Neuropsychologische Prädiktoren für den Erfolg beruflicher Wiedereingliederung

ZUSAMMENFASSUNG

Kognitive Leistungseinschränkungen stellen zentrale Erkrankungsmerkmale der Schizophrenie und wichtige Prognosefaktoren für den funktionalen Outcome Betroffener dar. In der beruflichen Rehabilitation werden sie daher als Zielgrößen für Trainings einerseits und als Erfolgsprädiktoren andererseits genutzt. Bei zunehmender Diversifizierung der rehabilitativen Angebote und der angesprochenen Klientel stellt sich die Frage, ob kognitive Defizite zielgruppen- und maßnahmenübergreifend ihre wichtige Funktion beibehalten können.

Eine Durchsicht der Literatur legt nahe, dass die zentralen Aussagen zu prognostischer Validität und Adressierbarkeit mittels kognitiver Trainings auf Patienten mit affektiven Störungen grundsätzlich ausgeweitet werden kann. Für Rehabilitanden anderer diagnostischer Gruppen liegen kaum Studien zur Erfolgsprognose vor. Es muss aber davon ausgegangen werden, dass bei nur geringen kognitiven Beeinträchtigungen andere Merkmale – z. B. Angst, Metakognitionen und Fähigkeiten der sozialen Kognition – zur Prognoseabschätzung herangezogen werden müssen.

ABSTRACT

Cognitive deficits are central characteristics of schizophrenia and represent important prognostic factors for the patients‘ functional outcome. In vocational rehabilitation, cognitive performance serves as target for trainings and as predictor of rehabilitation success. However, rehabilitation for patients with mental disorders increasingly chances in terms of program structure and in terms of diagnostic spectrum of the patients. This change raises the question whether cognition still fulfills its role of an important predictor.

Literature review suggests that cognitive impairments can also be addressed in trainings for patients suffering from mood disorders and are useful predictors for rehabilitation success for those patients. For neurotic disorders, studies on prediction of rehabilitation success are sparse. However, it cannot be assumed that cognitive deficits are substantial aspects of psychopathology and thus other characteristics have to be used for prognosis – i. e. meta-cognition, anxiety and social cognition.

