Rehabilitation von Menschen mit schizophrenen Psychosen: Die Bedeutung von Kognition und Training kognitiver Funktionen

Zusammenfassung

Erkrankungen aus dem schizophrenen Formenkreis beginnen zumeist in der Adoleszenz und verlaufen überwiegend chronisch. Sie gehen mit erheblichen Einschränkungen der Alltagsfunktionalität einher, beeinträchtigen das soziale Leben und behindern eine erfolgreiche berufliche Entwicklung. Teilhabe, Erhaltung der Alltagsfunktionalität sowie die soziale und berufliche Integration sind wesentliche Behandlungsziele bei Schizophrenie-Patienten. Die Rehabilitation zielt auf die Erhaltung und/oder die Verbesserung komplexer Alltagsfunktionen wie Wohnen, Arbeit und Sozialbeziehungen ab. Als wesentliche Prädiktoren für den Erfolg konnten kognitive Funktionen, Negativsymptome, Alter, Bildung, Arbeitsanamnese, soziale Unterstützung, soziale Fähigkeiten und professionelle Unterstützung bei der (Wieder-)Erlangung von Alltagsfunktionen identifiziert werden. Es ist belegt, dass die Besserung kognitiver Funktionen auch bei an Schizophrenie erkrankten Menschen möglich ist und dass psychologische Interventionen zur Verbesserung kognitiver Leistungen die Teilhabe verbessern. Dabei hängt der Erfolg wesentlich von der Integration spezifischer Maßnahmen in ein umfassendes Rehabilitationskonzept ab. In Deutschland besteht ein reichhaltiges sozialpsychiatrisches Angebot für Menschen, die an einer schizophrenen Psychose erkrankt sind. Schnittstellenprobleme, die z. B. durch Kostenträgergrenzen entstehen, erschweren die Gesamtplanung und verursachen schädliche Unterbrechungen. Als Herausforderungen für die Weiterentwicklung psychiatrischer Rehabilitation stellen sich unserer Einschätzung nach das Verstehen des komplexen Ineinandergreifens einzelner Maßnahmen, die Verbesserung der Gesamtplanung, die Gestaltung der Schnittstellen, die Entwicklung störungsspezifischer Konzepte, deren Beforschung sowie die realistische volkswirtschaftliche Bewertung dar.

Abstract

Schizophrenia is a chronic disorder, which severely limits the social and occupational functioning. Employment, education, relationships, housing and health are among the most frequently stated life and treatment goals among persons suffering from schizophrenia. Rehabilitation for persons with schizophrenia aims at preservation and improvement of psychosocial functions in areas such as work, social relationship and independent living skills, promotes recovery-oriented interventions and, therefore, serves the central goals of affected persons. Cognitive functioning, education, negative symptoms, social support and skills, age, work history, and rehabilitation service to restore community functioning have proven to be strong predictors for successful psychiatric rehabilitation. It makes sense to concentrate on these predictors when improvement of psychiatric rehabilitation is targeted. Cognitive remediation produces moderate improvements in cognitive performance and, when combined with functional training and embedded in comprehensive psychiatric rehabilitation, also enhances functional outcome. Germany provides a highly differentiated system of psychosocial support for schizophrenic patients. However, the “German disease” with different care providers being in charge in subsequent stages of recovery hampers efficient organisation of psychiatric rehabilitation. Improvement of overall organisation, i. e., configuration of interfaces, understanding of the complex interactions of measures, design of disease specific programmes, research and economic evaluation constitute major challenges in the field of psychiatric rehabilitation.

Schlüsselwörter

Schizophrenie - Rehabilitation - berufliche Rehabilitation - Kognition - Neuropsychologie - kognitive Remediation

Key words

schizophrenia - rehabilitation - vocational rehabilitation - cognition - neuropsychology - cognitive remediation therapy

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