Alternative biologische Therapien - In der Behandlung der Negativsymptomatik und der kognitiven Störungen

Die biologische Therapie der Schizophrenie beruht im Wesentlichen auf der Behandlung mit Psychopharmaka. In diesem Beitrag werden zwei weitere, neuere Verfahren vorgestellt, die zukünftig Einfluss auf die Behandlung schizophrener Patienten haben könnten. Die Behandlung mit intensivem körperlichen Training könnte über eine Verbesserung der Neuroplastizität Minussymptome und kognitive Störungen verbessern. Die repetitive transkranielle Magnetstimulation wird heute bereits teilweise zur Behandlung von Minussymptomatik und akustischen Halluzinationen eingesetzt. Für beide Verfahren werden die Rationale und der gegenwärtige Stand der wissenschaftlichen Erkenntnis dargestellt.

The biological therapy of schizophrenia is based on psychopharmacology. In this paper two novel approaches are presented which might contribute to future treatment of patients with schizophrenia. Exercise might improve negative symptoms and cognitive impairment through increased synaptic plasticity. Repetitive transcranial magnet stimulation is already used for the treatment of negative symptoms and acustic hallucinations. For both treatments the rationale and the current state of evidence is reviewed.

Key words

Schizophrenia - exercise - repetitive transcranial magnet stimulation - negative symptoms - cognition - acustic hallucinations

