Interventionen bei Personen mit erhöhtem Psychoserisiko: Eine aktuelle Übersicht über randomisiert kontrollierte Studien

Zusammenfassung

Mit der Früherkennung und validen Erfassung des präpsychotischen Risikosyndroms und der sich daraus ableitenden indizierten Prävention verbindet sich die Hoffnung einer Verhinderung bzw. Verzögerung oder Abschwächung der drohenden psychotischen Ersterkrankung, einer Verbesserung der aktuellen Symptomatik und die Vermeidung bzw. Verzögerung der sich bereits in der Vorphase häufig abzeichnenden psychosozialen Behinderung. Mithilfe einer systematischen Literaturrecherche identifizierten wir sieben abgeschlossene, randomisierte und kontrollierte Studien zu Interventionen bei Personen mit erhöhtem Psychoserisiko. Diese Studien evaluierten antipsychotische, neuroprotektive, kognitiv-verhaltenstherapeutische und integrierte Behandlungsansätze. Insgesamt zeigten alle spezifischen Interventionen Vorteile gegenüber der jeweiligen Kontrollgruppe bezüglich der Interventionsziele – wenn auch zum Teil nur auf deskriptiver Ebene. Dieser Vorteil spezifischer Behandlung konnte durch eine erste Metaanalyse statistisch signifikant abgesichert werden. Aufgrund der Studienlage kann derzeit jedoch keine spezifische Empfehlung für eine der evaluierten Strategien gegeben werden. Daher sind Interventionen einer gründlichen Nutzen-/Risikoanalyse zu unterziehen, wobei die Höhe des individuellen Risikos im Verhältnis zu den geeigneten Interventionen und deren Nebenwirkungsprofil zu betrachten sind. Methodisch gut geplante Replikationen der vorgestellten Interventionen mit höheren Fallzahlen sowie eine differenzielle Evaluation der Behandlungsoptionen sind notwendig.

Abstract

Early and valid detection of the psychosis risk syndrome, and indicated prevention aim at preventing, delaying or ameliorating frank psychosis, improving current symptoms as well as emerging psychosocial disability. In a systematic literature search we identified seven completed randomised controlled trials of interventions for individuals at high risk of developing first episode psychosis. These studies evaluated antipsychotics, neuroprotective agents, cognitive behavioural and integrated treatment approaches. All trials reported advantages for specific interventions as compared to the respective control conditions (although not significant in each of the studies), which proved to be significant in the first meta-analysis of the studies. However, the current results do not allow recommendations for any specific treatment. Therefore, interventions should be thoroughly reviewed based on their risk/benefit ratio. The level of individual clinical risk, assumed benefits and side effects of interventions are critical determinants for these considerations. Future research is needed with sufficiently powered, methodologically sound replication studies, which are designed to explore differential efficacy of the interventions.

Schlüsselwörter

Psychose-Risikosyndrom - Personen mit erhöhtem Psychoserisiko - Prodrom - Behandlung - randomisierte kontrollierte Interventionsstudien - Übersicht

Key words

psychosis risk syndrome - person at risk for psychosis - prodrome - intervention - randomised controlled trials - review

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