenuated Psychotic Symptoms Syndrome» are included in the upcoming DSM-5, it should be highlighted that its suitability for children and adolescents is only insufficiently known.
Literatur
(2003). Early and late neurodevelopmental influences in the prodrome to schizophrenia: Contributions of genes, environment, and their interactions. Schizophrenia Bulletin, 29, 653–669.
(2009). Anticipating DSM-V: Should psychosis risk become a diagnostic class? Schizophrenia Bulletin, 35, 841–843.
(2007). Can antidepressants be used to treat the schizophrenia prodrome? Results of a prospective, naturalistic treatment study of adolescents. Journal of Clinical Psychiatry, 68, 546–557.
(2010). Research in people with psychosis risk syndrome: A review of the current evidence and future directions. Journal of Child Psychology and Psychiatry, 51, 390–431.
(2008). Childhood and current autistic features in adolescents with schizotypal personality disorder. Schizophrenia Research, 104, 265–273.
(1987). Bonner Skala für die Beurteilung von Basissymptomen (BSABS). Berlin: Springer.
(1995). When and how does Schizophrenia produce social deficits? European Archives of Psychiatry and Clinical Neuroscience, 246, 17–28.
(2005). Phenomenology and diagnostic stability of youths with atypical psychotic symptoms. Journal of Child and Adolescent Psychopharmacology, 15, 497–509.
(1986). Psychiatrische Aspekte des Basisstörungskonzepts. In , Schizophrene Basisstörungen (S. 39–143). Berlin: Springer.
(2010). Rethinking schizophrenia. Nature, 468, 187–193.
(2003). Prolonged untreated illness duration from prodromal onset predicts outcome in first episode psychosis. Schizophrenia Bulletin, 29, 757–769.
(2001). Diagnosing schizophrenia in the initial prodromal phase. Archives of General Psychiatry, 58, 158–164.
(2005). The European Prediction of Psychosis Study (EPOS): Integrating early recognition and intervention in Europe. World Psychiatry, 4, 161–167.
(2001). Zur Bedeutung von Depersonalisation und Derealisation im Jugendalter. Persönlichkeitsstörungen: Theorie und Praxis, 5, 31–38.
(2010). On the importance and detection of prodromal symptoms from the perspective of child and adolescent psychiatry. Clinical Neuropsychiatry, 7, 38–48.
(2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients. Archives of General Psychiatry, 62, 975–983.
(1997). Validität der Erfassung schizophrener Basissymptome. Nervenarzt, 68, 205–211.
(2001). Structured interview for prodromal syndromes, Version 3.0. PRIME Research Clinic, Yale School of Medicine, New Haven, CT, USA.
(2010). The psychosis-risk syndrome. Handbook for diagnosis and follow-up. New York: Oxford University Press.
(2003). The Prime North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. I. Study rationale and design. Schizophrenia Research, 61, 7–18.
(2009). Basic symptoms in the general population and in psychotic and non-psychotic adolescents. Schizophrenia Research, 111, 32–38.
(2005). The psychosis prodrome in adolescent patients viewed through the lens of DSM-IV. Journal of Child and Adolescent Psychopharmacology, 15, 434–451.
(2010). From maps to mechanisms through neuroimaging of schizophrenia. Nature, 468, 194–202.
(2002). Randomised controlled trial of early detection and cognitive therapy for preventing transition to psychosis in high-risk individuals. British Journal of Psychiatry, 43(Suppl.), s78–s84.
(2008). Entwicklungspsychologie (6. Aufl.). Weinheim: Beltz Psychologie Verlags Union.
(2000). Identification of young people at risk of psychosis: Validation of the Personal Assessment and Crisis Evaluation Clinic intake criteria. Australian and New Zealand Journal of Psychiatry, 34(Suppl.), 164–169.
(2000). Children’s self-reported psychotic symptoms and adult schizophreniform disorder: A 15-year longitudinal study. Archives of General Psychiatry, 57, 1053–1058.
(2007). Basic symptoms, temperament and character in adolescent psychiatric disorders. Psychopathology, 40, 321–328.
(2008). Früherkennung und Frühbehandlung der Schizophrenie – Chance oder Dilemma? Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 36, 235–244.
(2002). Early detection of psychotic disorders in adolescents: Specificity of basic symptoms in psychiatric patient samples. Psychopathology, 35, 259–266.
(1998). On the existence of early warning signs of schizophrenic syndromes among children and adolescents. Neurology, Psychiatry and Brain Research, 6, 45–50.
(2004). Zur Frühdiagnose schizophrener Erkrankungen im Kindes- und Jugendalter. In , Schizophrene Erkrankungen im Kindes- und Jugendalter- Klinik, Ätiologie, Therapie und Rehabilitation (S. 3–15). Stuttgart: Schattauer.
(2002). Specificity of basic symptoms in early onset schizophrenia. In , Risk and protective factors in schizophrenia. Towards a conceptual model of the disease process (pp. 177–184). Darmstadt: Steinkopff.
(2010). Prediction of psychosis in adolescents and young adults – results from a prospective European multicenter study (EPOS). Archives of General Psychiatry, 67, 241–251.
(2007). Pre-treatment, baseline, and outcome differences between early-onset and adult-onset psychosis in an epidemiological cohort of 636 first-episode patients. Schizophrenia Research, 95, 1–8.
(2008). Impact of duration of untreated psychosis on pre-treatment, baseline, and outcome characteristics in an epidemiological first-episode psychosis cohort. Journal of Psychiatric Research, 42, 982–990.
(2009). Subjective symptoms of schizophrenia in research and the clinic: The basic symptom concept. Schizophrenia Bulletin, 35, 5–8.
(2007). Schizophrenia Proneness Instrument, Adult version (SPI-A). Roma: Giovanni Fioriti Editore s.r.l..
(2007). Predicting first-episode psychosis by basic symptom criteria. Clinical Neuropsychiatry, 4, 11–22.
(2010). Schizophrenia Proneness Instrument, Child & Youth version (SPI-CY). Roma: Giovanni Fioriti Editore s.r.l. (deutsche Ausgabe bestellbar unter www.fioriti.it/english.php.)
(2008). Früherkennung und Frühbehandlung von Psychosen. Bremen: UNI-MED.
(2010). Basic symptoms and ultrahigh risk criteria: Symptom development in the initial prodromal state. Schizophrenia Bulletin, 36, 182–191.
(2010). The dimensional structure of prodromal symptoms in early-onset psychosis: Indication of special needs in the early detection of younger adolescents. Schizophrenia Research, 117, 321.
(2008). The dimensional structure of self-reported «prodromal» disturbances in schizophrenia. Clinical Neuropsychiatry, 5, 140–150.
(1991). Manual zum Frankfurter Beschwerde-Fragebogen (FBF). Berlin: Springer.
(2010). The environment and schizophrenia. Nature, 468, 203–212.
(2008). Neurocognition and conversion to psychosis in adolescents at high risk. Schizophrenia Research, 101, 161–168.
(2004). Risk factors for psychosis in an ultra high-risk group: Psychopathology and clinical features. Schizophrenia Research, 67, 131–142.
(2006). Testing the ultra high risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people. Schizophrenia Research, 84, 57–66.
(2005). Mapping the onset of psychosis: The comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry, 39, 964–971.
(2011). Transition and remission in adolescents at ultra-high risk for psychosis. Schizophrenia Research, 126, 58–64.
