Vorhersage von Psychosen durch stufenweise Mehrebenenabklärung – Das Basler FePsy(Früherkennung von Psychosen)-Projekt

Zusammenfassung

Hintergrund: In Basel haben wir verschiedene Studien zur Verbesserung der Methodik zur Früherkennung von Psychosen ( FePsy ) durchgeführt.

Methodik: Vom 1.3.2000 bis 29.2.2004 wurden 234 Individuen mithilfe des Basler Screening Instruments für Psychosen (BSIP) gescreent. Bei 106 Patienten konnte ein Risikostatus für Psychosen diagnostiziert werden, 53 davon konnten bis zu 7 Jahre (Mittel 5,4 Jahre) nachuntersucht werden. Die weiteren Untersuchungen erfolgten u. a. mit einem spezifisch entwickelten Anamneseinstrument, verschiedenen Skalen zur Psychopathologie, Untersuchungen der Neuropsychologie und Feinmotorik, klinischem und quantitativem EEG, MRI des Gehirns, Labor.

Ergebnisse: Allein auf der Basis des BSIP konnte eine relativ zuverlässige Vorhersage getroffen werden: 21 (39,6 %) der als „Risikopatienten“ Identifizierten entwickelten innerhalb der Beobachtungszeit tatsächlich eine Psychose. Post hoc konnte durch spezifischere Gewichtung der Psychopathologie und Einbezug neuropsychologischer Untersuchungen die Vorhersagegenauigkeit auf 81 % gesteigert werden. Die anderen oben genannten Verfahren können offensichtlich zur weiteren Verbesserung der Prädiktion beitragen.

Schlussfolgerungen: Die Risikoabklärung für Psychose sollte stufenweise und unter Einbezug verschiedener Untersuchungsebenen erfolgen.

Abstract

Background: We have conducted various studies in Basel with the aim of improving the methods for the early detection of psychosis (Früherkennung von Psychosen, FePsy ).

Methods: From 1.3.2000 to 29.2.2004 234 individuals were screened using the Basel Screening Instrument for Psychosis (BSIP). 106 patients were identified as at risk for psychosis; out of these 53 remained in follow-up for up to 7 years (mean 5.4 years). The assessments were done with a specifically developed instrument for history taking, various scales for the psychopathology, assessments of neuropsychology and fine motor functioning, clinical and quantitative EEG, MRI of the brain, laboratory etc.

Results: Based on the BSIP alone, a relatively reliable prediction was possible: 21 (39.6 %) of the individuals identified as at risk developed psychosis within the follow-up time. Post-hoc prediction could be improved to 81 % by weighting psychopathology and including neuropsychology. Including the other domains obviously allows further improvements of prediction.

Conclusions: The risk for psychosis should be assessed in a stepwise procedure. In a first step, a clinically oriented screening should be conducted. If an at-risk status is found, further assessments in various domains should be done in a specialised centre.

Schlüsselwörter

Psychose - Prädiktion - Neuropsychologie - Risiko - Feinmotorik - EEG, MRT

Key words

psychosis - prediction - neuropsychology - at risk mental state - fine motor functioning - EEG, MRI

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