12 Jahre Kompetenznetz Schizophrenie: Ergebnisse und Perspektiven

Zusammenfassaung

Das Kompetenznetz Schizophrenie (KNS) wurde von 1999 bis 2011 vom Bundesministerium für Bildung und Forschung (BMBF) gefördert. Ziele und Struktur des Netzwerks mit horizontaler und vertikaler Vernetzung deutscher Forschungs- und Versorgungseinrichtungen dienten der wissenschaftlichen Bearbeitung offener Forschungsfragen zur Schizophrenie und der klinisch-praktischen Umsetzung von deren Ergebnissen. Im vorliegenden Beitrag werden Arbeitsweise und Ergebnisse des KNS anhand ausgewählter Forschungsprojekte dargestellt. Quantitative und qualitative Bewertungsparameter wie wissenschaftliche Publikationen und zusätzliche Drittmitteleinwerbung durch Folgeförderung sowie Nachwuchsförderung, Öffentlichkeitsarbeit, Kongressaktivitäten und Gründung einer europäischen Schizophreniegesellschaft belegen die erfolgreiche Arbeit des Netzwerks. Abschließend wird der Förderschwerpunkt des BMBF am Beispiel des KNS kritisch bewertet und künftige Förderperspektiven werden skizziert.

Abstract

The German Research Network on Schizophrenia (GRNS) was funded by the Federal Ministry of Education and Research (BMBF) from 1999 to 2011. The objectives and the structure of the network with its horizontal and vertical networking of German research and care facilities served for the scientific investigation of open research questions for schizophrenia, and the transfer of the results into clinical practice. In this paper, the functioning and results of the GRNS are described on the basis of selected research projects. Quantitative and qualitative evaluation parameters such as scientific publications and additional external funds, as well as promotion of young scientists, public relations activities, congress activities and foundation of an European Schizophrenia Association demonstrate the successful work of the network. As a final point, the funding programme of the BMBF is critically evaluated using the example of the GRNS and future funding prospects are outlined.

