Soziale Ängste im klinischen Hochrisikostadium für Psychosen

Zusammenfassung

In den letzten Jahren wird zunehmend über die Komorbidität von schizophrenen Störungen mit Angsterkrankungen berichtet. So wurde bei Patienten mit einer Störung aus dem Schizophrenie-Spektrum in 38,3 % eine Angsterkrankung und darunter mit 14,9 % am häufigsten eine soziale Phobie (SP) gefunden. Gerade sozialer Angst kommt bei Patienten mit Psychose eine besondere Bedeutung zu, weil sie sich oft mit Depressivität verbindet und zur Entstehung von psychosozialen Behinderungen beitragen kann. Auch im Hochrisikostadium für Psychosen („Clinical High- Risk State for Psychosis“, HRP) treten Angsterkrankungen bereits gehäuft auf. Daher stellen sich die Fragen, ob auch hier die soziale Angststörung dominiert und welche Bedeutung dies für die Arbeit in den Früherkennungs- und Präventivzentren hätte. Um diese Fragen zu klären, gibt diese Arbeit erstmals einen systematischen Überblick über alle bisher publizierten Untersuchungen zu sozialen Ängste im klinischen HRP.

Insgesamt wurden 124 Studien eingeschlossen. Nach der aussagekräftigsten dieser Arbeiten kamen Angsterkrankungen bei den HRP-Probanden mit knapp 51 % hochsignifikant häufiger als bei Kontrollpersonen mit nur knapp 4 % vor. Die SP dominierte und war mit einer Prävalenz 14,4 % gegenüber nur 0,36 % bei den Kontrollpersonen fast genauso häufig vertreten, wie man sie unter den Angststörungen im Schizophrenie-Spektrum (14,9 %) gefunden hat. Der in 9 Studien mit Hilfe der Social Interaction and Anxiety Scale (SIAS) ermittelte Ausprägungsgrad sozialer Ängstlichkeit (SÄ) lag im Mittel bei den HRP Gruppen nahezu genauso hoch (SIAS-Score = 34,4; SD = 6,11) wie bei den bereits an einer Psychose erkrankten Patienten (SIAS-Score = 35,0; SD = 9,56) und hob sich deutlich von den Werten für Angehörige von Psychosekranken (SIAS-Score = 22,1; SD = 8,7) und Kontrollen (SIAS Score =  14,6; SD = 7,28) ab. Der Ausprägungsgrad der SÄ stand zwar mit der für das HRP maßgeblichen attenuierten psychotischen Symptomatik im Zusammenhang, ließ aber keine Vorhersagekraft für den Übergang in die psychotische Erstmanifestation erkennen. Die psychosozialen Funktionsverluste im HRP scheinen zudem nicht nur mit der SÄ, sondern auch mit den ebenfalls häufigen komorbiden depressiven Störungen in Verbindung zu stehen. Ferner konnte eine Studie zeigen, dass es erfolgversprechend ist, die SÄ im HRP durch neu entwickelte spezialisierte kognitive Verhaltenstherapien anzugehen.

Abstract

In recent years an increased comorbidity of schizophrenic disorders with anxiety disorders has been reported. Thus, among patients with a disorder from the schizophrenia spectrum, a general anxiety disorder was found in 38.3 % of patients, with 14.9 % of these with social phobia (SP). Especially social anxiety (SA) is of particular importance because it is often associated with depression and can contribute to psychosocial disabilities in patients with psychosis.

Anxiety disorders already seem to occur prior to the first psychotic manifestation in the clinical high-risk state (CHR). Therefore, the questions arise as to whether this comorbidity is also dominated by SP in this patient group and, if so, what its consequences are on early detection and prevention of psychotic disorders. To clarify these questions, the present paper provides a systematic review of all published studies on social anxiety (SA) in the CHR.

A total of 124 studies were included comprising 1702 CHR individuals, 445 healthy controls, 67 relatives / siblings of patients with psychotic disorders and 95 patients with a psychosis. In the most meaningful study, anxiety disorders were generally highly significant in CHR individuals (51 %) compared to control subjects from the normal population (4 %). Among those with anxiety disorders, 14.4 % suffered from SP compared to 0.36 % in normal controls and thus SP was almost as frequent as the prevalence of this type of anxiety disorders in the schizophrenic spectrum (14.9 %). Also, the degree of SA in CHR individuals (SIAS score = 34.4, SD = 6.11) (SIAS-Score = 22.1, SD = 8.7), measured with the Social Interaction and Anxiety Scale (SIAS) in 9 studies, was almost as high as in psychotic patients (SIAS score = 35.0, SD = 9.56) and healthy controls (SIAS score = 14.,6; SD = 7,28). This degree of SA was also related to the attenuated psychotic symptomatology of the CHR individuals. However, the only study investigating the relationship between SA and a possible transition to a first psychotic manifestation did not reveal any predictive power. The feared psychosocial loss of function, which is already present in CHR, seems to be connected not only to the strong SA, but also to the similarly frequent comorbid depressive disorders.

Moreover, one study has already provided some evidence that it is promising to address the SA as well as functional impairments in the CHR through newly developed specialized cognitive behavioural therapies.

Schlüsselwörter

Angststörungen - Soziale Phobie - Soziale Ängstlichkeit - Hochrisikostadium für Psychose - Früherkennung

Key words

Social Phobia - Anxiety Disorders - Social Anxiety - Early Recognition - Clinical high-risk for Psychosis

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