Verbesserung der sozialen Funktionsfähigkeit schizophren Kranker

Zusammenfassung

Beeinträchtigungen in der sozialen Funktionsfähigkeit sind schwerwiegende, subjektiv sehr belastende Merkmale schizophrener Erkrankungen. Sie führen zu einer reduzierten Lebensqualität und stehen einer umfassenden „Recovery” entgegen. Medikamentöse und psychosoziale Therapiemaßnahmen haben diesbezüglich nur unzureichende Effekte, ebenso wie spezifische Behandlungsansätze, die isoliert auf basale Kognitionen, soziale Kognitionen und soziale Verhaltenskompetenzen als wesentliche Determinanten der Funktionsfähigkeit abzielen. Daher wird in einer laufenden multizentrischen randomisierten kontrollierten klinischen Studie des Forschungsverbunds ESPRIT versucht, die Funktionsfähigkeit durch die Integration von sozial kognitiven und sozialen verhaltensbezogenen Behandlungsstrategien wirksamer als bisher möglich zu verbessern. Neben der Haltequote in der Therapie als gemeinsamer Endpunkt aller klinischen Studien des ESPRIT-Verbunds werden insbesondere die soziale Funktionsfähigkeit und subjektive Lebensqualität als Wirksamkeitsindikatoren vor (V1) und nach Abschluss der jeweils sechsmonatigen Behandlung (V6) sowie nach sechs Monaten Nachbeobachtung (V12) erfasst.

Summary

Impairments in social functioning are serious, subjectively very stressful characteristics of schizophrenic disorders. They contribute to a reduced quality of life and counteract a comprehensive “recovery”. Current drug and psychosocial treatment have insufficient effects in this regard, as well as specific treatment approaches that focus either on basic cognition, or social cognition or social behavioral competencies as key determinants of functioning. Therefore, in an ongoing multicenter randomized controlled clinical trial of the ESPRIT research network, attempts are being made to improve psychosocial functioning more effectively by integrating social cognitive and social behavioral treatment strategies. In addition to the rate of treatment adherence as the common endpoint of all clinical trials in the ESPRIT network, social functioning and subjective quality of life are assessed as outcome measures before (V1) and at the end of the six-month treatment period (V6) as well as after six months of follow-up (V12).

Schlüsselwörter

Schizophrenie - soziale Kognitionen - kognitive Remediation - soziales Kompetenztraining

Keywords

Schizophrenia - social cognition - cognitive remediation - social skills training

