Psychiatrie und Psychotherapie up2date 2010; 4(04): 237-252
DOI: 10.1055/s-0030-1248504
Schizophrenien und andere psychotische Störungen

Klinische Prädiktion und Prävention von Psychosen

Stephan Ruhrmann
,
Julia Paruch
,
Joachim Klosterkötter
› Further Information
Also available at
    Permissions and Reprints All articles of this category

Corrected by:

ErratumPsychiatrie und Psychotherapie up2date 2010; 4(04): e6-e6
DOI: 10.1055/s-0030-1248519

Kernaussagen

  • Die Prävention von Psychosen und vor allem der Schizophrenie gilt gegenwärtig als beste Option zur Bekämpfung der mit diesen Krankheitsbildern verknüpften persönlichen und sozialen Folgen. Den besten Zugang bietet derzeit das Konzept der auf klinischen Risikosyndromen basierenden indizierten Prävention.

  • Die Prädiktionskriterien sind langfristig ausreichend valide, bedürfen jedoch noch der weiteren Optimierung, um die anzustrebende Anpassung von Präventionsmaßnahmen an das individuelle Risiko zu ermöglichen. Einen wichtigen Schritt in diese Richtung bietet die Berechnung prognostischer Scores, die zudem den dynamischen, volatilen Charakter des individuellen Risikos abbilden könnten.

  • Die neurobiologischen und neurokognitiven Studien zeigen, dass die klinischen Risikosyndrome bereits mit funktionellen und z. T. auch morphologischen Veränderungen assoziiert sind.

  • Prävention ist von Behandlung zu unterscheiden. Präventive Maßnahmen beruhen nicht auf diagnostischer Sicherheit, sondern auf prognostischer Wahrscheinlichkeit und werden insofern mit Wahrscheinlichkeit auch Personen einbeziehen, die dieser Maßnahmen nicht bedürfen. Daher bedürfen präventive Maßnahmen – einschließlich der Mitteilung eines erhöhten Psychoserisikos – einer besonderen Nutzen-Risiko-Abwägung.

  • Die bisher verfügbaren Präventionsstudien sind vielversprechend, bedürfen aber noch einer nachhaltigen Absicherung durch methodisch strengere, den Vorgaben der evidenzbasierten Medizin genügende Untersuchungen.



Publication History

Publication Date:
30 June 2010 (online)

© Georg Thieme Verlag KG Stuttgart · New York

 

