Zusammenfassung
Die Koexistenz schizophrener und Zwangsstörungen wird seit Jahrzehnten diskutiert.
Die vorliegende Arbeit gibt einen Überblick über diejenigen Studien, die entsprechende
empirisch fundierte Ergebnisse unter fünf Gesichtspunkten zusammen fassen: Zwangssymptome
bei Schizophreniekranken, schizophrene Psychosen bei Zwangspatienten, Schizophrenie-Spektrum-Störungen
und Zwangssymptome, neurobiologische Befunde bei Zwang und Psychose und atypische
Neuroleptika und Zwangsinduktion. Im Rahmen einer MEDLINE-Recherche wurden alle relevanten
Arbeiten von 1960 - 2004 in die Übersicht aufgenommen. Obwohl nach streng wissenschaftlichen
Kriterien nur wenige empirisch solide Studien vorliegen, scheinen gerade aktuellere
Untersuchungen zu bestätigen, dass eine Koexistenz von Zwang und Schizophrenie doch
nicht so selten ist. Die enge Verwandtschaft der dysfunktionalen neuronalen Zirkel
bei Zwang und Schizophrenie bleibt bemerkenswert und rechtfertigt das weitere wissenschaftliche
Interesse, zumal die differenzialdiagnostischen Probleme und therapeutischen und prognostischen
Konsequenzen unbestritten sind. Die Literaturübersicht fasst differenzialdiagnostische
Überlegungen und entsprechende therapeutische Implikationen betreffs der atypischen
Neuroleptika und Selektiven Serotonin-Wiederaufnahmehemmer (SSRI) zusammen. Künftige
double-blind, randomisierte und plazebo-kontrollierte Studien großer Patientenpopulationen
mit präziseren diagnostischen Zuordnungen sind notwendig, um einen möglichen schizo-obsessiven
Subtyp einer Schizophrenie bzw. schizotypen Subtyp einer Zwangsstörung identifizieren
und einen entsprechenden therapeutischen Algorithmus ableiten zu können.
Abstract
Co-occurence of psychotic and obsessive-compulsive symptoms has been recognized for
decades. This paper reviews published reports from five perspectives: schizophrenia
with obsessive-compulsive symptoms, obsessive-compulsive disorder (OCD) with psychotic
symptoms, schizophrenia-spectrum-personality disorder with obsessive-compulsive symptoms,
obsessive-compulsive symptoms induced by atypical antipsychotics and similarities
of functional neural circuits theory in OCD and schizophrenia. A MEDLINE search was
conducted to identify relevant articles from 1960 until 2004. Only a few systematic
data that explore the nature and significance of such occurrence have been published.
More recent studies using systematic diagnostic criteria suggest that the rate of
occurrence may not be rare at all. In schizophrenia, a similar dorsolateral prefrontal
cortex circuit shares anatomic substrates similar to those of the OCD orbitofrontal
circuit. Exploring the interface of schizophrenic and obsessive-compulsive symptoms
is important for diagnostic clarity and could have important implications for treatment
and long-term prognosis. The review emphasizes the different origins and natural course
of co-occurrence of schizophrenic and obsessive-compulsive symptoms and their various
outcome under atypical antipsychotics and selective serotonin reuptake inhibitors
(SSRI). Further double-blind, randomized, placebo-controlled investigations in larger
cohorts of schizophrenic and OCD patients are needed in order to identify a schizo-obsessive
schizophrenia and a schizotypal subtype of obsessive compulsive disorder and to substantiate
the algorithm for treatment.
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Dr. Kerstin Frommhold
Vivantes Klinikum Hellersdorf · Funktionsbereich Psychotherapie
Myslowitzer Straße 45
12621 Berlin
Email: kerstin.frommhold@vivantes.de