Remission und Recovery: Neue Hoffnung – realistische Ziele in der Schizophrenietherapie

Zusammenfassung

Der Übersichtsartikel stellt kritisch die unterschiedlichen Definitionen und die Diskussion um die Begriffe Remission und Recovery dar, die in der Verlaufsbeschreibung, Therapieplanung und bei der Festlegung von Therapiezielen wichtige Aspekte für Betroffene, Angehörige und Professionelle abbilden. Eine symptomatische Remission ist gut definiert und wird von ca. 30 – 60 % der Ersterkrankten erreicht. Diese ist aber nicht gleichzusetzen mit funktionaler, sozialer und subjektiver Remission. Der Begriff der Recovery wird unterschiedlich definiert und ist bisher noch relativ wenig empirisch untersucht worden, stellt jedoch eine wichtige Erweiterung oft eng gefasster Therapieziele dar, die durch subjektive und objektive sowie persönliche und klinische Perspektiven ergänzt werden. Hoffnung zu vermitteln und zu erhalten ist hierbei entscheidend und geht über das Therapieziel einer häufig eher resignativen Symptomtherapie hinaus. Dennoch bleibt der Umgang mit Hoffnung eine Gratwanderung. Zu wenig Hoffnung kann Pessimismus auslösen, der wiederum erhebliche negative therapeutische und persönliche Folgen haben kann. Umgekehrt kann ein unkritischer Umgang mit ihr auch unrealistische Erwartungen schüren, deren Folge ebenfalls Frustration und Resignation sein können.

Abstract

The present review critically appraises the various different definitions of and the ongoing discussions about the terms remission and recovery, which represent important aspects for describing the disease course, therapy planning and the setting of therapeutic targets for the patient, relatives and the professional care-giver. A symptomatic remission is well defined and is reached by about 30 – 60 % of the first-time patients. However, this is not to be equated with functional, social and subjective remission. The term recovery has various definitions and has as yet only been studied in a relatively unempirical manner but represents an important supplement to the often strictly formulated therapeutic targets that need to be complemented by subjective and objective as well as personal and clinical perspectives. To inspire and maintain hope is thus an essential factor that extends beyond the therapeutic target of an often rather resigning symptomatic therapy. Even so, the provision of hope remains a balancing act. Too little hope can induce pessimism which in turn may have considerable negative therapeutic and personal consequences. On the other hand an uncritical attitude to hope may lead to unrealistic expectations – inevitably to be followed by frustration and resignation again.