  • Literatur

  • Clouth J. Kosten der Frühverrentung am Beispiel der Schizophrenie.. Psychiat Prax 2004; 31 (Suppl. 2): S238-245
    Article in Thieme ConnectPubMedGoogle Scholar
  • Mrazek PJ, Haggerty HJ. Reducing risks for mental disorders: frontiers for preventive research.. Washington DC: Academy Press 1994
    PubMedGoogle Scholar
  • Ruhrmann S, Schultze-Lutter F, Klosterkötter J. Probably at-risk, but certainly ill – Advocating the introduction of a psychosis spectrum disorder in DSM-V.. Schizophrenia Research 2010; DOI: DOI: 10.1016/j.schres.2010.03.015.
    CrossrefPubMedGoogle Scholar
  • Huber G, Gross G, Schüttler R. Schizophrenie. Verlaufs- und sozialpsychiatrische Langzeituntersuchungen an den 1945–1959 in Bonn hospitalisierten schizophrenen Kranken.. Monographien aus dem Gesamtgebiet der Psychiatrie 1979; 21: 1-399
    Google Scholar
  • Häfner H. et al. The influence of age and sex on the onset and early course of schizophrenia.. British Journal of Psychiatry 1993; 162: 80-86
    CrossrefPubMedGoogle Scholar
  • Schultze-Lutter F. et al. Basic Symptoms and Ultrahigh Risk Criteria: Symptom Development in the Initial Prodromal State.. Schizophr Bull 2010; 36: 182-191
    CrossrefPubMedGoogle Scholar
  • Klosterkötter J. et al. Diagnosing schizophrenia in the initial prodromal phase.. Archives of General Psychiatry 2001; 58: 158-164
    CrossrefPubMedGoogle Scholar
  • Schultze-Lutter F, Ruhrmann S. Früherkennung und Frühbehandlung von Psychosen.. Bremen: Uni-Med 2008
    PubMedGoogle Scholar
  • Schultze-Lutter F. et al. Predicting first-episode psychosis by basic symptom criteria.. Clinical Neuropsychiatry 2007; 4: 11-22
    Google Scholar
  • Schultze-Lutter F. et al. Schizophrenia Proneness Instrument – Adult version (SPI-A).. Rome: Giovanni Fioriti 2007
    PubMedGoogle Scholar
  • Ruhrmann S. et al. Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study.. Archives of General Psychiatry 2010; 67: 241-251
    CrossrefPubMedGoogle Scholar
  • Schultze-Lutter F, Ruhrmann S, Klosterkötter J. Early detection of psychosis – establishing a service for persons at risk.. Eur Psychiatry 2009; 24: 1-10
    CrossrefPubMedGoogle Scholar
  • Ruhrmann S, Schultze-Lutter F, Klosterkötter J. Early detection and intervention in the initial prodromal phase of schizophrenia.. Pharmacopsychiatry 2003; 36 (Suppl. 3): S162-167
    PubMedGoogle Scholar
  • Yung A. et al. Validation of „prodromal” criteria to detect individuals at ultra high risk of psychosis: 2 year follow-up.. Schizophrenia Research 2008; 105: 10-17
    CrossrefPubMedGoogle Scholar
  • Cannon TD. et al. Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America.. Archives of General Psychiatry 2008; 65: 28-37
    CrossrefPubMedGoogle Scholar
  • Yung AR. et al. Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features.. Schizophrenia Research 2004; 67: 131-142
    CrossrefPubMedGoogle Scholar
  • Woods SW. et al. Validity of the Prodromal Risk Syndrome for First Psychosis: Findings From the North American Prodrome Longitudinal Study.. Schizophr Bull 2009; 35: 894-908
    CrossrefPubMedGoogle Scholar
  • Schultze-Lutter F, Ruhrmann S, Klosterkötter J. Can schizophrenia be predicted phenomenologically? In: Johannesen JO, Martindale BV, Cullberg J, eds Evolving Psychosis: Different Stages, Different Treatments.. Hove, Routledge: 2006: 104-123
    PubMedGoogle Scholar
  • Yung A. et al. Testing the Ultra High Risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people.. Schizophrenia Research 2006; 84: 57-66
    CrossrefPubMedGoogle Scholar
  • Koutsouleris N. et al. Use of neuroanatomical pattern classification to identify subjects in at-risk mental states of psychosis and predict disease transition.. Arch Gen Psychiatry 2009; 66: 700-712
    CrossrefPubMedGoogle Scholar
  • Seiferth NY. et al. Increased neural response related to neutral faces in individuals at risk for psychosis.. Neuroimage 2008; 40: 289-297
    CrossrefPubMedGoogle Scholar
  • Brockhaus-Dumke A. et al. Sensory gating in schizophrenia: P50 and N100 gating in antipsychotic-free subjects at risk, first-episode, and chronic patients.. Biological Psychiatry 2008; 64: 376-384
    CrossrefPubMedGoogle Scholar
  • Frommann I. et al. Auditory P300 in individuals clinically at risk for psychosis.. Int J Psychophysiol 2008; 70: 192-205
    CrossrefPubMedGoogle Scholar
  • Özgürdal S. et al. Reduction of auditory event-related P300 amplitude in subjects with at-risk mental state for schizophrenia.. Schizophr Res 2008; 105: 272-278
    CrossrefPubMedGoogle Scholar
  • Howes OD. et al. Elevated striatal dopamine function linked to prodromal signs of schizophrenia.. Arch Gen Psychiatry 2009; 66: 13-20
    CrossrefPubMedGoogle Scholar
  • Riecher-Rössler A. et al. Efficacy of using cognitive status in predicting psychosis: a 7-year follow-up.. Biol Psychiatry 2009; 66: 1023-1030
    CrossrefPubMedGoogle Scholar
  • McGorry PD. et al. Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms.. Archives of General Psychiatry 2002; 59: 921-928
    CrossrefPubMedGoogle Scholar
  • Phillips LJ. et al. Medium term follow-up of a randomized controlled trial of interventions for young people at ultra high risk of psychosis.. Schizophrenia Research 2007; 96: 25-33
    CrossrefPubMedGoogle Scholar
  • McGlashan TH. et al. Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis.. American Journal of Psychiatry 2006; 163: 790-799
    CrossrefPubMedGoogle Scholar
  • Ruhrmann S. et al. Acute effects of treatment for prodromal symptoms for people putatively in a late initial prodromal state of psychosis.. British Journal of Psychiatry 2007; 191: S88-S95
    CrossrefPubMedGoogle Scholar
  • Ruhrmann S. et al. Reduced subjective quality of life in persons at risk for psychosis.. Acta Psychiatrica Scandinavica 2008; 117: 357-368
    CrossrefPubMedGoogle Scholar
  • Woods SW. et al. Randomized trial of olanzapine versus placebo in the symptomatic acute treatment of the schizophrenic prodrome.. Biological Psychiatry 2003; 54: 453-464
    CrossrefPubMedGoogle Scholar
  • Woods SW. et al. Aripiprazole in the treatment of the psychosis prodrome: an open-label pilot study.. British Journal of Psychiatry Suppl 2007; 51: 96-101
    CrossrefPubMedGoogle Scholar
  • Cornblatt BA. et al. Can antidepressants be used to treat the schizophrenia prodrome? Results of a prospective, naturalistic treatment study of adolescents.. The Journal of Clinical Psychiatry 2007; 68: 546-557
    CrossrefPubMedGoogle Scholar
  • Ruhrmann S, Schultze-Lutter F, Klosterkotter J. Intervention in the at-risk state to prevent transition to psychosis.. Curr Opin Psychiatry 2009; 22: 177-183
    CrossrefPubMedGoogle Scholar
  • Morrison AP. et al. Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial.. British Journal of Psychiatry 2004; 185: 291-297
    CrossrefPubMedGoogle Scholar
  • Morrison AP. et al. Three-year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk.. Schizophrenia Bulletin 2007; 33: 682-687
    CrossrefPubMedGoogle Scholar
  • Bechdolf A. et al. Randomized controlled multicentre trial of cognitive behaviour therapy in the early initial prodromal state: effects on social adjustment post treatment.. Early Intervention in Psychiatry 2007; 1: 71-78
    CrossrefPubMedGoogle Scholar