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Psychother Psychosom Med Psychol 2020; 70(05): 197-204
DOI: 10.1055/a-0975-9628
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Remission, Response und deren Prädiktion nach einer kognitiven Verhaltenstherapie der Zwangsstörung im stationären Setting

Remission, Response and its Prediction after Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in an Inpatient Setting
Susanne Nowak
1   Psychosomatik, Schön Klinik Bad Bramstedt
,
Bernhard Osen
1   Psychosomatik, Schön Klinik Bad Bramstedt
,
Christoph Kröger
2   Institut für Psychologie, Universität Hildesheim
› Author Affiliations
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Publication History

eingereicht 03 January 2019

akzeptiert 04 March 2019

Publication Date:
29 August 2019 (online)

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Zusammenfassung

Die kognitive Verhaltenstherapie einschließlich Exposition und Reaktionsmanagement gilt bei Zwangsstörungen als Psychotherapie der ersten Wahl. In dieser Studie wurde der Therapieerfolg von 799 Patienten im Rahmen einer stationären kognitiv-behavioralen Psychotherapie untersucht. Als zentrales Erfolgsmaß wurde die Yale-Brown Obsessive Compulsive Scale (Y-BOCS) eingesetzt. Der Therapieerfolg wurde in Effektstärken (ES) sowie in Remissions- und Responseraten ausgedrückt. Im Prä-Post-Vergleich der Y-BOCS betrug die ES 1,32. Response wurde nach 2 verschiedenen Definitionen klassifiziert: dem Reliabel Change Index (RCI) und der prozentualen Symptomverbesserung (PSV). Die Responseraten betrugen 75,5% (RCI) bzw. 37% (PSV). Remission erreichten 39,3% nach RCI und 32,2% nach PSV. Von den eingeschlossenen Patienten beendeten 10,4% die Therapie vorzeitig. Das Abbruchrisiko war bei Männern sowie bei Patienten, die zusätzlich mit Neuroleptika behandelt wurden, erhöht. Der negative Einfluss von Neuroleptika auf den Therapieverlauf legt nahe, dass eine entsprechende Medikation im Rahmen der Expositionsbehandlung kritisch überprüft werden sollte.

Abstract

Cognitive-behavioral therapy, including exposure and response management, is considered the first-choice psychotherapy for obsessive-compulsive disorder. In this study, the therapy outcome of 799 patients was examined in the context of inpatient cognitive-behavioral psychotherapy. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used as the central outcome measure. Therapy outcome was defined in effect sizes (ES) as well as in remission and response rates. In the pre-post comparison of Y-BOCS, the ES was 1.32. Response was classified according to two different definitions: the reliable change index (RCI) and the percental symptom improvement (PSI). The rates of response were 75.5% (RCI) and 37% (PSI). The rates of remission were 39.3% based on RCI and 32.2% based on PSI. 10.4 % of the participating patients finished the treatment prematurely. The risk of dropout was increased in male gender as well as in patients who were additionally treated with neuroleptics. The negative impact of neuroleptics on the outcome of therapy indicates that such medication should be used critically as part of exposure treatment.

Schlüsselwörter

Kognitive Verhaltenstherapie - Zwangsstörung - Remission - Response - Abbruch

Key words

cognitive-behavioral therapy - obsessive-compulsive disorder - remission - response - dropout

Ergänzendes Material

 

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