Literatur

• 1 Adams L.. How exercise can help people with mental health problems.  Nurs Times. 1995;  91 37-39
• 2 Arnold SE, Han L-Y, Moberg PJ. et al. . Dysregulation of olfactory receptor neuron lineage in schizophrenia.  Arch Gen Psychiatry. 2001;  58 829-835
• 3 Bertolino A, Callicott JH, Elman I. et al. . Regionally specific neuronal pathology in untreated patients with schizophrenia: a proton magnetic resonance spectroscopic imaging study.  Biol Psychiatry. 1998;  43 641-8
• 4 Cameron HA, McEwen BS, Gould E.. Regulation of adult neurogenesis by excitatory input and NMDA receptor activation in the dentate gyrus.  J Neurosci. 1995;  15 4687-4692
• 5 Chibbaro G, Daniele M, Alagona G. et al. . Repetitive transcranial magnetic stimulation in schizophrenic patients reporting auditory hallucinations.  Neurosci Lett. 2005;  383 54-57
• 6 Colcombe SJ, Kramer AF, Erickson KI. et al. . Cardiovascular fitness, cortical plasticity, and aging.  Proc Nat Acad Sci USA. 2004;  101 3316-3321
• 7 Cordes J, Arends M, Mobascher A. et al. . Potential clinical targets of repetitive transcranial magnetic stimulation treatment in schizophrenia.  Neuropsychobiology. 2006;  54 87-99
• 8 Cotman CW, Berchtold NC.. Exercise: a behavioral intervention to enhance brain health and plasticity.  Trends Neurosci. 2002;  25 295-301
• 9 Dannhorn R.. Leistungssport in der Psychose.  Psychother Med Psychol. 1985;  35 193-197
• 10 Deimel H, Lohmann S.. Zur körperlichen Leistungsfähigkeit von schizophren erkrankten Patienten.  Rehabilitation. 1983;  22 81-85
• 11 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) (Hrsg.). .S3-Praxisleitlinien Psychiatrie und Psychotherapie. Band 1. Behandlungsleitlinie Schizophrenie. Leitlinienprojektgruppe: W. Gaebel, P. Falkai, S. Weinmann, T. Wobrock. Darmstadt: Steinkopff-Verlag 2006
• 12 Draganski B, Gaser C, Busch V. et al. . Changes in grey matter induced by training.  Nature. 2004;  427 311-312
• 13 Eriksson PS, Perfilieva E, Bjork-Eriksson T. et al. . Neurogenesis in the adult human hippocampus.  Nat Med. 1998;  4 1313-1317
• 14 Falkai P, Wobrock T, Lieberman J. et al. . World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, Part 1: acute treatment of schizophrenia.  World J Biol Psychiatry. 2005;  3 132-191
• 15 Gaser C, Schlaug G.. Brain structures differ between musicians and non-musicians.  J Neurosci. 2003;  23 9240-9245
• 16 Gould E, McEwen BS, Tanapat P. et al. . Neurogenesis in the dentate gyrus of the adult tree shrew is regulated by psychosocial stress and NMDA receptor activation.  J Neurosci. 1997;  17 2492-2498
• 17 Hajak G, Marienhagen J, Langguth B. et al. . High-frequency repetitive transcranial magnetic stimulation in schizophrenia: a combined treatment and neuroimaging study.  Psychol Med. 2004;  34 1157-1163
• 18 Harrison PJ, Weinberger DR.. Schizophrenia genes, gene expression, and neuropathology: on the matter of their convergence.  Mol Psychiatry. 2005;  10 40-68
• 19 Heinrichs RW, Zakzanis KK.. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence.  Neuropsychology. 1998;  12 426-445
• 20 Hoff AL, Sakuma M, Wieneke M. et al. . Longitudinal neuropsychological follow-up study of patients with first-episode schizophrenia.  Am J Psychiatry. 1999;  156 1336-1341
• 21 Hoffman RE, Boutros NN, Hu S. et al. . Transcranial magnetic stimulation and auditory hallucinations in schizophrenia.  Lancet. 2000;  355 1073-1075
• 22 Hoffman RE, Hawkins KA, Gueorguieva R. et al. . Transcranial magnetic stimulation of left temporoparietal cortex and medication-resistant auditory hallucinations.  Arch Gen Psychiatry. 2003;  60 49-56
• 23 Hoffman RE, Gueorguieva R, Hawkins KA. et al. . Temporoparietal transcranial magnetic stimulation for auditory hallucinations: safety, efficacy and moderators in a fifty patient sample.  Biol Psychiatry. 2005;  58 97-104
• 24 Holi MM, Eronen M, Toivonen K. et al. . Left prefrontal repetitive transcranial magnetic stimulation in schizophrenia.  Schizophr Bull. 2004;  30 429-434
• 25 Hollmann W, Strüder H.. Gehirn, Psyche und körperliche Aktivität.  Orthopäde. 2000;  28 948-956
• 26 Hollmann W, Strüder H, Tagarakis C.. Körperliche Aktivität fördert Gehirngesundheit und -leistungsfähigkeit - Übersicht und eigene Befunde.  Nervenheilkunde. 2003;  22 467-474
• 27 Jin Y, Potkin SG, Kemp AS. et al. . Therapeutic effects of individualized alpha-frequency transcranial magnetic stimulation (alpha-TMS) on the negative symptoms of schizophrenia.  Schizophr Bull. 2006;  32 556-561
• 28 Kim JJ, Mohamed S, Andreasen NC. et al. . Regional neural dysfunction in chronic schizophrenia studied with positron emission tomography.  Am J Psychiatry. 2000;  157 542-548
