Therapie von sozial-kognitiven Störungen

Zusammenfassung

Gegenstand und Ziel: Beeinträchtigungen in sozial-kognitiven Prozessen wird in der Schizophrenieforschung in den letzen Jahren zunehmendes Interesse zugebracht. Eine Basiskomponente sozialer Kognitionen ist die Affektdekodierung, für die Beeinträchtigungen bei schizophren Erkrankten gut belegt sind. Diese Beeinträchtigungen sind verlaufsunabhängig und tragen wesentlich zu dem oft schlechten sozialen Funktionsniveau der Betroffenen bei. Da die Beeinträchtigungen von den herkömmlichen Behandlungsmethoden weitestgehend unbeeinflusst bleiben, stellt sich die Frage nach alternativen Behandlungsansätzen. Material und Methoden: Das neu entwickelte Training der Affektdekodierung (TAR) wurde in zwei aufeinander aufbauenden Untersuchungen jeweils im Prä-post-Kontrollgruppendesign im Hinblick auf potenzielle Leistungssteigerungen bei der mimischen Affekterkennung evaluiert. In beiden Untersuchungen wurde das TAR zur Kontrolle unspezifischer impliziter kognitiver Trainingseffekte mit einem kognitiven Remediationstraining (CRT) verglichen, das die Verbesserung neurokognitiver Basisfunktionen zum Ziel hatte. Ergebnisse: Der Einsatz des TAR führte jeweils zu signifikanten Verbesserungen der Dekodierung des mimischen Affektausdrucks, während das CRT im Sinne einer doppelten Dissoziation zu Verbesserungen in den Basiskognitionen führte. Vorläufige Ergebnisse der Replikationsstudie weisen auf eine Dauerhaftigkeit des Trainingseffekts des TAR von mindestens vier Wochen über das Trainingsende hinaus. Darüber hinaus deuten sich Effekte des TAR im Sinne einer Verbesserung auch der prosodischen Affektdekodierung sowie der Leistung in einer Theory-of-mind-Aufgabe an, während sich bisher keine Effekt auf die soziale Kompetenz in einem Rollenspieltest zeigen. Schlussfolgerungen: Beeinträchtigungen der Dekodierung des mimischen Affekts sind bei schizophren Kranken prinzipiell behandelbar, sofern funktionsspezifische Trainingsstrategien wie das TAR angewandt werden. Klinische Relevanz: Die Entwicklung, Evaluation und Implementierung neurokognitiver Trainingsverfahren erscheint viel versprechend und diese könnten in absehbarer Zeit eine wertvolle Ergänzung bisheriger Behandlungsmaßnahmen schizophren Kranker darstellen.

Summary

Objective: Impairments in social cognition have increasingly attracted interest in schizophrenia research during the last years. A basic component of social cognition is affect recognition. Impairments in affect recognition are well known in schizophrenia, are trait characteristics and seem to play a crucial role in patients’ poor social functioning. Since these impairments are mostly unaffected by traditional treatment, the present study shall contribute to the open question of alternative treatment options. Material and methods: A newly developed „Training of Affect Recognition“ (TAR) was evaluated in two consecutive studies with regard to performance in facial affect recognition using prepost- control group designs. In both studies TAR was compared with a „Cognitive Remediation Training“ (CRT) aiming at improvement of basic neurocognitive functioning, in order to control for non-specific effects of implicit cognitive training. Results: In both studies application of the TAR led to improved facial affect recognition whereas the CRT led to improved basic cognition, constituting a double dissociation of treatment effects. Preliminary results of the replication study hint to sustainability of TAR effects for at least one month after end of training. Moreover, the TAR also seems to improve prosodic affect recognition and theory of mind functioning, but not yet regarding social competence within a role play test. Conclusions: Impairments in facial affect recognition in schizophrenia are treatable in principle, provided that functional specific training strategies like the TAR are used. Clinical relevance: The development, evaluation and implementation of neurocognitive training seem to be promising and such treatments could soon become an important completion of treatment in schizophrenia.

Schlüsselwörter

Schizophrenie - Affektdekodierung - sozial-kognitive Remediationstraining

Keywords

Schizophrenia - affect-recognition - social-cognitive remediation

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