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DOI: 10.1055/s-2004-830233
Neurokognitive Veränderungen und Negativsymptomatik bei schizophrenen Erkrankungen
Neurocognitive Changes and Negative Symptoms in SchizophreniaPublication History
Publication Date:
20 April 2005 (online)
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Zusammenfassung
Es ist weithin bekannt, dass schizophrene Erkrankungen häufig mit Beeinträchtigungen der kognitiven Leistungsfähigkeit einhergehen. In neuerer Zeit haben insbesondere Defizite höherer Kontroll- und Steuerungsprozesse („exekutive Funktionen”) das Forschungsinteresse erregt, da sie die Fähigkeit der Patienten, unabhängig zu leben, nachhaltig beeinträchtigen können. Darüber hinaus wird versucht, der Heterogenität schizophrener Psychopathologie gerecht zu werden, indem voneinander abgrenzbare psychopathologische Syndrome und Veränderungen in einzelnen kognitiven Bereichen miteinander in Beziehung gesetzt werden. Die vorliegende Übersichtsarbeit unterzieht vor allem diejenigen Befunde einer eingehenden Betrachtung, die eine Assoziation zwischen schizophrener Negativsymptomatik und Beeinträchtigungen exekutiver Steuerungsprozesse herstellen. Aus neurobiologischer Sicht ergeben sich Hinweise darauf, dass biochemische, strukturelle und funktionelle Abweichungen im Frontalkortex und assoziierten fronto-subkortikalen Schleifen eine gemeinsame Basis der schizophrenen Negativsymptomatik und Störungen der exekutiven Handlungskontrolle bilden. Zahlreiche neuropsychologische Untersuchungen belegen eine Assoziation zwischen Negativsymptomatik und Defiziten in den kognitiven Bereichen Reaktionsinhibition, parallele Aufgabenbearbeitung, kognitive Flexibilität, Kontextaktualisierung, Problemlösen und Wortflüssigkeit. In manchen Fällen wird jedoch eher das Desorganisationssyndrom und nicht die Negativsymptomatik mit mangelhaften Leistungen in den genannten Bereichen in Verbindung gebracht. Die inkonsistenten Befunde werden teilweise auf eine unbefriedigende Abgrenzung der beiden Symptomkomplexe zurückgeführt.
Künftige Forschungsvorhaben sollten eine genauere Differenzierung zwischen primärer und sekundärer Negativsymptomatik in Betracht ziehen. Auch wäre sowohl eine möglichst spezifische als auch eine ökologisch valide Erfassung höherer Kontroll- und Steuerungsprozesse wünschenswert.
Abstract
It is widely recognized that schizophrenic disorders are often associated with impairments of cognitive performance. More recently, disorders of higher cognitive control processes (“executive control functions”) have captured the attention of researchers as they can considerably impair patients’ abilities to live an independent life. Apart from that, considering the heterogeneity of schizophrenia, there have been attempts to relate psychopathological syndromes to changes in distinct cognitive domains. The present review selectively focuses on evidence associating negative symptoms in schizophrenia with deficient performance in specific executive domains. Neurobiological evidence points to biochemical, structural and functional abnormities in the frontal cortex and associated fronto-subcortical circuits as a common basis of both schizophrenic negative symptoms and disorders of executive control. In a multitude of neuropsychological studies, an association between negative symptoms and problems in the domains of response inhibition, multitasking, cognitive flexibility, contextual updating, problem solving and verbal fluency has been reported. In some cases, however, the disorganization syndrome but not the negative syndrome has been linked with impaired behaviour in these domains. The inconsistencies might be partly due to the unsatisfactory differentiation between the two symptom complexes. Future research should furthermore consider a more precise differentiation between primary and secondary negative symptoms. Finally, the assessment of executive control functions should be both specific and ecologically valid.
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Dipl.-Psych. Patrizia Thoma
Institut für Kognitive Neurowissenschaft, Abteilung Neuropsychologie · Ruhr-Universität Bochum
Universitätsstraße 150
44801 Bochum
Email: Patrizia.Thoma@rub.de