Spezialisierte Behandlungsangebote für erstmals schizophren Erkrankte: Konzepte und Ergebnisse

Zusammenfassung

Vielfältige Evidenz legt nahe, dass Patienten in der frühen Phase einer psychotischen Erkrankung eine spezielle Behandlungsstrategie benötigen, die ihren speziellen Bedürfnissen und Problemen in dieser „kritischen“ Phase gerecht wird. Die vorliegende Übersicht fasst diese Evidenz zusammen und stellt Frühbehandlungsansätze vor, wie sie international bereits in sehr unterschiedlicher Ausgestaltung aufgebaut wurden, sich in Deutschland jedoch erst vereinzelt im Pilotstadium befinden. Bisherige Evaluationsergebnisse weisen auf eine überlegene Wirksamkeit solcher Frühbehandlungsansätze gegenüber herkömmlicher Standardbehandlung sowohl in Bezug auf das klinische Ergebnis als auch in Bezug auf die Gesamtkosten der Behandlung. Offene Fragen bestehen jedoch vor allem noch bezüglich der Spezifität und der Nachhaltigkeit solcher Effekte sowie der wirksamen Behandlungskomponenten. Bevor ähnliche Angebote in Deutschland auf breiter Basis aufgebaut werden, sollte eine Konsentierung der unverzichtbaren Charakteristika und somit zu entsprechenden Qualitätsindikatoren erfolgen.

Abstract

Multifaceted evidence suggests that patients in the early phase of a psychotic disorder need a specific treatment strategy meeting their specific needs and problems in this “critical” phase of the disorder. The present review summarises this evidence and presents early treatment approaches according to already internationally established different models, while in Germany comparable concepts are only in a pilot stage. Previous evaluation studies showed a superior efficacy of such early treatment approaches compared to conventional standard treatment in terms of both clinical outcome and in relation to the total costs of treatment. Questions remain, however, especially with regard to the specificity and durability of such effects, and with regard to the effective treatment components. Before similar programmes can be broadly established in Germany, a consensus on their indispensable characteristics and appropriate quality indicators should be achieved.

Schlüsselwörter

Schizophrenie - kritische Phase - Frühbehandlung - Adhärenz - Erstmanifestation

Key words

schizophrenia - critical period - early intervention - adherence - first episode psychosis