Schlüsselwörter

Kognition - Rehabilitation - Prognose

Key words

Cognition - rehabilitation - prognosis

• Literatur

• 1 Watzke S, Brieger P. Neuropsychologische Diagnostik in der beruflichen Rehabilitation schizophrener Menschen.. Fortschr Neurol Psychiatr 2004; 72: 643-651
• 2 Anthony WA, Jansen MA. Predicting the vocational capacity of the chronically mentally ill. Research and policy implications.. Am Psychol 1984; 39: 537-544
• 3 Reker T. Arbeitsrehabilitation in der Psychiatrie.. Darmstadt: Steinkopff; 1998
• 4 Cook JA, Razzano L. Vocational rehabilitation for persons with schizophrenia. Recent research and implications for practice.. Schizophr Bull 2000; 26: 87-103
• 5 Green MF, Kern RS, Braff DL. et al Neurocognitive deficits and functional outcome in schizophrenia. Are we measuring the „right stuff“?. Schizophr Bull 2000; 26: 119-136
• 6 Aktion Psychisch Kranke Bestandsaufnahme zur Rehabilitation psychisch Kranker.. Zwischenbericht zum 31.03.2002 Bonn: Bundesministerium für Arbeit und Sozialordnung; 2002
• 7 Brieger P, Watzke S, Galvao A, Hühne M, Gawlik B. Wie wirkt berufliche Rehabilitation und Integration psychisch kranker Menschen?. Bonn: Psychiatrie-Verlag; 2006
• 8 Marschall J, Hildebrandt S, Zich K, Tisch T, Sörensen J, Nolting HD, Burgart E, Woköck T. DAK-Gesundheitsreport 2018.. Hamburg: DAK-Forschung; 2018
• 9 Deutsche Rentenversicherung Bund (Hrsg.) Positionspapier der Deutschen Rentenversicherung zur Bedeutung psychischer Erkrankungen in der Rehabilitation und bei Erwerbsminderung.. Berlin: Deutsche Rentenversicherung Bund; 2014
• 10 Knieps F, Pfaff H. Hrsg. Gesundheit und Arbeit. Zahlen, Daten, Fakten. Bd. 2016. BKK Gesundheitsreport.. Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft; 2016
• 11 Bond GR, Becker DR, Drake RE. et al Implementing supported employment as an evidence-based practice.. Psychiatr Serv 2001; 52: 313-322
• 12 Keller K, Kreß S, Kumbier-Jordan B, Theißing A. Hrsg. Medizinisch-berufliche Rehabilitation RPK und die Konzeption des Supported Employment.. BAG-RPK; 2015
• 13 Bond GR, Drake RE, Mueser KT. et al An update on supported employment for people with severe mental illness.. Psychiatr Serv 1997; 48: 335-346
• 14 Green MF, Nuechterlein KH. Should schizophrenia be treated as a neurocognitive disorder?. Schizophr Bull 1999; 25: 309-319
• 15 Tripathi A, Kar SK, Shukla R. Cognitive deficits in schizophrenia: Understanding the biological correlates and remediation strategies.. Clin Psychopharmacol Neurosci 2018; 16: 7-17
• 16 Goldberg TE, Greenberg RD, Griffin SJ. et al The effect of Clozapine on cognition and psychiatric symptoms in patients with schizophrenia.. Br J Psychiatry 1993; 162: 43-48
• 17 Cleghorn JM. A neurodiagnostic approach to schizophrenia.. Can J Psychiatry 1988; 33: 555-561
• 18 Bilder RM, Goldman RS, Robinson D. et al Neuropsychology of first-episode schizophrenia. Initial characterization and clinical correlates.. Am J Psychiatry 2000; 157: 549-559
• 19 Gold JM, Green MF. Neurocognition in Schizophrenia. In: Kaplan HI, Sadock BJ (Hrsg). Kaplan and Sadock’s Comprehensive Textbook of Psychiatry.. Baltimore: Lippincott, Williams & Wilkins; 2005: 1426-1448
• 20 Reed RA, Harrow M, Herbener ES. et al Executive function in schizophrenia. Is it linked to psychosis and poor life functioning?. J Nerv Ment Dis 2002; 190: 725-732
• 21 Watzke S, Brieger P, Kuss O. et al Learning potential and rehabilitation outcome in schizophrenia. A longitudinal study.. Psychiatr Serv 2008; 59: 248-255
• 22 Watzke S, Brieger P, Wiedl KH. Prediction of vocational rehabilitation outcome in schizophrenia. Incremental prognostic validity of learning potential beyond basic cognitive performance.. JCEP 2009; 8: 52-62
• 23 Metcalfe JD, Riley J, McGurk S. et al Comparing predictors of employment in Individual Placement and Support: A longitudinal analysis.. Psychiatry Res 2018; 264: 85-90
• 24 Reddy LF, Kern RS. Supported employment among veterans with serious mental illness: the role of cognition and social cognition on work outcome.. Schizophr Res Cogn 2014; 1: 144-148
• 25 Kaneda Y, Jayathilak K, Meltzer H. Determinants of work outcome in neuroleptic-resistant schizophrenia and schizoaffective disorder: cognitive impairment and clozapine treatment.. Psychiatry Res 2010; 178: 57-62
• 26 Tan B-L. Profile of cognitive problems in schizophrenia and implications for vocational functioning.. Aust Occup Ther J 2009; 56: 220-228
• 27 Chang WC, Man Tang JY, Ming Hui CL. et al Clinical and cognitive predictors of vocational outcome in first-episode schizophrenia: a prospective 3 year follow-up study.. Psychiatry Res 2014; 220: 834-839
• 28 Puig O, Thomas KR, Twamley EW. Age and improved attention predict work attainment in combined compensatory cognitive Ttaining and supported employment for people with severe mental illness.. J Nerv Ment Dis 2016; 204: 869-872
• 29 King S, Stone JM, Cleare A. et al A systematic review on neuropsychological function in bipolar disorders type I and II and subthreshold bipolar disorders-something to think about.. CNS Spectr 2019; 24: 127-143
• 30 Severus WE, Watzke S, Brieger P. Bipolare affektive Störungen. Teil II. Genetik, Kognition und Therapie.. Fortschr Neurol Psychiatr 2008; 76: 294-308
