Kognitiv-verhaltenstherapeutische Behandlung von Negativsymptomatik bei schizophrenen Psychosen

S. Klingberg; K. Hesse; J. Herrlich; S. Kossow; G. Wiedemann; A. Wittorf; W. Wölwer; G. Buchkremer

doi:10.1055/s-0038-1627232

Nervenheilkunde, Inhaltsverzeichnis

Nervenheilkunde 2008; 27(11): 997-1006
DOI: 10.1055/s-0038-1627232

Originaler Artikel

Schattauer GmbH

Kognitiv-verhaltenstherapeutische Behandlung von Negativsymptomatik bei schizophrenen Psychosen

Hintergrund und Therapiekonzeption der TONES-Studie^[*] Cognitive behavioral therapy on negative symptoms of schizophrenia disordersbackground and therapy of the TONES-study

S. Klingberg

¹Universitätsklinik für Psychiatrie und Psychotherapie Tübingen

,

K. Hesse

¹Universitätsklinik für Psychiatrie und Psychotherapie Tübingen

,

J. Herrlich

²Universitätsklinik für Psychiatrie und Psychotherapie Frankfurt

,

S. Kossow

²Universitätsklinik für Psychiatrie und Psychotherapie Frankfurt

,

G. Wiedemann

³Klinik für Psychiatrie und Psychotherapie, Klinikum Fulda

,

A. Wittorf

¹Universitätsklinik für Psychiatrie und Psychotherapie Tübingen

,

W. Wölwer

⁴Universitätsklinik für Psychiatrie und Psychotherapie Düsseldorf

,

G. Buchkremer

¹Universitätsklinik für Psychiatrie und Psychotherapie Tübingen

› Institutsangaben

Abstract

Zusammenfassung

Der Artikel gibt einen kurzen Überblick über den aktuellen Stand der Forschung zu kognitiver Verhaltenstherapie (KVT) von Negativsymptomatik bei schizophrenen Psychosen. Es werden zugrunde liegende Modellvorstellungen beleuchtet und Studienergebnisse dargestellt. Das vorgestellte Konzept wird in einer multizentrischen, randomisierten klinischen Studie überprüft, das Studiendesign und das Therapiekonzept werden vorgestellt.

Die Therapie ist eine manualbasierte, individuell angepasste ambulante Einzeltherapie. Zusammen mit dem Patienten wird ein Fallkonzept und ein Therapieplan erstellt. Das Fallkonzept bildet die Grundlage für die individualisierte Therapie, die sich auf die Module „Initiative und Planung“, „Soziale Aktivitäten“, „Sprachliche Aktivitäten“, „Emotionale Beteiligung“ und „Emotionaler Ausdruck“ beziehen. Vorbereitend für diese Hauptphase der Therapie werden in den ersten Stunden ein bio-psycho-soziales Krankheitsmodell erarbeitet, die Behandlungskooperation unterstützt, die Belastungsbewältigung gefördert und der Umgang mit Krisen trainiert. Die einzelnen Module werden vorgestellt und an einem Fallbeispiel verdeutlicht.

Summary

This paper presents a short review of the current state of research on cognitive behavioral therapy (CBT) on negative symptoms of schizophrenia disorders. The underlying models are highlighted and the studies results are described. The treatment rational presented will be evaluated within a multicenter randomized clinical trial. The study design and the study treatment are presented. The therapy is a manual based, individually adapted outpatient treatment which is conducted in individual sessions. Together with the patient a case formulation and a therapy plan are developed. The case formulation is the basis for the individualized therapy which addresses “initiative and planning”, “social activities”, “verbal activities”, “emotional participation”, and “emotional expression”. Preparatory for this main phase of therapy a bio-psycho-social disease model is developed, the treatment compliance is fostered, stress management skills are enhanced, and the handling of crises is trained. The different modules are presented and clarified by means of a case vignette.