Schlüsselwörter

Remission - Recovery - Schizophrenie

Key words

remission - recovery - schizophrenia

• Literatur

• 1 Frese 3rd FJ, Knight EL, Saks E. Recovery from schizophrenia: with views of psychiatrists, psychologists, and others diagnosed with this disorder. Schizophr Bull 2009; 35: 370-380
• 2 Rund BH. Fully recovered schizophrenics: a retrospective study of some premorbid and treatment factors. Psychiatry 1990; 53 (02) 127-139
• 3 Remington G, Foussias G, Agid O. Progress in defining optimal treatment outcome in schizophrenia. CNS Drugs 2010; 24 (01) 9-20
• 4 Andreasen NC et al. Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 2005; 162 (03) 441-449
• 5 Robinson DG et al. Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry 2004; 161 (03) 473-479
• 6 Harrison G et al. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry 2001; 178: 506-517
• 7 Harrow M et al. Do patients with schizophrenia ever show periods of recovery? A 15-year multi-follow-up study. Schizophr Bull 2005; 31 (03) 723-734
• 8 Carr VJ. Recovery from schizophrenia: a review of patterns of psychosis. Schizophr Bull 1983; 9: 95-121
• 9 Jobe TH, Harrow M. Long-term outcome of patients with schizophrenia: a review. Can J Psychiatry 2005; 50 (14) 892-900
• 10 Warner R. Recovery from schizophrenia and the recovery model. Curr Opin Psychiatry 2009; 22 (04) 374-380
• 11 Henry LP et al. The EPPIC follow-up study of first-episode psychosis: longer-term clinical and functional outcome 7 years after index admission. J Clin Psychiatry 2010; 71 (06) 716-728
• 12 Frank E et al. Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Arch Gen Psychiatry 1991; 48 (09) 851-855
• 13 Leucht S et al. Defining 'response' in antipsychotic drug trials: recommendations for the use of scale-derived cutoffs. Neuropsychopharmacology 2007; 32 (09) 1903-1910
• 14 Leucht S et al. Methodological issues in current antipsychotic drug trials. Schizophr Bull 2008; 34 (02) 275-285
• 15 Lambert M et al. Remission in schizophrenia: validity, frequency, predictors, and patients' perspective 5 years later. Dialogues Clin Neurosci 2010; 12 (03) 393-407
• 16 Emsley R et al. The concepts of remission and recovery in schizophrenia. Curr Opin Psychiatry 2011; 24 (02) 114-121
• 17 Cassidy CM et al. Testing definitions of symptom remission in first-episode psychosis for prediction of functional outcome at 2 years. Schizophr Bull 2010; 36 (05) 1001-1008
• 18 Oorschot M et al. Symptomatic remission in psychosis and real-life functioning. Br J Psychiatry 2012; 201 (03) 215-220
• 19 Harvey PD, Bellack AS. Toward a terminology for functional recovery in schizophrenia: is functional remission a viable concept?. Schizophr Bull 2009; 35 (02) 300-306
• 20 Kane JM et al. The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary. J Clin Psychiatry 2003 ; 64 (Suppl. 12) 5-19
• 21 Chang WC et al. The concurrent and predictive validity of symptomatic remission criteria in first-episode schizophrenia. Schizophr Res 2013; 143 (01) 107-115
• 22 Boter H et al. Effectiveness of antipsychotics in first-episode schizophrenia and schizophreniform disorder on response and remission: an open randomized clinical trial (EUFEST). Schizophr Res 2009; 115 (2-3) 97-103
• 23 Ceskova E et al. One-year follow-up of patients with first-episode schizophrenia (comparison between remitters and non-remitters). Neuropsychiatr Dis Treat 2007; 3 (01) 153-160
• 24 Crespo-Facorro B et al. Relapse prevention and remission attainment in first-episode non-affective psychosis. A randomized, controlled 1-year follow-up comparison of haloperidol, risperidone and olanzapine. J Psychiatr Res 2011; 45 (06) 763-769
• 25 Menezes NM et al. A multi-site Canadian perspective: examining the functional outcome from first-episode psychosis. Acta Psychiatr Scand 2009; 120 (02) 138-146
• 26 Saravanan B et al. Outcome of first-episode schizophrenia in India: longitudinal study of effect of insight and psychopathology. Br J Psychiatry 2010; 196 (06) 454-459
• 27 Ventura J et al. Remission and recovery during the first outpatient year of the early course of schizophrenia. Schizophr Res 2011; 132 (01) 18-23
• 28 Wunderink L et al. Predictive validity of proposed remission criteria in first-episode schizophrenic patients responding to antipsychotics. Schizophr Bull 2007; 33 (03) 792-796
• 29 Addington J, Addington D. Symptom remission in first episode patients. Schizophr Res 2008; 106 (02) 281-285