• 29 Klein E, Kolsky Y, Puyerovsky M. et al. . Right prefrontal slow repetitive transcranial magnetic stimulation in schizophrenia: a double-blind sham-controlled pilot study.  Biol Psychiatry. 1999;  46 1451-1454
• 30 Längle G, Sießmen G, Hornberger S.. Die Rolle des Sports in der Behandlung und Rehabilitation schizophrener Patienten.  Rehabilitation. 2000;  39 276-282
• 31 Lee SH, Kim W, Chung YC. et al. . A double blind study showing that two weeks of daily repetitive TMS over the left or right temporoparietal cortex reduces symptoms in patients with schizophrenia who are having treatment-refractory auditory hallucinations.  Neurosci Lett.. 2005;  376 177-181
• 32 Maeda F, Pascual-Leone A.. Transcranial magnetic stimulation: studying motor neurophysiology of psychiatric disorders.  Psychopharmacology. 2003;  168 359-376
• 33 May A, Hajak G, Gänssbauer S. et al. . Structural brain alterations following 5 days of intervention: dynamic aspects of neuroplasticity.  Cereb Cortex. 2006;  17 205-210
• 34 McIntosh AM, Semple D, Tasker K. et al. . Transcranial magnetic stimulation for auditory hallucinations in schizophrenia.  Psychiatry Res. 2004;  127 9-17
• 35 Pajonk FG, Berner D, Kaizl I. et al. . The effects of physical exercise on brain morphology in patients with schizophrenia.  Schiz Res. 2008;  98 129-130
• 36 Pereira AC, Huddleston DE, Brickman AM. et al. . An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus.  Proc Nat Acad Sci USA. 2007;  104 5638-5643
• 37 Potkin SG, Alva G, Fleming K. et al. . A PET study of the pathophysiology of negative symptoms in schizophrenia.  Am J Psychiatry. 2002;  159 227-237
• 38 Poulet E, Brunelin J, Bediou B. et al. . Slow transcranial magnetic stimulation can rapidly reduce resistant auditory hallucinations in schizophrenia.  Biol Psychiatry. 2005;  57 188-191
• 39 Reif A, Fritzen S, Finger M. et al. . Neural stem cell proliferation is decreased in schizophrenia, but not in depression.  Mol Psychiatry. 2006;  11 514-522
• 40 Rollnik JD, Huber TJ, Mogk H. et al. . High frequency repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex in schizophrenic patients.  Neuroreport. 2000;  11 4013-4015
• 41 Saba G, Verdon CM, Kalalou K. et al. . Transcranial magnetic stimulation in the treatment of schizophrenic symptoms: a double blind sham controlled study.  J Psychiatr Res. 2006;  40 147-152
• 42 Schmitt A, Weber-Fahr W, Jatzko A. et al. . Aktueller Überblick über strukturelle Magnetresonanztomographie bei Schizophrenie.  Fortschr Neurol Psychiatr. 2001;  69 105-15
• 43 Schönfeldt-Lecuona C, Gron G, Walter H. et al. . Stereotaxic rTMS for the treatment of auditory hallucinations in schizophrenia.  Neuroreport. 2004;  15 1669-1673
• 44 Seidman LJ, Faraone SV, Goldstein JM. et al. . Left hippocampal volume as a vulnerability indicator for schizophrenia: a magnetic resonance imaging morphometric study of nonpsychotic first-degree relatives.  Arch Gen Psychiatry. 2002;  59 839-849
• 45 Silbersweig DA, Stern E, Frith C. et al. . A functional neuroanatomy of hallucinations in schizophrenia.  Nature. 1995;  378 176-179
• 46 Smesny S, Sauer H.. Wirksamkeitsnachweis der Elektrokonvulsionstherapie. In: Baghai TC, Frey R, Kasper S, Möller HJ (Hrsg.). Elektrokonvulsionstherapie. Klinische und wissenschaftliche Aspekte. Heidelberg: Springer-Verlag 2004: 43-46
• 47 Tharyan P, Adams CE.. Electroconvulsive therapy for schizophrenia (Cochrane Review). In: The Cochrane Library 2004 , Issue 2. Chichester, UK: John Wiley & Sons, Ltd
• 48 van Praag H, Christie BR, Sejnowski TJ, Gage FH.. Running enhances neurogenesis, learning, and long-term potentiation in mice.  Proc Natl Acad Sci USA. 1999;  96 13427-13431
• 49 van Praag H, Kempermann G, Gage FH.. Running increases cell proliferation and neurogenesis in the adult mouse dentate gyrus.  Nat Neurosci. 1999;  2 266-270
• 50 Vogeley K, Schneider-Axmann T, Pfeiffer U. et al. . Disturbed gyrification of the prefrontal region in male schizophrenic patients: A morphometric postmortem study.  Am J Psychiatry. 2000;  157 34-39
• 51 Wassermann EM, Lisanby SH.. Therapeutic application of repetitive transcranial magnetic stimulation: a review.  Clin Neurophysiol. 2000;  112 1367-1377
• 52 Weinberger DR.. Cell biology of the hippocampal formation in schizophrenia.  Biol Psychiatry. 1999;  45 395-402
• 53 Winter B, Breitenstein C, Mooren FC. et al. . High impact running improves learning.  Neurobiol Learn Mem. 2007;  87 597-609
• 54 Wobrock T, Kadovic D, Falkai P.. Kortikale Erregbarkeit bei Schizophrenie: Untersuchungen mit der transkraniellen Magnetstimulation (TMS).  Nervenarzt. 2007;  78 753-763
• 55 Wright IC, Rabe-Hesketh S, Woodruff PW. et al. . Meta-analysis of regional brain volumes in schizophrenia.  Am J Psychiatry. 2000;  157 16-25

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