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Themenschwerpunkt

Evidenzbasierte Interventionen in der frühen Entwicklungsphase schizophrener Störungen

Published Online:April 04, 2017https://doi.org/10.1024/1661-4747/a000310

Abstract

Zusammenfassung. Gerade in der frühen ersten Erkrankungsphase entscheidet sich oft die Langzeitprognose schizophrener Störungen, d.h. wie vollständig Symptome und die Neuroplastizität einschränkende Rückfälle aus dem Leben der Betroffenen rausgehalten werden können und wie die soziale und berufliche Integration erfolgt, entscheidet sich hier. Daher kommt wirksamen Interventionen gerade in dieser sog. „critical period“ eine entscheidende Bedeutung zu. Der Artikel referiert hierzu Grenzen und Möglichkeiten aktueller Ansätze, die auf dem „Menuplan“ in dieser Krankheitsphase stehen sollten und was bei Ersterkrankungen im Unterschied zu wiederholt erkrankten Menschen zu beachten ist. Die Behandlungsmöglichkeiten haben sich gerade hier in den letzten Jahren weiterentwickelt: Es geht um die frühe Optimierung der antipsychotischen Therapie mit Wirkungsmaximierung und Nebenwirkungsminimierung, den Einsatz von langwirksamen Antipsychotika von Anfang an zur Minimierung von akzidentieller Malcompliance und konsekutiver Verhinderung von Rückfällen. Weiterhin besteht die Notwendigkeit, störungs- und problemspezifische Verhaltenstherapie zu ergänzen, um eine personalisierte, individualisierte Medizin zu realisieren, die durch eine entwicklungspsychologische und selbstkonzeptbezogene Dimension gekennzeichnet ist. Neben der Sekundär- (Verhinderung neuroplastizitätsvernichtender Rückfälle) stellt hier die Tertiärprophylaxe (frühe Verhinderung von Chronifizierungsprozessen) ein wichtiges Ziel dar.


Evidence-based interventions in the early phase of schizophrenic disorders

Abstract. By addressing the early phase of first episode psychosis, we focus on the “critical period” in the development of schizophrenia. Treatment success during this vulnerable period of development of schizophrenia sets the course for the future long-term development of the illness (partial remission, role functioning). This indicates the need not only for an optimization of the cost-benefit-ratio of antipsychotic treatment with more recent atypicals and newer formulations, but also the need to supplement disorder-specific, problem-specific and phase-specific cognitive-behavioral interventions within a more individualized approach which focuses on developmental tasks and the more evaluative dimension of self-concept. Preventing neurotoxic relapse as well as partial remission in schizophrenia and enhancing role functioning in education and work (i.e. social integration) are the most important goals of early interventions in this early phase of the course of schizophrenia.

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