• 30 Petersen L et al. Predictors of remission and recovery in a first-episode schizophrenia spectrum disorder sample: 2-year follow-up of the OPUS trial. Can J Psychiatry 2008; 53 (10) 660-670
• 31 Emsley R et al. Remission in first-episode psychosis: predictor variables and symptom improvement patterns. J Clin Psychiatry 2006; 67 (11) 1707-1712
• 32 Emsley R, Rabinowitz J, Medori R. Remission in early psychosis: Rates, predictors, and clinical and functional outcome correlates. Schizophr Res 2007; 89 (1-3) 129-139
• 33 Oosthuizen P et al. The relationships between depression and remission in first-episode psychosis. World Psychiatry 2006; 5 (03) 172-176
• 34 Verma S et al. Symptomatic and functional remission in patients with first-episode psychosis. Acta Psychiatr Scand 2012; 126 (04) 282-289
• 35 de Haan L et al. Improvement of subjective well-being and enduring symptomatic remission, a 5-year follow-up of first episode schizophrenia. Pharmacopsychiatry 2008; 41 (04) 125-128
• 36 Clarke M et al. Untreated illness and outcome of psychosis. Br J Psychiatry 2006; 189: 235-240
• 37 Ucok A, Serbest S, Kandemir PE. Remission after first-episode schizophrenia: results of a long-term follow-up. Psychiatry Res 2011; 189 (01) 33-37
• 38 Boden R et al. Association between symptomatic remission and functional outcome in first-episode schizophrenia. Schizophr Res 2009; 107 (2-3) 232-237
• 39 Crumlish N et al. Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis. Br J Psychiatry 2009; 194 (01) 18-24
• 40 Hegelstad WT et al. Long-term follow-up of the TIPS early detection in psychosis study: effects on 10-year outcome. Am J Psychiatry 2012; 169 (04) 374-380
• 41 van Os J et al. Validation of remission criteria for schizophrenia. Am J Psychiatry 2006; 163 (11) 2000-2002
• 42 Helldin L et al. Remission in prognosis of functional outcome: a new dimension in the treatment of patients with psychotic disorders. Schizophr Res 2007; 93 (01) 160-168
• 43 Helldin L et al. Remission and cognitive ability in a cohort of patients with schizophrenia. J Psychiatr Res 2006; 40 (08) 738-745
• 44 Shrivastava A et al. Redefining outcome measures in schizophrenia: integrating social and clinical parameters. Curr Opin Psychiatry 2010; 23 (02) 120-126
• 45 van Os J et al. Standardized remission criteria in schizophrenia. Acta Psychiatr Scand 2006; 113 (02) 91-95
• 46 Lambert M et al. Rates and predictors of remission and recovery during 3 years in 392 never-treated patients with schizophrenia. Acta Psychiatr Scand 2008; 118 (03) 220-229
• 47 Karow A et al. Remitted but still impaired? Symptomatic versus functional remission in patients with schizophrenia. Eur Psychiatry 2011; 27 (06) 401-405
• 48 Naber D. Keeping care survey. in prep. 2013;
• 49 Karow A et al. Remission as perceived by people with schizophrenia, family members and psychiatrists. Eur Psychiatry 2011; 27 (06) 426-431
• 50 Lysaker PH et al. The Scale to Assess Narrative Development: association with other measures of self and readiness for recovery in schizophrenia spectrum disorders. J Nerv Ment Dis 2006; 194 (03) 223-225
• 51 Slade M. Personal Recovery and Mental Illness: A Guide for Mental Health Professionals. Cambridge UK: ed. C. U. Press; 2009
• 52 Anthony WA. Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal 1993; 16: 11-23
• 53 Leamy M et al. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Br J Psychiatry 2011; 199 (06) 445-452
• 54 Andresen R, Oades L, Caputi P. The experience of recovery from schizophrenia: towards an empirically validated stage model. Aust N Z J Psychiatry 2003; 37 (05) 586-594
• 55 Liberman RP. Recovery from schizophrenia: form follows functioning. World Psychiatry 2012; 11 (03) 161-162
• 56 Bellack AS. Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. Schizophr Bull 2006; 32 (03) 432-442
• 57 Noiseux S et al. The process of recovery of people with mental illness: the perspectives of patients, family members and care providers: part 1. BMC Health Serv Res 2010; 10: 161
• 58 Roe D, Mashiach-Eizenberg M, Lysaker PH. The relation between objective and subjective domains of recovery among persons with schizophrenia-related disorders. Schizophr Res 2011; 131 (1-3) 133-138
• 59 Andresen R, Caputi P, Oades LG. Do clinical outcome measures assess consumer-defined recovery?. Psychiatry Res 2010; 177 (03) 309-317
• 60 Lloyd C, King R, Moore L. Subjective and objective indicators of recovery in severe mental illness: a cross-sectional study. Int J Soc Psychiatry 2009; 56 (03) 220-229
