Zusammenfassung
Die Dichotomisierung schizophrener Symptomatik in „Plus-” und „Minussymptome”, die in letzter Zeit in erster Linie aus dem Blickwinkel der Psychopharmakologie erfolgte, hat die ja schon von Eugen Bleuler als zentral angesehenen kognitiven Störungen in den Hintergrund treten lassen. Dabei zeigen viele einschlägige Studien, dass schizophrene Patienten recht konsistent an kognitiven Störungen leiden. Dazu zählen in erster Linie Beeinträchtigungen der Daueraufmerksamkeit und der Gedächtnisfunktionen sowie der exekutiven Funktionen wie Planen und Problemlösen. Diese Störungen sind stabil oder progredient, bestehen oft auch während der Remissionsphasen der Schizophrenie weiter und beeinträchtigen sowohl die soziale Integration als auch die berufliche Leistungsfähigkeit. In der vorliegenden Übersichtsarbeit werden zunächst Forschungsergebnisse über kognitive Störungen bei Patienten mit schizophrenen Erkrankungen und ihre Beziehung zu psychosozialen Behinderungen beschrieben. Im Anschluss daran werden der therapeutische Wert und die möglichen Implikationen des Einsatzes der atypischen Antipsychotika und verschiedener kognitiver Therapiemethoden für die klinische Praxis dargestellt. Methodische Mängel und offene Fragen sowohl der pharmakologischen als auch der kognitiven Interventionen werden diskutiert.
Cognitive Dysfunctions in Schizophrenia - Medical and Psychological Treatment
Primarily from the perspective of psychopharmacology, schizophrenic symptomatology has recently been dichotomized into „plus” and „minus” symptoms, although the role of cognitive dysfunctions has been regarded as particularly important for the diagnosis since the time of Eugen Bleuler. Many studies show that schizophrenic patients suffer consistently from cognitive dysfunction. Among these, are impairments of attention and memory functions as well as executive functions such as planning and problem solving. These impairments are stable or progressive and often continue into the remission phase of schizophrenia and impair both social integration as well as occupational performance. In this overview, research results on cognitive dysfunction in patients with schizophrenic illnesses and their relation to psychosocial disabilities are described first. The therapeutic value and possible clinical-practice implications of atypical anti-psychotics and various cognitive therapy methods are then presented. Methodological weaknesses and open questions, both pharmacological and with regard to cognitive interventions, are discussed.
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Dr. med. Dr. phil. Gabriele Sachs
Universitätsklinik für Psychiatrie
Klinische Abt. für Sozialpsychiatrie u. Evaluationsforschung
Währinger Gürtel 18 - 201090 WienÖsterreich
Email: sachga1@akh-wien.ac.at