Schlüsselwörter

Schizophrenie - Kompetenznetz - Forschung - Versorgung - Förderprogramm

Key words

schizophrenia - competence network - research - health-care - funding programmes

• Literatur

• 1 Wölwer W, Buchkremer G, Häfner H et al. German research network on schizophrenia-bridging the gap between research and care. Eur Arch Psychiatry Clin Neurosci 2003; 253: 321-329
• 2 Schaffner N, Schimmelmann BG, Niedersteberg A et al. Versorgungswege von erstmanifesten psychotischen Patienten – eine Übersicht internationaler Studien. Fortschr Neurol Psychiatr 2011; 80: 72-78
• 3 Marshall M, Lewis S, Lockwood A et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 2005; 62: 975-983
• 4 Sahlmann MM, Vieten AB, Sheldrick AJ et al. Früherkennung und Frühbehandlung bei Patienten mit erhöhtem Schizophrenierisiko in Deutschland. Gesundheitswesen 2010; 72: 771-775
• 5 Häfner H, Maurer K, Ruhrmann S et al. Early detection and secondary prevention of psychosis: facts and visions. Eur Arch Psychiatry Clin Neurosci 2004; 254: 117-128
• 6 Klosterkötter J, Hellmich M, Steinmeyer EM et al. Diagnosing schizophrenia in the initial prodromal phase. Arch Gen Psychiatry 2001; 58: 158-164
• 7 Bechdolf A, Ruhrmann S, Wagner M et al. Interventions in the initial prodromal states of psychosis in Germany: concept and recruitment. Br J Psychiatry Suppl 2005; 48: s45-s48
• 8 Bechdolf A, Wagner M, Ruhrmann S et al. Preventing progression to first-episode psychosis in early initial prodromal states. Br J Psychiatry 2012; 200: 22-29
• 9 Ruhrmann S, Bechdolf A, Kuhn KU et al. Acute effects of treatment for prodromal symptoms for people putatively in a late initial prodromal state of psychosis. Br J Psychiatry Suppl 2007; 51: s88-s95
• 10 Ruhrmann S, Schultze-Lutter F, Salokangas RK et al. Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Arch Gen Psychiatry 2010; 67: 241-251
• 11 Bechdolf A, Muller H, Stutzer H et al. Rationale and baseline characteristics of PREVENT: a second-generation intervention trial in subjects at-risk (prodromal) of developing first-episode psychosis evaluating cognitive behavior therapy, aripiprazole, and placebo for the prevention of psychosis. Schizophr Bull 2011; 37 (Suppl. 02) S111-S121
• 12 Leucht S, Barnes TR, Kissling W et al. Relapse prevention in schizophrenia with new-generation antipsychotics: a systematic review and exploratory meta-analysis of randomized, controlled trials. Am J Psychiatry 2003; 160: 1209-1222
• 13 Geddes J, Freemantle N, Harrison P et al. Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. Bmj 2000; 321: 1371-1376
• 14 Marder SR, Essock SM, Miller AL et al. The Mount Sinai conference on the pharmacotherapy of schizophrenia. Schizophr Bull 2002; 28: 5-16
• 15 Kane JM, Leucht S, Carpenter D 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
• 16 National Institute for Clinical Excellence (NICE). Guidance on the Use of Newer (Atypical) Antipsychotic Drugs for the Treatment of Schizophrenia. Technology Appraisal Guidance 2002; 43
• 17 Stroup TS, McEvoy JP, Swartz MS et al. The National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project: schizophrenia trial design and protocol development. Schizophr Bull 2003; 29: 15-31
• 18 Fleischhacker WW, Keet IP, Kahn RS. The European First Episode Schizophrenia Trial (EUFEST): rationale and design of the trial. Schizophr Res 2005; 78: 147-156
• 19 Jones PB, Barnes TR, Davies L et al. Randomized controlled trial of the effect on Quality of Life of second- vs first-generation antipsychotic drugs in schizophrenia: Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS 1). Arch Gen Psychiatry 2006; 63: 1079-1087
• 20 American Psychiatric Association. Practice Guideline for the Treatment of Patients with Schizophrenia. Amer Psychiatric Pub Inc 1997;
• 21 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN). Praxisleitlinien in Psychiatrie und Psychotherapie. Darmstadt: Steinkopff; 2005. 1998
