Download PDF
Nervenheilkunde 2008; 27(11): 1014-1020
DOI: 10.1055/s-0038-1627234
Originaler Artikel
Schattauer GmbH

Kognitiv-verhaltenstherapeutische Behandlung von Positivsymptomatik psychotischer Störungen

Hintergrund und Therapiekonzeption der POSITIVE-Studie[*] Cognitive-behavioural therapy of positive symptoms in psychotic disordersbackground and treatment rational of the POSITIVE-study
S. Klingberg
1   Universitätsklinik für Psychiatrie und Psychotherapie Tübingen
,
S. Sickinger
1   Universitätsklinik für Psychiatrie und Psychotherapie Tübingen
,
A. Wittorf
1   Universitätsklinik für Psychiatrie und Psychotherapie Tübingen
,
G. Buchkremer
1   Universitätsklinik für Psychiatrie und Psychotherapie Tübingen
› Author Affiliations
Further Information

Publication History

Eingegangen am: 01 July 2008

angenommen am: 09 September 2008

Publication Date:
20 January 2018 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Psychotherapeutische Interventionen galten lange als nicht indiziert für die Behandlung psychotischer Störungen. Seit Mitte der 1990er-Jahre wurde jedoch in Großbritannien systematisch daran gearbeitet, kognitiv verhaltenstherapeutische Strategien für die Behandlung dieser schweren psychischen Störungen zu adaptieren. Inzwischen liegt eine Vielzahl von Befunden aus randomisierten klinischen Studien vor, die die bisherige Zurückhaltung auf diesem Gebiet in Frage stellen. Metaanalysen zeigen für die kognitive Verhaltenstherapie (KVT) moderate, mittlere gewichtete Effektstärken um 0,4 über die Wirkung der antipsychotischen Medikation hinaus. Aktuelle Behandlungsleitlinien empfehlen vor diesem Hintergrund diese Behandlungsstrategie in der Routineversorgung.

Gleichwohl ist eine Vielzahl von Fragen offen. Darum wird im Rahmen der vom BMBF geförderten Psychotherapieforschungsverbünde eine multizentrische klinische Studie zur Frage gefördert, ob kognitive Verhaltenstherapie spezifisch wirksam ist, oder ob sich die beschriebenen Therapieeffekte auf unspezifische Faktoren zurückführen lassen. Im vorliegenden Beitrag wird die Therapiekonzeption der in dieser Studie durchgeführten kognitiven Verhaltenstherapie vorgestellt und anhand von Fallbeispielen erläutert.

Summary

For a long time, psychotherapeutic interventions had not been considered as indicated for the treatment of psychotic disorders. However, in the middle of the nineties of the last century British researchers systematically adapted cognitive behaviourally interventions for treatment of these severe mental diseases. In the meantime, there is a multitude of findings from randomised clinical trials which call the psychotherapeutic abstinence in this field into question. Meta-analyses showed moderate effect sizes about 0.4 for cognitive behavioural therapy (CBT) in addition to antipsychotic medication. On this background the current treatment guidelines recommend the implementation of CBT in routine treatment.

Nevertheless, there remain many unanswered questions. In the framework of the BMBF-funded research networks on psychotherapy a multicenter clinical study addresses the question whether CBT is specifically efficacious or whether the described treatment effects might be ascribed to unspecific factors. The present paper presents the treatment rational of CBT on the basis of case vignettes.

Schlüsselwörter

Psychotische Störungen - Positivsymptomatik - kognitive Verhaltenstherapie - Therapiekonzept

Keywords

Psychotic disorder - positive symptoms - cognitive behavioral therapy - therapy

* Gefördert vom Bundesministerium für Bildung und Forschung (Förderkennzeichen: 01GV0618)


 