• Literatur

• 1 Harvey PD, Bellack AS. Toward a terminology for functional recovery in schizophrenia: is functional remission a viable concept?. Schizophr Bull 2009; 35 (02) 300-6.
• 2 Tsang HW. et al. Review on vocational predictors: a systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998. Aust N Z J Psychiatry 2010; 44 (06) 495-504.
• 3 Couture S, Penn DL, Roberts DL. The functional significance of social cognition in schizophrenia: a review. Schizophr Bull 2006; 32: 44-63.
• 4 Reichenberg A. The assessment of neuropsychological functioning in schizophrenia. Dialogues Clin Neurosci 2010; 12 (03) 383-92.
• 5 Savla GN. et al. Deficits in domains of social cognition in schizophrenia: a meta-analysis of the empirical evidence. Schizophr Bull 2013; 39 (05) 979-92.
• 6 Fett AK. et al. The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neurosci Biobehav Rev 2011; 35 (03) 573-88.
• 7 Wykes T, Huddy V, Cellard C, McGurk SR, Czobor P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry 2011; 168 (05) 472-85.
• 8 Kurtz MM, Richardson CL. Social Cognitive Training for Schizophrenia: A Meta-Analytic Investigation of Controlled Research. Schizophr Bull 2012; 38: 1092-104.
• 9 Paquin K, Wilson AL, Cellard C, Lecomte T, Potvin S. A systematic review on improving cognition in schizophrenia: which is the more commonly used type of training, practice or strategy learning?. BMC Psychiatry 2014; 14: 139.
• 10 Fiszdon JM, Reddy LF. Review of social cognitive treatments for psychosis. Clin Psychol Rev 2012; 32 (08) 724-40.
• 11 Medalia A, Saperstein AM. Does cognitive remediation for schizophrenia improve functional outcomes?. Curr Opin Psychiatry 2013; 26 (02) 151-7.
• 12 Bowie CR, McGurk SR, Mausbach B, Patterson TL, Harvey PD. Combined cognitive remediation and functional skills training for schizophrenia: effects on cognition, functional competence, and real-world behavior. Am J Psychiatry 2012; 169 (07) 710-8.
• 13 Wykes T, Spaulding WD. Thinking about the future cognitive remediation therapy - what works and could we do better? jSchizophr Bull. 2011; 37 (Suppl. 02) S80-90.
• 14 Choi J, Medalia A. Factors associated with a positive response to cognitive remediation in a community psychiatric sample. Psychiatr Serv 2005; 56 (05) 602-4.
• 15 Spiekermann A, Schulz M, Behrens J, Driessen M, Rahn E, Beblo T. Kognitive Leistungen und Adhärenzverhalten bei Patienten mit schizophrenen Psychosen. Fortschr Neurol Psychiatr 2011; 79 (02) 73-82.
• 16 Johansen R, Hestad K, Iversen VC, Agartz I, Sundet K, Andreassen OA. et al. Cognitive and clinical factors are associated with service engagement in early-phase schizophrenia spectrum disorders. J Nerv Ment Dis 2011; 199 (03) 176-82.
• 17 Gaebel W. et al. Maintenance treatment with risperidone or low-dose haloperidol in first-episode schizophrenia: 1-year results of a randomized controlled trial within the German Research Network on Schizophrenia. J Clin Psychiatry 2007; 68 (11) 1763-74.
• 18 Kahn RS, Fleischhacker WW, Boter H, Davidson M, Vergouwe Y, Keet IP. et al. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 2008; 371 9618 1085-97.
• 19 Birchwood M, Todd P, Jackson C. Early intervention in psychosis. The critical period hypothesis. Br J Psychiatry Suppl 1998; 172 (33) 53-9.
• 20 Frommann N, Drusch K, Wölwer W. Integriertes Therapieprogramm sozialer Kognitionen und sozialer Fertigkeiten (ISST) (unveröffentlichtes Therapiemanual). 2016
• 21 Wölwer W, Frommann N, Halfmann S, Piaszek A, Streit M, Gaebel W. Remediation of impairments in facial affect recognition in schizophrenia: efficacy and specificity of a new training program. Schizophr Res 2005; 80 (2–3): 295-303.
• 22 Luckhaus C, Frommann N, Stroth S, Brinkmeyer J, Wölwer W. Training of affect recognition in schizophrenia patients with violent offences: Behavioral treatment effects and electrophysiological correlates. Soc Neurosci 2013; 08 (05) 505-14.
• 23 Wölwer W, Frommann N. Social-Cognitive Remediation in Schizophrenia: Generalization of Effects of the Training of Affect Recognition (TAR). Schizophrenia Bulletin 2011; 37 (Suppl. 02) 63-70.
• 24 Sachs G, Winklbaur B, Jagsch R, Lasser I, Kryspin-Exner I, Frommann N. et al. Training of affect recognition (TAR) in schizophrenia – Impact on functional outcome. Schizophr Res 2012; 138: 262-7.
• 25 Eberle MC. et al. STAR: Spielerisches Training affektiver Ressourcen – Das Manual (unveröffentliches Therapiemanual). 2011
• 26 Kurtz MM, Mueser KT. A meta-analysis of controlled research on social skills training for schizophrenia. J Consult Clin Psychol 2008; 76 (03) 491-504.
• 27 Frommann N, Lowe A, Wölwer W. Neurokognitive Remediationstherapie (NCRT) (unveröffentlichtes Therapiemanual). 2016
• 28 Klingberg S. et al. Negative symptoms of schizophrenia as primary target of cognitive behavioral therapy: results of the randomized clinical TONES study. Schizophr Bull 2011; 37 (Suppl. 02) S98-110.
• 29 Finauer G. (Hrsg.) Therapiemanuale für neuropsychologische Rehabilitation: Kognitive und kompetenzorientierte Therapie für die Gruppen-und Einzelbehandlung. Heidelberg: Springer Medizin Verlag; 2007
• 30 Llorca PM. et al. The “Functional Remission of General Schizophrenia” (FROGS) scale: development and validation of a new questionnaire. Schizophr Res 2009; 113 (2–3): 218-25.
• 31 WHO. WHOQOL-BREF Introduction, Administration, Scoring and Generic Version of the Assessment – Field Trial Version. Geneva: 1996