Subscribe to RSS
Download PDF
DOI: 10.1055/s-0038-1626440
Prädiktion des Verlaufs schizophrener Ersterkrankungen
Prediction of course of illness in first-episode schizophreniaPublication History
Publication Date:
22 January 2018 (online)
Zusammenfassung
Trotz einer Vielzahl bekannter Variablen, die zum Verlauf schizophrener Erkrankungen in statistischer Beziehung stehen, lassen sich gerade am Beginn der Erkrankung im Einzelfall keine sicheren Angaben über Verlauf und langfristigen Krankheitsausgang machen. Insbesondere das zeitlich umschriebene Ereignis eines Rückfalls ist bisher nur sehr schwierig zu prädizieren. Zunehmend untersucht wird die rückfallprädiktive Validität von Prodromalsymptomatik, die bei vielen Patienten einem Rückfall vorausgeht und damit auch zur Interventionssteuerung bei Intervalltherapien genutzt werden könnte. Im Rahmen einer im Kompetenznetz Schizophrenie durchgeführten Untersuchung unter kontrollierter antipsychotischer Langzeitbehandlung an erstmals schizophren Erkrankten konnte gezeigt werden, dass ein Summenwert unspezifischer Prodrome in der Vorhersage klinischer Verschlechterungen statistisch bedeutsame Sensitivitäts- und Spezifitätswerte aufweist. Für einen Routineeinsatz von prodromgestützter Frühintervention in der Langzeitbehandlung schizophrener Erkrankungen muss diese Vorhersagekraft z.B. durch Hinzunahme und Kombination mit anderen Parametern optimiert werden.
Summary
Despitea multiplicity of well-known variables, which are statistically correlated with the course of schizophrenia, no valid prediction of long-term outcome can be made in individual cases, in particular at the beginning of the disorder. Notably the temporally circumscribed event of a relapse is only very difficult to predict so far. Recently the predictive validity of prodromal symptoms is increasingly examined. Prodromes precede a relapse in many patients and thus may be used for guidance of interval treatment strategies. In the context of a study conducted within the German Research Network on Schizophrenia it could be shown thata sum score of unspecific prodromal symptoms obtained considerable sensitivity and specificity in predicting clinical deterioration in first episode patients under controlled longterm treatment. For an application within early intervention long-term strategies in schizophrenia this predictive validity has to be improved, for example by completing or combining prodromes with other variables.
-
Literatur
- 1 American-Psychiatric-Association (APA) Practice guideline for the treatment of patients with schizophrenia, second edition. Am J Psychiatry. 2004; 161 (Suppl): 1-56.
- 2 Behrendt B. Meine persönlichen Warnsignale. Tübingen: DGVT-Verlag; 2001
- 3 Bottlender R, Sato T, Jager M, Wegener U, Wittmann J, Strauss A, Moller HJ. The impact of the duration of untreated psychosis prior to first psychiatric admission on the 15-year outcome in schizophrenia. Schizophr Res 2003; 62: 37-44.
- 4 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN). (Hrsg). Behandlungsleitlinie Schizophrenie. Darmstadt: Steinkopf Verlag; 1998
- 5 Erlenmeyer-Kimling L, Rock D, Roberts SA, Janal M, Kestenbaum C, Cornblatt B, Adamo UH, Gottesman II. Attention, memory, and motor skills as childhood predictors of schizophrenia-related psychoses: The New York High-Risk Project. Am J Psychiatry 2000; 157: 1416-22.
- 6 Gaebel W, Awad AG. (eds). Prediction of neuroleptic treatment outcome in schizophrenia– concepts and methods. Wien: Springer; 1994
- 7 Gaebel W, Frick U, Köpcke W, Linden M, Müller P, Müller-Spahn F, Pietzker A, Tegeler J. Early Neuroleptic Intervention in Schizophrenia: Are Prodromal Symptoms Valid Predictors of Relapse. Br J Psychiatry 1993; 163 (Suppl. 21) 8-12.
- 8 Gaebel W, Jänner M, Frommann N, Pietzcker A, Köpcke W, Linden M, Müller P, Müller-Spahn F, Tegeler J. Prodromal States in Schizophrenia. Comprehensive Psychiatry 2000; 41 (Suppl. 01) 76-85.