• Literatur

• 1 Mossaheb N, Wiesegger G, Amminger GP et al. Early recognition and intervention for schizophrenia. Nervenarzt 2006; 77: 23-24, 27-30, 32-24
• 2 Eranti SV, Maccabe JH, Bundy H et al. Gender difference in age at onset of schizophrenia: a meta-analysis. Psychol Med 2013; 43: 155-167
• 3 Fusar-Poli P, Borgwardt S, Bechdolf A et al. The Psychosis High-Risk State: A Comprehensive State-of-the-Art Review. Arch Gen Psychiatry 2012; 1-14 [Epub ahead of print]
• 4 Häfner H, Nowotny B, Löffler W et al. When and how does schizophrenia produce social deficits?. Eur Arch Psychiatry Clin Neurosci 1995; 246: 17-28
• 5 Schaffner N, Schimmelmann BG, Niedersteberg A et al. Versorgungswege von erstmanifesten psychotischen Patienten – eine Übersicht internationaler Studien. Fortschr Neurol Psychiatr 2011; 80: 72-78
• 6 Marshall M, Lewis S, Lockwood A et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 2005; 62: 975-983
• 7 Coldham EL, Addington J, Addington D. Medication adherence of individuals with a first episode of psychosis. Acta Psychiatr Scand 2002; 106: 286-290
• 8 Schennach-Wolff R, Jäger M, Seemüller F et al. Attitude towards adherence in patients with schizophrenia at discharge. J Psychiatr Res 2009; 43: 1294-1301
• 9 Gaebel W, Riesbeck M, Wölwer 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: 1763-1774
• 10 Schimmelmann BG, Conus P, Schacht M et al. Predictors of service disengagement in first-admitted adolescents with psychosis. J Am Acad Child Adolesc Psychiatry 2006; 45: 990-999
• 11 Robinson D, Woerner MG, Alvir JM et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry 1999; 56: 241-247
• 12 Meister K, Burlon M, Rietschel L et al. Dual diagnosis psychosis and substance use disorders in adolescents – part 1. Fortschr Neurol Psychiatr 2010; 78: 81-89
• 13 Romm KL, Rossberg JI, Berg AO et al. Depression and depressive symptoms in first episode psychosis. J Nerv Ment Dis 2010; 198: 67-71
• 14 Maurer K, Trendler G, Schmidt M et al. Schizophrenie und Depression. Nervenarzt 2006; 77: 809-822
• 15 Birchwood M. Pathways to emotional dysfunction in first-episode psychosis. Br J Psychiatry 2003; 182: 373-375
• 16 Tarrier N, Khan S, Cater J et al. The subjective consequences of suffering a first episode psychosis: trauma and suicide behaviour. Soc Psychiatry Psychiatr Epidemiol 2007; 42: 29-35
• 17 McGorry PD, Killackey E, Yung A. Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry 2008; 7: 148-156
• 18 Cannon TD, Cadenhead K, Cornblatt B et al. Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Arch Gen Psychiatry 2008; 65: 28-37
• 19 Fusar-Poli P, Bonoldi I, Yung AR et al. Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry 2012; 69: 220-229
• 20 Birchwood M, Todd P, Jackson C. Early intervention in psychosis. The critical period hypothesis. Br J Psychiatry Suppl 1998; 172: 53-59
• 21 Pompili M, Serafini G, Innamorati M et al. Suicide risk in first episode psychosis: a selective review of the current literature. Schizophr Res 2011; 129: 1-11
• 22 Wiersma D, Nienhuis FJ, Slooff CJ et al. Natural course of schizophrenic disorders: a 15-year followup of a Dutch incidence cohort. Schizophr Bull 1998; 24: 75-85
• 23 Remington G. Rational pharmacotherapy in early psychosis. Br J Psychiatry Suppl 2005; 48: S77-S84
• 24 Barnes TR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2011; 25: 567-620
• 25 Marshall M, Lockwood A, Lewis S et al. Essential elements of an early intervention service for psychosis: the opinions of expert clinicians. BMC Psychiatry 2004; 4: 17-24
• 26 McGorry P, Addington J, Amminger P et al. International early psychosis writing group: International clinical practice guidelines for early psychosis. British Journal of Psychiatry 2005; 48: 120-124
• 27 Bertolote J, McGorry P. Early intervention and recovery for young people with early psychosis: consensus statement. Br J Psychiatry Suppl 2005; 48: S116-S119
• 28 WPA. World Psychiatric Association. Guidelines for Psychiatrists on Early Intervention in Psychosis. WPA Committee for Education Letter to all WPA Member Societies; 2010
• 29 NICE. National Institute for Health & Clinical Excellence. Schizophrenia The Nice Guidelines on Core Interventions and Management of Schizophrenia in Adults in Primary and Secondary Care. London: The British Psychological Society and The Royal College of Psychiatrists; 2010
• 30 DGPPN. Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde. Behandlungsleitlinie Schizophrenie. Darmstadt: Steinkopf; 2006
• 31 McGorry PD, Edwards J, Mihalopoulos C et al. EPPIC: an evolving system of early detection and optimal management. Schizophr Bull 1996; 22: 305-326
