Neurokognition, psychosozialer Outcome und berufliche Integration

Zusammenfassung

In den letzten Jahren konnten deutliche Fortschritte in der Schizophreniebehandlung, vor allem in der Behandlung der Positivsymptomatik erreicht werden. Trotzdem zeigen jedoch viele Betroffene eine unbefriedigendes funktionelles Behandlungsresultat, vor allem im sozialen und beruflichen Bereich. Es konnte in verschiedenen Studien gezeigt werden, dass ein Zusammenhang zwischen neurokognitiven Defiziten und dem funktionellen Behandlungsresultat besteht. Therapeutische Interventionsmöglichkeiten hinsichtlich kognitiver Defizite sind z. B. medikamentöse und/oder verhaltenstherapeutische bzw. soziotherapeutische Maßnahmen. Neurokognitive Defizite beeinflussen zudem das Behandlungsergebnis hinsichtlich der beruflichen Integration. Es gilt Rehabilitationsverfahren unter individueller Berücksichtigung der jeweiligen kognitiven Defizite zu entwerfen.

Abstract

A lot of progress has been made in the treatment of schizophrenia against hallucinations and delusions. However, Schizophrenia still remains a highly disabling disease causing tremendous deficits in social- and vocational functioning. Cognitive deficits are known since the early 90's as a further core feature of schizophrenia, and it has been shown that social- and vocational dysfunctions are closely related to neurocognitive deficits. Whether those findings bear a potential for therapeutic implications still needs to be shown. In this overview therapeutic interventions with respect to cognitive deficits and their effectiveness and their role for vocational rehabilitation will be summarized.

Literatur

• 1 Robinson D G, Woerner M G, Alvir J M. et al . Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder.  Am J Psychiatry. 1999;  156 544-549
• 2 Kane J, Honigfeld G, Singer J. et al . Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine.  Arch Gen Psychiatry. 1988;  45 789-779
• 3 Haggerty C, Buckley P, Kenny J T. et al . Improvement in cognitive function and psychiatric symptoms in treatment refractory schizophrenic patients receiving clozapine.  Biol Psychiatry. 1993;  34 702-712
• 4 Dickerson F B, Ringel N B, Parente F. Subjective Quality of Life in out-patients with schizophrenia: clinical and utilization correlates.  Acta Psychiatr Scand. 1998;  98 124-127
• 5 Brekke J S, Kohrt B, Green M F. Neuropsychological functioning as a moderator of the relationship between psychosocial functioning and the subjective experience of self and life in schizophrenia.  Schizophr Bull. 2001;  27 697-708
• 6 Dworkin E H, Cornblatt B A, Frieman R, Kaplansky L M, Lewis J A, Rinaldi A, Shilliday C, Erlenmeyer L. Childhood precursors of affective vs. social deficits in adolescents at risk for schizophrenia.  Schizophrenia Bulletin. 1993;  19 563-577
• 7 Erlenmeyer-Kimling L, Cornblatt B A. The New York High-Risk Report: A follow up report.  Schizophrenia Bulletin. 1987;  13 451-463
• 8 Bilder R M, Goldman R S, Robinson D. et al . Neuropsychology of first-episode schizophrenia: initial characterization and clinical correlates.  Am J Psychiatry. 2000;  157 549-559
• 9 Nuechterlein K H, Dawson M E, Green M. Information-processing abnormalities as neuropsychological vulnerability indicators for schizophrenia.  Acta Psychiatrica Scandinavica. 1994;  90, Suppl 384 71-79
• 10 Green M F, Kern R S, Braff D L, Mintz J. Neurocognitive Deficits and Functional Outcome in Schizophrenia: Are we measuring the ”Right Stuff”?.  Schizophrenia Bulletin. 2000;  26 119-136
• 11 Harvey P D, Grenn F M, Keefe R S, Velligan D I. Cognitive Functioning in Schizophrenia: A consensus statement on its Role in the Definition and Evaluation of Effective Treatments for the Illness.  J Clin Psychiatry. 2004;  65 361-372
• 12 Spohn H E, Strauss M E. Relation of neuroleptic and anticholinergic medication to cognitive functions in Schizophrenia.  J Abnorm Psychol. 1989;  98 478-486
• 13 Green M F, Marder S R, Glynn S M. et al . The neurocognitive effects of low-dose haloperidol: a two year comparison with risperidone.  Biol Psychiatry. 2002;  51 972-978
• 14 Harvey P D, Green M F, Meltzer H Y. et al . The cognitive effects of risperidone and olanzapine in patients with schizoaffective disorder or schizophrenia.  Psychopharmacology (Berl). 2003;  169 404-411
• 15 Velligan D I, Prihoda T J, Sui D. et al . The effectiveness of quetiapine versus conventional antipsychotics in improving cognitive and functional outcomes in standard treatment settings.  J Clin Psychiatry. 2003;  64 (5) 524-531
• 16 Brenner H D, Stranke W G, Mewes W G, Liese J, Seeger G. Erfahrungen mit einem spezifischen Therapieprogramm zum Training kognitiver und kommunikativer Fähigkeiten in der Rehabilitation chronisch schizophrener Patienten.  Nervenarzt. 1980;  51 106-112
• 17 Kern R S, Green M F, Goldstein M J. Modification of performance on the Span of Apprehension, a putative marker of vulnerability to schizophrenia.  J Abnorm Psychology. 1995;  104 385-409
• 18 O'Carrol R E, Russel H H, Lawrie S M, Johnstone E C. Errorless Learning and the cognitive rehabilitation of memory-impaired schizophrenic patients.  Psychological medicine. 1999;  29 105-112
• 19 Olbrich R, Mussgay L. Reduction of schizophrenic deficits by cognitive training. An evaluative study.  Eur Arch Psychiatry and Neurological Science. 1990;  239 366-369
• 20 Hermanutz M, Gestrich J. Computer assisted attention training in schizophrenics: A comperative study.  Eur Arch Psychiatry and Neurological Science. 1991;  240 282-287
• 21 Jaeger J, Douglas E. Neuropsychiatric rehabilitation for persistent mental illness.  Psychiatric Quarterly. 1992;  63 71-101
• 22 Hegarty J D, Baldessarini R J, Tohen M. One hundred years of schizophrenia: a meta-analysis of the outcome literature.  Am J Psychiatry. 1994;  151 1409-1416
• 23 Goldman R S, Axelrodt B N, Tandon R, Ribeiro S CN. et al . Neuropsychological prediction of treatment efficacy and one-year outcome in schizophrenia.  Psychopathology. 1993;  26 (3 - 4) 122-126
• 24 Meltzer H Y, McGurk S R. The effects of clozapine, risperidone and olanzapine on cognitive functioning in schizophrenia.  Schizophrenia Bulletin. 1999;  25 233-255
• 25 McGurk S R, Meltzer H Y. The role of cognition in vocational functioning in schizophrenia.  Schizophrenia research. 2000;  45 175-184
• 26 Drake R E, McHugo G J, Becker D R, Anthony W A, Clark R E. The New Hampshire Study of supported employment for people with severe mental illness.  Journal of Labor Economics. 1996;  64 391-399