  • Literatur

  • 1 Appelbaum PS, Robbins PC, Roth LH. Dimensional approach to delusions: comparison across types and diagnoses. Am J Psychiatry 1999; 156 (Suppl. 12) 1938-1943.
    CrossrefPubMedGoogle Scholar
  • 2 Barrowclough C, Tarrier N, Humphreys L, Ward J, Gregg L, Andrews B. Self-esteem in schizophrenia: Relationships between self-evaluation, family attitudes, and symptomatology. J Abnorm Psychol 2003; 112 (Suppl. 01) 92-99.
    CrossrefPubMedGoogle Scholar
  • 3 Bentall RP, Corcoran R, Howard R, Blackwood N, Kinderman P. Persecutory delusions: A review and theoretical integration. Clin Psychol Rev 2001; 21 (Suppl. 08) 1143-1192.
    CrossrefPubMedGoogle Scholar
  • 4 Birchwood M. Pathways to emotional dysfunction in first-episode psychosis. Br J Psychiatry 2003; 182 (Suppl. 05) 373-375.
    CrossrefPubMedGoogle Scholar
  • 5 Blackwood NJ, Howard RJ, Bentall RP, Murray RM. Cognitive neuropsychiatric models of persecutory delusions. Am J Psychiatry 2001; 158 (Suppl. 04) 527-539.
    CrossrefPubMedGoogle Scholar
  • 6 Chadwick PK. Borderline: A psychological study of paranoia and delusional thinking. Florence, US: Taylor & Frances; 1992
    Google Scholar
  • 7 Fowler D, Freeman D, Smith B, Kuipers E, Bebbington P, Bashforth H. et al. The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in nonclinical and psychosis samples. Psychol Med 2006; 36 (Suppl. 06) 749-759.
    CrossrefPubMedGoogle Scholar
  • 8 Fowler D. Cognitive behavior therapy for psychosis: From understanding to treatment. Psychiatric Rehabilitation Skills 2000; 4 (Suppl. 02) 200-215.
    Google Scholar
  • 9 Freeman D, Garety PA. Worry, worry processes and dimensions of delusions: An exploratory investigation of a role for anxiety processes in the maintenance of delusional distress. Behavioural and Cognitive Psychotherapy 1999; 27 (Suppl. 01) 47-62.
    Google Scholar
  • 10 Freeman D, Garety PA. Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behaviour Research and Therapy 2003; 41 (Suppl. 08) 923-947.
    CrossrefPubMedGoogle Scholar
  • 11 Freeman D, Garety PA, Kuipers E, Fowler D, Bebbington PE. A cognitive model of persecutory delusions. Br J Clin Psychol 2002; 41 (Suppl. 04) 331-347.
    CrossrefPubMedGoogle Scholar
  • 12 Garety PA, Bebbington P, Fowler D, Freeman D, Kuipers E. Implications for neurobiological research of cognitive models of psychosis:a theoretical paper. Psychol Med 2007; 37 (Suppl. 10) 1377-1391.
    CrossrefPubMedGoogle Scholar
  • 13 Garety PA, Freeman D. Cognitive approaches to delusions: A critical review of theories and evidence. Br J Clin Psychol 1999; 38 (Suppl. 02) 113-154.
    CrossrefPubMedGoogle Scholar
  • 14 Garety PA, Freeman D, Jolley S, Dunn G, Bebbington PE, Fowler DG. et al. Reasoning, emotions, and delusional conviction in psychosis. J Abnorm Psychol 2005; 114 (Suppl. 03) 373-384.
    CrossrefPubMedGoogle Scholar
  • 15 Garety PA, Kuipers E, Fowler D, Freeman D, Bebbington PE. A cognitive model of the positive symptoms of psychosis. Psychol Med 2001; 31: 89-195.
    Google Scholar
  • 16 Garety PA, Kuipers L, Fowler D, Chamberlain F, Dunn G. Cognitive behavioural therapy for drugresistant psychosis. Br J Med Psychol 1994; 67: 259-271.
    CrossrefPubMedGoogle Scholar
  • 17 Goldman-Rakic PS, Castner SA, Svensson TH, Siever LJ, Williams GV. Targeting the dopamine D-sub-1 receptor in schizophrenia: insights for cognitive dysfunction. Psychopharmacology 2004; 174 (Suppl. 01) 3-16.
    PubMedGoogle Scholar
  • 18 Jaspers K. Allgemeine Psychopathologie. Berlin: Springer; 1959
    Google Scholar
  • 19 Jones E, Watson JP. Delusion, the overvalued idea and religious beliefs: A comparative analysis of their characteristics. Br J Psychiatry 1997; 170 (Suppl. 04) 381-386.