• 22 Gaebel W, Möller HJ, Buchkremer G et al. Pharmacological long-term treatment strategies in first episode schizophrenia--study design and preliminary results of an ongoing RCT within the German Research Network on Schizophrenia. Eur Arch Psychiatry Clin Neurosci 2004; 254: 129-140
• 23 Gaebel W, Riesbeck M, Wölwer W et al. Maintenance treatment with risperidone or low-dose haloperidol in first-episode schizophrenia: 1-year results of a randomized controlled trial within the German Research Network on Schizophrenia. J Clin Psychiatry 2007; 68: 1763-1774
• 24 Gaebel W, Riesbeck M, Wölwer W et al. Relapse prevention in first-episode schizophrenia--maintenance vs intermittent drug treatment with prodrome-based early intervention: results of a randomized controlled trial within the German Research Network on Schizophrenia. J Clin Psychiatry 2011; 72: 205-218
• 25 Wölwer W, Toeller V, Klingberg S et al. Spezialisierte Behandlungsangebote für erstmals schizophren Erkrankte: Konzepte und Ergebnisse. Fortschr Neurol Psychiatr 2012; 81: 276-283
• 26 Kirkpatrick B, Fenton WS, Carpenter Jr WT et al. The NIMH-MATRICS consensus statement on negative symptoms. Schizophr Bull 2006; 32: 214-219
• 27 Buchanan RW. Persistent negative symptoms in schizophrenia: an overview. Schizophr Bull 2007; 33: 1013-1022
• 28 Leucht S, Corves C, Arbter D et al. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet 2009; 373: 31-41
• 29 Correll CU. From receptor pharmacology to improved outcomes: individualising the selection, dosing, and switching of antipsychotics. Eur Psychiatry 2010; 25 (Suppl. 02) S12-S21
• 30 Le Francois B, Czesak M, Steubl D et al. Transcriptional regulation at a HTR1A polymorphism associated with mental illness. Neuropharmacology 2008; 55: 977-985
• 31 Drago A, Ronchi DD, Serretti A. 5-HT1A gene variants and psychiatric disorders: a review of current literature and selection of SNPs for future studies. Int J Neuropsychopharmacol 2008; 11: 701-721
• 32 Mössner R, Schuhmacher A, Kuhn KU et al. Functional serotonin 1A receptor variant influences treatment response to atypical antipsychotics in schizophrenia. Pharmacogenet Genomics 2009; 19: 91-94
• 33 Mössner R, Schuhmacher A, Wagner M et al. DAOA/G72 predicts the progression of prodromal syndromes to first episode psychosis. Eur Arch Psychiatry Clin Neurosci 2010; 260: 209-215
• 34 Gmür M, Tschopp A. Die Behandlungskontinuität bei schizophrenen Patienten in der Ambulanz. Eine 5-Jahres Untersuchung. Nervenarzt 1998; 59: 727-730
• 35 Lehman AF, Steinwachs DM. Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophr Bull 1998; 24: 1-10
• 36 Janssen B, Weinmann S, Berger M et al. Leitlinienkonformität und Behandlungsergebnisse in der stationären Schizophreniebehandlung. Ein Klinikvergleich. Nervenarzt 2005; 76: 315-326
• 37 Janssen B, Ludwig S, Eustermann H et al. Improving outpatient treatment in schizophrenia: effects of computerized guideline implementation–results of a multicenter-study within the German Research Network on Schizophrenia. European Archives of Psychiatry and Clinical Neuroscience 2010; 260: 51-57
• 38 Janssen B, van Brederode M, Kitzig F et al. Benchmarking in psychiatric acute care--a demonstration project in a hospitals network. Z Evid Fortbild Qual Gesundhwes 2011; 105: 371-375
• 39 Grossimlinghaus I, Falkai P, Gaebel W et al. Developmental process of DGPPN quality indicators. Nervenarzt 2013; 84: 350-365
• 40 Schmidt-Kraepelin C, Janssen B, Gaebel W. Prevention of rehospitalization in schizophrenia: results of an integrated care project in Germany. European Archives of Psychiatry and Clinical Neuroscience 2009; 259: 205-212
• 41 WPA. Global Programme Against Stigma and Discrimination Because of Schizophrenia. Chicago III: Closer Look Creative, Inc; USA 1999
• 42 Gaebel W, Baumann AE. Interventions to reduce the stigma associated with severe mental illness: experiences from the open the doors program in Germany. Can J Psychiatry 2003; 48: 657-662
• 43 Gaebel W, Baumann A, Witte AM et al. Public attitudes towards people with mental illness in six German cities: results of a public survey under special consideration of schizophrenia. Eur Arch Psychiatry Clin Neurosci 2002; 252: 278-287
