Zusammenfassung
Patienten mit „Early-Onset”-Psychosen (EOP, Erstmanifestation einer Psychose zwischen 14. und 18. Lebensjahr) weisen oft einen noch ungünstigeren Erkrankungsverlauf auf als Patienten, bei denen die erste psychotische Episode im Erwachsenenalter auftritt. Dies gilt sowohl für die Persistenz der psychotischen Symptomatik als auch für die soziale Remission. Obwohl für erwachsene Patienten mit einer psychotischen Störung mittlerweile zahlreiche kognitiv-verhaltenstherapeutische Therapieverfahren existieren, die erfolgreich evaluiert wurden und die auch die Kernprobleme der EOP zu adressieren scheinen, liegen für die kognitive Verhaltenstherapie (KVT) bei EOP bisher auch international keine Daten vor. Vor diesem Hintergrund haben wir in der eigenen Arbeitsgruppe eine an die Zielgruppe adaptierte KVT-Intervention entwickelt, deren Grundzüge der vorliegende Text erläutert. Akzeptanz und Durchführbarkeit der Therapie werden gegenwärtig im Rahmen einer randomisierten, kontrollierten Pilotstudie untersucht.
Abstract
Early onset psychoses (EOP, age of onset between age 14 and 18 years) are known to be associated with a poorer outcome than adult onset psychoses, both in terms of psychotic symptoms and social remission. For adult patients with psychosis, numerous cognitive-behavioral interventions have proven their effectiveness in recent years. This contrasts with a dearth of findings for EOP, even though it can be considered as a variant of adult onset psychosis. Thus, we have developed a cognitive-behavioral therapy intervention that was specifically adapted to the characteristics and needs of young people suffering from psychosis. The concept of the intervention is outlined in the present article. Acceptability and feasibility of the intervention are currently undergoing evaluation in a randomised, controlled pilot study.
Schlüsselwörter
Psychose - Schizophrenie - Early-Onset - Psychotherapie - Kognitive Verhaltenstherapie - RCT
Keywords
psychosis - Schizophrenia - early onset - psychotherapy - cognitive-behavioral therapy - RCT
Literatur
1 Caplan R. Childhood schizophrenia assessment and treatment: a developmental approach. In: Volkmar F R, Hrsg. Psychoses and pervasive developmental disorders.. Philadelphia: Saunders; 1994: 15-30
2
Biswas P, Malhotra S, Malhotra A et al.
Comparative study of neurological soft signs in schizophrenia with onset in childhood, adolescence and adulthood.
Acta Psychiat Scand.
2007;
115
295-303
3
White T, Ho B C, Ward J et al.
Neuropsychological performance in first-episode adolescent with schizophrenia: a comparison with first-episode adults and adolescent control subjects.
Biol Psychiat.
2006;
60
463-471
4
McClellan J, McCurry C, Snell J et al.
Early-onset psychotic disorders: course and outcome over a 2-year period.
J Am Acad Child Psy.
1999;
38
1380-1388
5
Pencer A, Addington J, Addington D.
Outcome of a first episode of psychosis in adolescence: a 2-year follow-up.
Psychiat Res.
2005;
133
35-43
6
Schimmelmann B G, Conus P, Cotton S et al.
Pre-treatment, baseline, and outcome differences between early-onset and adult-onset psychosis in an epidemiological cohort of 636 first-episode patients.
Schizophr Res.
2007;
95
1-8
7
Lay B, Blanz B, Hartmann M et al.
The psychosocial outcome of adolescent onset schizophrenia: a 12-year follow-up.
Schizophrenia Bull.
2000;
26
801-816
8
Röpcke B, Eggers C.
Early-onset schizophrenia: a 15-year follow-up.
Eur Child Adoles Psy.
2005;
14
341-350
9
Schmidt M, Blanz B, Dippe A et al.
Course of patients diagnosed as having schizophrenia during first episode occurring under age 18 years.
Eur Arch Psy Clin N.