Schlüsselwörter

Schizophrenie - Negativsymptomatik - kognitive Verhaltenstherapie - Therapiekonzept

Keywords

Schizophrenia disorder - negative symptoms - cognitive behavioral therapy - therapy

Volltext

Referenzen

Literatur
1 American Psychiatric Association.. Practice Guideline for the Treatment of Patients with Schizophrenia, Second Edition. Am J Psychiatry. 2004: 161 (Suppl.).
2 Bartlig G, Echelmeyer L, Engberding M. Problemanalyse im therapeutischen Prozess. Stuttgart: Kohlhammer; 1994
3 Bilder RM. et al. Neuropsychology of first-episode schizophrenia: initial characterization and clinical correlates. Am J Psychiatry 2000; 157 (Suppl. 04) 549-559.
4 Birchwood M. et al. Cognitive approach to depression and suicidal thinking in psychosis I. Ontogeny of post-psychotic depression. Br J Psychiatry 2000; 177: 516-521.
5 Blanchard JJ, Cohen AS. The structure of negative symptoms within schizophrenia: Implications for assessment. Schizophr Bull 2006; 32 (Suppl. 02) 238-245.
6 Breier A. et al. National institute of mental health longitudinal study of chronic schizophrenia. Prognosis and predictors of outcome. Arch Gen Psychiatry 1991; 48: 239-246.
7 Brenner HD. et al. Integrated psychological therapy for schizophrenic patients. Seattle: Hogrefe & Huber; 1994
8 Cannon M. et al. Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder – Results from a longitudinal birth cohort. Arch Gen Psychiatry 2002; 59 (Suppl. 05) 449-456.
9 David M. et al. IQ and risk for schizophrenia: a population- based cohort study. Psychol Med 1997; 27 (Suppl. 06) 1311-1323.
10 Deutsche Gesellschaft für Psychiatrie Psychotherapie und Nervenheilkunde.. Behandlungsleitlinie Schizophrenie, Redaktion. Gaebel W, Falkai P. Darmstadt: Steinkopff; 2006
11 Emsley R, Rabinowitz J, Torreman M. The factor structure for the Positive and Negative Syndrome Scale (PANSS) in recent-onset psychosis. Schizophr Res 2003; 61 (Suppl. 01) 47-57.
12 Frommann N, Streit M, Wolwer W. Remediation of facial affect recognition impairments in patients with schizophrenia: a new training program. Psychiatry Res 2003; 117 (Suppl. 03) 281-284.
13 Gard DE. et al. Anhedonia in schizophrenia: Distinctions between anticipatory and consummatory pleasure. Schizophr Res 2007; 93 1–3 253-260.
14 Germans MK, Kring AM. Hedonic deficit in anhedonia: support for the role of approach motivation. Personality and individual differences 2000; 28 (Suppl. 04) 659-672.
15 Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia. Am J Psychiatry 1996; 153 (Suppl. 03) 321-330.
16 Green MF. et al. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the „right stuff“?. Schizophr Bull 2000; 26 (Suppl. 01) 119-136.
17 Grube BS, Bilder RM, Goldman RS. Meta-analysis of symptom factors in schizophrenia. Schizophr Res 1998; 31 2–3 113-120.
18 Huxley NA, Rendall M, Sederer L. Psychosocial treatments in schizophrenia – A review of the past 20 years. J Nerv Ment Dis 2000; 188 (Suppl. 04) 187-201.
19 Ihnen GH, Penn DL, Corrigan PW, Martin J. Social perception and social skill in schizophrenia. Psychiatry Res 1998; 80 (Suppl. 03) 275-286.
20 Kirkpatrick B. et al. The NIMH-MATRICS consensus statement on negative symptoms. Schizophr Bull 2006; 32 (Suppl. 02) 214-219.
21 Lenzenweger MF, Dworkin RH, Wethington E. Examining the Underlying Structure of Schizophrenic Phenomenology – Evidence for A 3-Process Model. Schizophr Bull 1991; 17 (Suppl. 03) 515-524.
22 MacDonald EM, Hayes RL, Baglioni AJ. The quantity and quality of the social networks of young people with early psychosis compared with closely matched controls. Schizophr Res 2000; 46 (Suppl. 01) 25-30.