• 61 Lysaker PH, Roe D, Buck KD. Recovery and wellness amidst schizophrenia: definitions, evidence, and the implications for clinical practice. J Am Psychiatr Nurses Assoc 2010; 16 (01) 36-42
• 62 Lysaker PH et al. Psychotherapy and recovery from schizophrenia: A review of potential applications and need for future study. Psychol Serv 2010; 7 (02) 75-91
• 63 Amering M, Schmolke M. Recovery – das Ende der Unheilbarkeit. Psychiatrie Verlag Gmbh; 2007
• 64 Klapheck K et al. Subjective experience and meaning of psychoses: the German Subjective Sense in Psychosis Questionnaire (SUSE). Psychol Med 2012; 42 (01) 61-71
• 65 Boydell KM et al. A descriptive review of qualitative studies in first episode psychosis. Early Interv Psychiatry 2010; 4 (01) 7-24
• 66 Klapheck K et al. Subjective experience and meaning of psychoses: the German Subjective Sense in Psychosis Questionnaire (SUSE). Psychol Med 2011; 42 (01) 61-71
• 67 Health, P. s. N. F. C. o.M. Achieving the Promise: Transforming mental health care in America, Final Report. Rockville: 2003 Md: DHHS. Pub SMA-03-3832: http://mentalhealth.samhsa.gov/reports/FinalReport.htr
• 68 SAMSHA. National Consensus Statement on Mental Health Recovery Definition. 2003
• 69 Bellack AS, Drapalski A. Issues and developments on the consumer recovery construct. World Psychiatry 2012; 11 (03) 156-160
• 70 Drapalski AL et al. Assessing recovery of people with serious mental illness: development of a new scale. Psychiatr Serv 2012; 63 (01) 48-53
• 71 Leucht S, Lasser R. The concepts of remission and recovery in schizophrenia. Pharmacopsychiatry 2006; 39 (05) 161-170
• 72 Liberman R et al. Operational criteria and factors related to recovery from schizophrenia. Int Rev Psychiatry 2002; 14: 256-272
• 73 Davidson L, Rakfeldt J, Strauss J. The Roots of the Recovery Movement in Psychiatry. West Sussex: Wiley-Blackwell; 2010
• 74 Jaaskelainen E et al. A Systematic Review and Meta-Analysis of Recovery in Schizophrenia. Schizophr Bull 2012;
• 75 Menezes NM, Arenovich T, Zipursky RB. A systematic review of longitudinal outcome studies of first-episode psychosis. Psychol Med 2006; 36 (10) 1349-1362
• 76 Faerden A, Nesvag R, Marder SR. Definitions of the term 'recovered' in schizophrenia and other disorders. Psychopathology 2008; 41 (05) 271-278
• 77 Bock T et al. On subjective meaning of psychoses. Construction, validation and first application of a new questionnaire–the SuSi-Project (Hamburg). Psychiatr Prax 2010; 37 (06) 285-291
• 78 Bock T, Klapheck K, Ruppelt F. Sinnsuche und Genesung – Erfahrungen und Forschung zum subjektiven Sinn von Psychosen. Psychiatrie Verlag; 2014
• 79 Harrow M, Jobe TH. Does long-term treatment of schizophrenia with antipsychotic medications facilitate recovery?. Schizophr Bull 2013; 39 (05) 962-965
• 80 Bock T et al. Eigensinn und Psychose, Peer-Beratung und Psychotherapie. Psychotherapeut 2013; 58 (04) 364-370
• 81 Utschakowski J, Sielaff G, Bock T. Vom Erfahrenen zum Experten – Wie Peers die Psychiatrie verändern. Psychiatrie Verlag; 2009
• 82 Bock T, Priebe S. Psychosis seminars: an unconventional approach. Psychiatr Serv 2005; 56 (11) 1441-1443
• 83 Bock T, Naber D. „Anti-stigma campaign from below“ at schools--experience of the initiative „Irre menschlich Hamburg e. V.“. Psychiatr Prax 2003; 30 (07) 402-408
• 84 Whitley R, Drake RE. Recovery: a dimensional approach. Psychiatr Serv 2010; 61 (12) 1248-1250
• 85 Slade M et al. International differences in understanding recovery: systematic review. Epidemiol Psychiatr Sci 2012; 21 (04) 353-364
• 86 Doughty C, Tse S. Can consumer-led mental health services be equally effective? An integrative review of CLMH services in high-income countries. Community Ment Health J 2010; 47 (03) 252-266
• 87 MacCulloch T. Recovery and the rhetoric of illusion. Issues Ment Health Nurs 2011; 32 (03) 187-188
• 88 DGPPN. S3-Leitlinie Psychosoziale Therapien bei schweren psychischen Erkrankungen. Berlin: Springer; 2012
• 89 Leucht S et al. Definitions of response and remission in schizophrenia: recommendations for their use and their presentation. Acta Psychiatr Scand Suppl 2009; (438) 7-14
• 90 Liberman RP, Kopelowicz A. Recovery from schizophrenia: a concept in search of research. Psychiatr Serv 2005; 56 (06) 735-742
• 91 Lieberman JA et al. Science and recovery in schizophrenia. Psychiatr Serv 2008; 59 (05) 487-496