• 31 Malhi GS, Ivanovski B, Hadzi-Pavlovic D. et al Neuropsychological deficits and functional impairment in bipolar depression, hypomania and euthymia.. Bipolar Disord 2007; 9: 114-125
• 32 Martinez-Aran A, Vieta E, Reinares M. et al Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder.. Am J Psychiatry 2004; 161: 262-270
• 33 Altshuler LL, Ventura J, van Gorp WG. et al Neurocognitive function in clinically stable men with bipolar I disorder or schizophrenia and normal control subjects.. Biol Psychiatry 2004; 56: 560-569
• 34 Bora E, Yucel M, Fornito A. et al Major psychoses with mixed psychotic and mood symptoms. Are mixed psychoses associated with different neurobiological markers?. Acta Psychiatr Scand 2008; 118: 172-187
• 35 Green MF. Cognitive Iímpairment and functional outcome in schizophrenia and bipolar disorder.. J Clin Psychiatry 2006; 67 (Suppl. 09) 3-8 discussion 36–42
• 36 Dickerson F, Origoni A, Stallings C. et al Occupational status and social adjustment six months after hospitalization early in the course of bipolar disorder. A prospective study.. Bipolar Disord 2010; 12: 10-20
• 37 Rock PL, Roiser JP, Riedel WJ. et al Cognitive impairment in depression: a systematic review and meta-analysis.. Psychol Med 2014; 44: 2029-2040
• 38 Snyder HR. Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: a meta-analysis and review.. Psychol Bull 2013; 139: 81-132
• 39 Conradi HJ, Ormel J, Jonge P de. Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study.. Psychol Med 2011; 41: 1165-1174
• 40 Woo YS, Rosenblat JD, Kakar R. et al Cognitive deficits as a mediator of poor occupational function in remitted major depressive disorder patients.. Clin Psychopharmacol Neurosci 2016; 14: 1-16
• 41 Judd LL, Schettler PJ, Solomon DA. et al Psychosocial disability and work role function compared across the long-term course of bipolar I, bipolar II and unipolar major depressive disorders.. J Affect Disord 2008; 108: 49-58
• 42 Boland EM, Stange JP, Molz Adams A. et al Associations between sleep disturbance, cognitive functioning and work disability in Bipolar Disorder.. Psychiatry Res 2015; 230: 567-574
• 43 Jaeger J, Berns S, Uzelac S. et al Neurocognitive deficits and disability in major depressive disorder.. Psychiatry Res 2006; 145: 39-48
• 44 Buist-Bouwman MA, Ormel J, Graaf R de. et al Mediators of the association between depression and role functioning.. Acta Psychiatr Scand 2008; 118: 451-458
• 45 Beblo T, Mensebach C. Neuropsychologie der Borderlin-Persönlichkeitsstörung.. In: Lautenbacher S, Gauggel S. Hrsg. Neuropsychologie psychischer Störungen Berlin Heidelberg: Springer; 2010: 383-398
• 46 Dinn WM, Harris CL, Aycicegi A. et al Neurocognitive function in borderline personality disorder.. Prog Neuropsychopharmacol Biol Psychiatry 2004; 28: 329-341
• 47 Hengartner MP, Müller M, Rodgers S. et al Occupational functioning and work impairment in association with personality disorder trait-scores.. Soc Psychiatry Psychiatr Epidemiol 2014; 49: 327-335
• 48 Zanarini MC, Jacoby RJ, Frankenburg FR. et al The 10-year course of social security disability income reported by patients with borderline personality disorder and axis II comparison subjects.. J Pers Disord 2009; 23: 346-356
• 49 Juurlink TT, Have M, ten Lamers F. et al Borderline personality symptoms and work performance: a population-based survey.. BMC Psychiatry 2018; 18: 202
• 50 Lautenbacher S. Neuropsychologie der Angststörungen.. In: Lautenbacher S, Gauggel S. Hrsg. Neuropsychologie psychischer Störungen Berlin Heidelberg: Springer; 2010: 189-198
• 51 Craske MG, Stein MB, Eley TC. et al Anxiety disorders.. Nat Rev Dis Primers 2017. 3: Article 17024
• 52 Muschalla B. Work-anxiety rather than cognitive performance contributes to workability decisions in patients with mental disorders.. J Occup Environ Med 2018; 60: 1042-1048
• 53 Handel M. Trends in Job Skill Demands in OECD Countries.. OECD Social: Employment and Migration Working Papers; 2012
• 54 Then FS, Luck T, Luppa M. et al Association between mental demands at work and cognitive functioning in the general population – results of the health study of the Leipzig research center for civilization diseases (LIFE).. J Occup Med Toxicol 2014; 9: 23
• 55 Green MF, Llerena K, Kern RS. The “Right Stuff” revisited. What have we learned about the determinants of daily functioning in cchizophrenia?. Schizophr Bull 2015; 41: 781-785
• 56 Nordahl H, Wells A. Social anxiety and work status: the role of negative metacognitive beliefs, symptom severity and cognitive-behavioural factors.. J Ment Health 2017; 1-5
• 57 Donohoe G, Schmidt H, Robertson IH. Cognitive remediation therapy for schizophrenia: what is it and does it work?. Ir J Psychol Med 2011; 28: 217-221
• 58 Greig TC, Zito W, Wexler BE. et al Improved cognitive function in schizophrenia after one year of cognitive training and vocational services.. Schizophr Res 2007; 96: 156-161
• 59 van Duin D, Winter L, de Oud M. et al. The effect of rehabilitation combined with cognitive remediation on functioning in persons with severe mental illness: systematic review and meta-analysis.. Psychol Med 2019; 1-12
• 60 Hoertnagl CM, Hofer A. Social cognition in serious mental illness.. Curr Opin Psychiatry 2014; 27: 197-202