    CrossrefPubMedGoogle Scholar
  • 20 Joyce E, Huddy V. Defining the cognitive impairment in schizophrenia. Psychol Med 2004; 34 (Suppl. 07) 1151-1155.
    CrossrefPubMedGoogle Scholar
  • 21 Kane JM, Marder SR. Psychopharmacologic Treatment of Schizophrenia. Schizophr Bull 1993; 19 (Suppl. 02) 287-302.
    CrossrefPubMedGoogle Scholar
  • 22 Kapur S. Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. Am J Psychiatry 2003; 160 (Suppl. 01) 13-23.
    CrossrefPubMedGoogle Scholar
  • 23 Kapur S, Arenovich T, Agid O, Zipursky R, Lindborg S, Jones B. Evidence for onset of antipsychotic effects within the first 24 hours of treatment. Am J Psychiatry 2005; 162 (Suppl. 05) 939-946.
    CrossrefPubMedGoogle Scholar
  • 24 Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13 (Suppl. 02) 261-276.
    CrossrefPubMedGoogle Scholar
  • 25 Kemp R, Hayward P, Applewhaite G, Everitt B, David A. Compliance therapy in psychotic patients: randomised controlled trial. BMJ 1996; 312 7027 345-349.
    CrossrefPubMedGoogle Scholar
  • 26 Lewis S, Tarrier N, Haddock G, Bentall R, Kinderman P, Kingdon D. et al. Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes. Br J Psychiatry Suppl 2002; 43: s91-s97.
    Google Scholar
  • 27 Lindenmayer JP. Treatment refractory schizophrenia. Psychiatric Quarterly 2000; 71 (Suppl. 04) 373-384.
    CrossrefPubMedGoogle Scholar
  • 28 Moritz S, Woodward TS. Jumping to conclusions in delusional and non-delusional schizophrenic patients. Br J Clin Psychol 2005; 44 (Suppl. 02) 193-207.
    CrossrefPubMedGoogle Scholar
  • 29 Morrison AP. The interpretation of intrusions in psychosis: An integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy 2001; 29 (Suppl. 03) 257-276.
    Google Scholar
  • 30 Pilling S, Bebbington P, Kuipers E, Garety PA, Geddes J, Orbach G. et al. Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med 2002; 32: 763-782.
    CrossrefPubMedGoogle Scholar
  • 31 Sensky T, Turkington D, Kingdon D, Scott JL, Scott J, Siddle R. et al. A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Arch Gen Psychiatry 2000; 57 (Suppl. 02) 165-172.
    CrossrefPubMedGoogle Scholar
  • 32 Smith B, Fowler DG, Freeman D, Bebbington P, Bashforth H, Garety PA. et al. Emotion and psychosis: Links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations. Schizophr Res 2006; 86 1–3 181-188.
    CrossrefPubMedGoogle Scholar
  • 33 Startup H, Freeman D, Garety PA. Persecutory delusions and catastrophic worry in psychosis: Developing the understanding of delusion distress and persistence. Behaviour Research and Therapy 2007; 45 (Suppl. 03) 523-537.
    CrossrefPubMedGoogle Scholar
  • 34 Tarrier N, Beckett R, Harwood S, Baker A, Yusupoff L, Ugarteburu I. A trial of two cognitive-behavioural methods of treating drug- resistant residual psychotic symptoms in schizophrenic patients: I. Outcome. Br J Psychiatry 1993; 162: 524-532.
    CrossrefPubMedGoogle Scholar
  • 35 Tarrier N, Wykes T. Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale?. Behav Res Ther 2004; 42 (Suppl. 12) 1377-1401.
    CrossrefPubMedGoogle Scholar
  • 36 Tarrier N, Yusupoff L, Kinney C, McCarthy E, Gledhill A, Haddock G. et al. Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia. BMJ 1998; 317 (Suppl. 08) 303-307.
    CrossrefPubMedGoogle Scholar
  • 37 Wykes T, Steel C, Everitt B, Tarrier N. Cognitive behavior therapy for schizophrenia: Effect sizes, clinical models, and methodological rigor. Schizophr Bull 2008; 34 (Suppl. 03) 523-537.
    PubMedGoogle Scholar
  • 38 Klingberg S. et al. Kognitiv-verhaltenstherapeutische Behandlung von Negativsymptomatik bei schizophrenen Psychosen. Nervenheilkunde 2008; 27: 997-1006.
    Article in Thieme ConnectGoogle Scholar