- 9 Gaebel W, Jänner M, Frommann N, Pietzcker A, Köpcke W, Linden M, Müller P, Müller-Spahn F, Tegeler J. First vs. multiple episode schizophrenia: Two-year outcome of intermittent and maintenance medication strategies. Schizophr Res 2002; 53: 145-59.
- 10 Gaebel W, Janssen B, Riesbeck M. Modern treatment concepts in schizophrenia. Pharmacopsychiatry 2003; 36 (Suppl. 03) 168-75.
- 11 Gaebel W, Möller HJ, Buchkremer G, Ohmann C, Riesbeck M, Wölwer W, von Wilmsdorff M, Bottlender R, Klingberg S. Pharmacological longterm treatment strategies in first episode schizophrenia. Study design and preliminary results of an ongoing RCT within the German Research Network on Schizophrenia. Eur Arch Psychiat Clin Neurosc 2004; 254: 129-40.
- 12 Gaebel W, Müller-Spahn F. Diagnostik und Therapie psychischer Störungen. Stuttgart: Kohlhammer; 2001
- 13 Grawe RW, Levander S. Neuropsychological impairments in patients with schizophrenia: stability and prediction of outcome. Acta Psychiatrica Scandinavica 2001; 104 (Suppl. 408): 60-4.
- 14 Green MF. Schizophrenia from a Neurocognitive Perspective: Probing the Impenetrable Darkness. Boston: Allyn and Bacon; 1998
- 15 Herz M, Melville C. Relapse in schizophrenia. Am J Psychiatry 1980; 137: 801-12.
- 16 Herz MI, Lamberti SJ. Prodromal symptoms and relapse prevention in schizophrenia. Schizophrenia Bulletin 1995; 21: 541-51.
- 17 Hsiao JK, Bartko JJ, Potter WZ. Diagnosing Diagnosis. Arch Gen Psychiatry 1989; 46: 664-7.
- 18 Jørgensen P. Early signs of psychotic relapse in schizophrenia. Br J Psychiatry 1998; 172: 327-330.
- 19 Klingberg S, Schaub A, Conradt B. Rezidivprophylaxe bei schizophrenen Störungen. Weinheim: Beltz Verlag; 2003
- 20 Maier W, Sandmann J. Diagnostik in Langzeitstudien. In: Stieglitz RD, Baumann U. (Hrsg). Psychodiagnostik psychischer Störungen. Stuttgart: Enke; 1994: 272-83.
- 21 Marder SR, Mintz J, Van Putten T, Lebell M, Wirshing WC, Johnston-Cronk K. Early prediction of relapse in schizophrenia: an application of receiver operating characteristic (ROC) methods. Psychopharmacol Bull 1991; 27: 79-82.
- 22 Milev P, Ho BH, Arndt S, Andreasen N. Predictive Values of Neurocognition and Negative Symptoms on Functional Outcome in Schizophrenia: A Longitudinal First-Episode Study With 7-Year Follow-Up. Am J Psychiatry 2005; 162: 495-506.
- 23 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. www.nice.org.uk.
- 24 Nuechterlein KH, Dawson ME. A heuristic vulnerability/stress model of schizophrenic episodes. Schizophr Bull 1984; 10: 300-12.
- 25 Royal Australian and New Zealand College of Psychiatrists (RANZCP). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Aust NZ J Psychiatry 2005; 39: 1-30.
- 26 van Os J, Wright P, Murray RM. Follow-up studies of schizophrenia I: natural history and non-psychopathological predictors of outcome. Eur Psychiatry 1997; 12: 327-41.
- 27 Wölwer W, Buchkremer G, Häfner H, Klosterkötter J, Maier W, Möller HJ, Gaebel W. German Research Network on Schizophrenia – Bridging the gap between research and care. Eur Arch Psychiat Clin Neurosc 2003; 253: 321-9.
- 28 Zubin J, Spring B. Vulnerability: A new view of schizophrenia. Journal of Abnormal Psychology 1977; 86: 103-26.