• 44 Baumann A, Zäske H, Decker P et al. Veränderungen in der sozialen Distanz der Bevölkerung gegenüber schizophren Erkrankten in 6 deutschen Großstädten. Ergebnisse einer repräsentativen Telefonbefragung 2001 und 2004. Nervenarzt 2007; 78: 787-788 , 790–785
• 45 Pinfold V, Thornicroft G, Huxley P et al. Active ingredients in anti-stigma programmes in mental health. Int Rev Psychiatry 2005; 17: 123-131
• 46 Freimüller L, Wölwer W. Antistigma-Kompetenz in der psychiatrisch-psychotherapeutischen und psychosozialen Praxis. Stuttgart: Schattauer; 2012
• 47 Gaebel W, Zäske H, Baumann AE et al. Evaluation of the German WPA „program against stigma and discrimination because of schizophrenia–Open the Doors“: results from representative telephone surveys before and after three years of antistigma interventions. Schizophr Res 2008; 98: 184-193
• 48 Angermeyer MC, Matschinger H, Carta MG et al. Changes in the perception of mental illness stigma in Germany over the last two decades. Eur Psychiatry 2013;
• 49 Klingberg S, Schaub A, Conradt B. Rezidivprophylaxe bei schizophrenen Störungen – Ein kognitiv-verhaltenstherapeutisches Behandlungsmanual. Weinheim: BeltzPVU; 2003
• 50 Bechdolf A, Pützfeld V, Güttgemanns J et al. Kognitive Verhaltenstherapie bei Personen mit erhöhtem Psychoserisiko – Ein Behandlungsmanual. Bern: Huber; 2010
• 51 Häfner H, Bechdolf A, Klosterkötter J et al. Psychosen – Früherkennung und Frühintervention. Stuttgart: Schattauer; 2012
• 52 Wölwer W, Frommann N, Halfmann S et al. Remediation of impairments in facial affect recognition in schizophrenia: efficacy and specificity of a new training program. Schizophr Res 2005; 80: 295-303
• 53 Klingberg S, Wittorf A, Meisner C et al. Cognitive behavioural therapy versus supportive therapy for persistent positive symptoms in psychotic disorders: the POSITIVE Study, a multicenter, prospective, single-blind, randomised controlled clinical trial. Trials 2010; 11: 123
• 54 Klingberg S, Wölwer W, Engel C et al. Negative symptoms of schizophrenia as primary target of cognitive behavioral therapy: results of the randomized clinical TONES study. Schizophr Bull 2011; 37 (Suppl. 02) S98-S110
• 55 Cordes J, Falkai P, Guse B et al. Repetitive transcranial magnetic stimulation for the treatment of negative symptoms in residual schizophrenia: rationale and design of a sham-controlled, randomized multicenter study. Eur Arch Psychiatry Clin Neurosci 2009; 259 (Suppl. 02) S189-S197
• 56 Puschner B, Steffen S, Volker KA et al. Needs-oriented discharge planning for high utilisers of psychiatric services: multicentre randomised controlled trial. Epidemiol Psychiatr Sci 2011; 20: 181-192
• 57 Hamann J, Cohen R, Leucht S et al. Shared decision making and long-term outcome in schizophrenia treatment. J Clin Psychiatry 2007; 68: 992-997
• 58 Hasan A, Wobrock T, Grefkes C et al. Deficient inhibitory cortical networks in antipsychotic-naive subjects at risk of developing first-episode psychosis and first-episode schizophrenia patients: a cross-sectional study. Biol Psychiatry 2012; 72: 744-751
• 59 Nenadic I, Yotter RA, Sauer H et al. Cortical surface complexity in frontal and temporal areas varies across subgroups of schizophrenia. Hum Brain Mapp 2013;
• 60 Wittorf A, Wiedemann G, Buchkremer G et al. Prediction of community outcome in schizophrenia 1 year after discharge from inpatient treatment. Eur Arch Psychiatry Clin Neurosci 2008; 258: 48-58
• 61 Quednow BB, Frommann I, Berning J et al. Impaired sensorimotor gating of the acoustic startle response in the prodrome of schizophrenia. Biol Psychiatry 2008; 64: 766-773
• 62 Bodatsch M, Ruhrmann S, Wagner M et al. Prediction of psychosis by mismatch negativity. Biol Psychiatry 2011; 69: 959-966
• 63 Koutsouleris N, Borgwardt S, Meisenzahl EM et al. Disease prediction in the at-risk mental state for psychosis using neuroanatomical biomarkers: results from the FePsy study. Schizophr Bull 2012; 38: 1234-1246