23 MacDonald EM. et al. Social skill as a determinant of social networks and perceived social support in schizophrenia. Schizophr Res 1998; 29 (Suppl. 03) 275-286.
24 Mueser KT. et al. Factor structure of the brief psychiatric rating scale in schizophrenia. Psychol Assess 1997; 9 (Suppl. 03) 196-204.
25 Muller D, Roder V, Brenner H. Effectiveness of Integrated Psychological Therapy for schizophrenia patients. A meta-analysis including 28 independent studies. Nervenarzt 2007; 78 (Suppl. 01) 62-73.
26 Myin-Germeys I, Delespaul P, van Os J. Behavioural sensitization to daily life stress in psychosis. Psychol Med 2005; 35 (Suppl. 05) 733-741.
27 Pekkala E, Merinder L. Psychoeducation for schizophrenia (Cochrane Review). Oxford: The Cochrane Library, Issue 1, Update Software; 2003
28 Peralta V, Cuesta MJ. How many and which are the psychopathological dimensions in schizophrenia? Issues influencing their ascertainment. Schizophr Res 2001; 49 (Suppl. 03) 269-285.
29 Pfammatter M. et al. Efficacy of psychological therapy in schizophrenia: Conclusions from metaanalyses. Schizophr Bull 2006; 32: S64-S80.
30 Pharoah FM, Mari JJ, Streiner DL. Family intervention for schizophrenia (Cochrane Review). Oxford: The Cochrane Library, Issue 1, Update Software; 2003
31 Pilling S. et al. Psychological treatments in schizophrenia: II. Meta-analysis of randomized controlled trials of social skills training and cognitive remediation. Psychol Med 2002; 32: 783-791.
32 Pinto A. et al. Cognitive-behavioral therapy and clozapine for clients with treatment-refractory schizophrenia. Psychiatr Serv 1999; 50 (Suppl. 07) 901-904.
33 Pitschel-Walz G. et al. The Effect of Family Interventions on Relapse and Rehospitalization in Schizophrenia – A Meta-Analysis. Schizophr Bull 2001; 27 (Suppl. 01) 73-92.
34 Rector NA, Beck AT. Cognitive behavioral therapy for schizophrenia: an empirical review. J Nerv Ment Dis 2001; 189 (Suppl. 05) 278-287.
35 Rector NA, Beck AT, Stolar N. The negative symptoms of schizophrenia: A cognitive perspective. Can J Psychiatry 2005; 50 (Suppl. 05) 247-257.
36 Stratta P. et al. Association between striatal reduction and poor Wisconsin Card Sorting Test performance in patients with schizophrenia. Biol Psychiatry 1997; 42 (Suppl. 09) 816-820.
37 Thorup A. et al. Social network among young adults with first-episode schizophrenia spectrum disorders – Results from the Danish OPUS trial. Soc Psychiatry Psychiatr Epidemiol 2006; 41 (Suppl. 10) 761-770.
38 Toomey R. et al. Nonverbal social perception and symptomatology in schizophrenia. Schizophr Res 2002; 53 1–2 83-91.
39 van der Does JW, van den Bosch RJ. What determines Wisconsin Card Sorting Test performance in schizophrenia. Clin Psychol Rev 1992; 12: 567-583.
40 van Os J. et al. The schizophrenia enviroment. Curr Opin Psychiatry 2005; 18 (Suppl. 02) 141-145.
41 Weinberger DR. Implications of normal brain development for the pathogenesis of schizophrenia. Arch Gen Psychiatry 1987; 44: 660-669.
42 Wittorf A. et al. Prediction of community outcome in schizophrenia 1 year after discharge from inpatient treatment. Eur Arch Psychiatry ClinNeurosci 2007; 258 (Suppl. 01) 48-58.
43 Wölwer W. et al. Remediation of impairments in facial affect recognition in schizophrenia: Efficacy and specificity of a new training program. Schizophr Res 2005; 80 2–3 295-303.
44 Wykes T. et al. Cognitive Behavio Therapy for schizophrenia: Effect Sizes, Clinical Models and Methodological Rigor. Schizophr Bull 2007; 34: 523-537.
45 Zubin J, Spring B. Vulnerability – a new view of schizophrenia. J Abnorm Psychol 1977; 86: 103-126.
46 Klingberg S. et al. Kognitiv-verhaltenstherapeutische Behandlung von positiv psychotischen Störungen. Nervenheilkunde 2008; 27: 1014-1020.