• 32 DoH. Department of Health. The Mental Health Policy Implementation Guide. Retrieved 08.01.2012 London: 2001 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009350
• 33 DoH, Department of Health. The NHS plan: a summary. Retrieved 08.01.2012 London: 2000 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4010198
• 34 Shiers D, Smith J. Early Intervention in Psychosis: A Briefing for Service Planners. Retrieved from 2010 www.earlypsychosis.org.nz/PDF/eip-briefing.pdf
• 35 Petersen L, Jeppesen P, Thorup A et al. A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. Brit Med J 2005; 331: 602-605
• 36 Johannessen JO, McGlashan TH, Larsen TK et al. Early detection strategies for untreated first-episode psychosis. Schizophr Res 2001; 51: 39-46
• 37 Sahlmann MM, Vieten AB, Sheldrick AJ et al. Früherkennung und Frühbehandlung bei Patienten mit erhöhtem Schizophrenierisiko in Deutschland. Gesundheitswesen 2010; 72: 771-775
• 38 French P, Smith J, Shiers D et al. Promoting Recovery in Early Psychosis: A Practice Manual. Wiley-Blackwell; 2010
• 39 Waldheter E, Penn D. A Psychological Treatment to Facialitate Recovery in Early Psychosis – The Graduate Recovery Program: (GRIP). Saarbrücken: VDM Verlag Dr. Müller; 2009
• 40 Dodgson G, McGowan C. Early intervention service models. In: French P, Smith J, Shiers D, et al. (Hrsg) Promoting recovery in early psychosis: A practice manual. Oxford: Wiley-Blackwell; 2010: 45-52
• 41 Fowler D, Hodgekins J, Howells L et al. Can targeted early intervention improve functional recovery in psychosis? A historical control evaluation of the effectiveness of different models of early intervention service provision in Norfolk 1998–2007. Early Intervention in Psychiatry 2009; 3: 282-288
• 42 Lambert M, Bock T, Moritz S et al. Der Arbeitsbereich Psychosen: Behandlungskonzept, Forschung und Lehre. Zentrum für Psychosoziale Medizin am Universitätsklinikum Hamburg-Eppendorf; 2007
• 43 Malla A. Early Intervention Services for psychotic disorders: Expectations, benefits, challenges. IRIS Commissioner Conference. , October 2009 2009
• 44 Harvey PO, Lepage M, Malla A. Benefits of enriched intervention compared with standard care for patients with recent-onset psychosis: a metaanalytic approach. Can J Psychiatry 2007; 52: 464-472
• 45 Bird V, Premkumar P, Kendall T et al. Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry 2010; 197: 350-356
• 46 Kuipers E, Holloway F, Rabe-Hesketh S et al. An RCT of early intervention in psychosis: Croydon Outreach and Assertive Support Team (COAST). Soc Psychiatry Psychiatr Epidemiol 2004; 39: 358-363
• 47 Craig TK, Garety P, Power P et al. The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. Brit Med J 2004; 329: 1067
• 48 Grawe RW, Falloon IR, Widen JH et al. Two years of continued early treatment for recent-onset schizophrenia: a randomised controlled study. Acta Psychiatr Scand 2006; 114: 328-336
• 49 McCrone P, Knapp M. Economic evaluation of early intervention services. Br J Psychiatry Suppl 2007; 51: S19-S22
• 50 Cullberg J, Mattsson M, Levander S et al. Treatment costs and clinical outcome for first episode schizophrenia patients: a 3-year follow-up of the Swedish “Parachute Project” and two comparison groups. Acta Psychiatr Scand 2006; 114: 274-281
• 51 Mihalopoulos C, McGorry PD, Carter RC. Is phase-specific, community-oriented treatment of early psychosis an economically viable method of improving outcome?. Acta Psychiatr Scand 1999; 100: 47-55
• 52 Mihalopoulos C, Harris M, Henry L et al. Is early intervention in psychosis cost-effective over the long term?. Schizophr Bull 2009; 35: 909-918
• 53 McCrone P, Craig TK, Power P et al. Cost-effectiveness of an early intervention service for people with psychosis. Br J Psychiatry 2010; 196: 377-382
• 54 McCrone P, Park A, Knapp M. Economic Evaluation of Early Intervention (EI) Services: Phase IV Report. 2010
• 55 Marshall M, Rathbone J. Early intervention for psychosis. Cochrane Database Syst Rev 2011; Juni 15: CD004718
• 56 Catts SV, Evans RW, O'Toole BI et al. Is a national framework for implementing early psychosis services necessary? Results of a survey of Australian mental health service directors. Early Interv Psychiatry 2010; 4: 25-30
• 57 Bertelsen M, Jeppesen P, Petersen L et al. Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Arch Gen Psychiatry 2008; 65: 762-771
• 58 Gafoor R, Nitsch D, McCrone P et al. Effect of early intervention on 5-year outcome in non-affective psychosis. Br J Psychiatry 2010; 196: 372-376
• 59 Friis S. Early specialised treatment for first-episode psychosis: does it make a difference?. Br J Psychiatry 2010; 196: 339-340