1995;
245
93-100
10
Hollis C.
Adult outcomes of child- and adolescent-onset schizophrenia: diagnostic stability and predictive validity.
Am J Psychiat.
2000;
157
1652-1659
11
Gillberg I C, Hellgren L, Gillberg C.
Psychotic disorders diagnosed in adolescence. Outcome at age 30 years.
J Child Psychol Psyc.
1993;
34
1173-1185
12
Cawthron P, James A, Dell J et al.
Adolescent onset psychosis. A clinical and outcome study.
J Child Psychol Psyc.
1994;
35
1321-1332
13 Havighurst R J. Developmental tasks and education. 3. Aufl. New York: Longman; 1981
14 Resch F. Therapie der Adoleszentenpsychosen: Psychopathologische, psychobiologische und entwicklungspsychologische Aspekte aus therapeutischer Sicht. Stuttgart: Thieme; 1992
15
Werry J S, McClellan J M, Chard L.
Childhood and adolescent schizophrenic, bipolar, and schizoaffective disorders: a clinical and outcome study.
J Am Acad Child Psy.
1991;
30
457-465
16
Ballageer T, Malla A, Manchanda R et al.
Is adolescent-onset first-episode psychosis different from adult onset?.
J Am Acad Child Psy.
2005;
44
782-789
17
Joa I, Johannessen J O, Langeveld J et al.
Baseline profiles of adolescent vs. adult-onset first-episode psychosis in an early detection program.
Acta Psychiat Scand.
2009;
119
494-500
18
AACAP: American Academy of Child and Adolescent Psychiatry .
Practice parameter for the assessment and treatment of children and adolescents with schizophrenia.
Am Acad Child Psy.
2001;
40 (7 Suppl)
4S-23S
19 DGKJP: Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie und -psychotherapie .Schizophrenie, schizotype und wahnhafte Störungen (F2). In: Hrsg Leitlinien zur Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter.. 3. überarbeitete Aufl. Köln: Deutscher Ärzte Verlag; 2003: 33-42
20
Lindenmayer J P.
Treatment refractory schizophrenia.
Psychiat Quart.
2000;
71
373-384
21
Stieglitz R, Vauth R.
Die Wirksamkeit kognitiv-verhaltenstherapeutischer Ansätze in der Behandlung chronischer Positivsymptomatik – Wo stehen wir?.
Z Kl Psych Psychot.
2001;
30
279-284
22
Leucht S, Corves C, Arbter D et al.
Second-generation versus first-generation anti-psychotic drugs for schizophrenia: a meta-analysis.
Lancet.
2009;
373
31-41
23
Sikich L, Frazier J A, McClellan J et al.
Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: findings from the Treatment of Early-Onset Schizophrenia Spectrum disorders (TEOSS) study.
Am J Psychiat.
2008;
165
1420-1431
24
Findling R L, Johnson J L, McClellan J et al.
Double-blind maintenance safety and effectiveness findings from the Treatment of Early-Onset Schizophrenia Spectrum (TEOSS) study.
J Am Acad Child Psy.
2010;
49
583-594
25
Kemp R, Hayward P, Applewhaite G et al.
Compliance therapy in psychotic patients: randomised controlled trial.
Brit Med J.
1996;
312
345-349
26
Lacro J, Dunn L, Dolder C et al.
Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature.
J Clin Psychiat.
2002;
63
892-909
27
Lieberman J A, Stroup T S, McEvoy J P et al.
Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.
New Engl J Med.
2005;
353
1209-1223
28
Gould R A, Mueser K T, Bolton E et al.
Cognitive therapy for psychosis in schizophrenia: an effect size analysis.
Schizophr Res.
2001;
48
335-342
29
Pfammatter M, Junghan U, Brenner H.
Efficacy of psychological therapy in schizophrenia: conclusions from metaanalyses.
Schizophrenia Bull.
2006;
32
S64-S80
30
Rector N A, Beck A T.
Cognitive behavioral therapy for schizophrenia: an empirical review.
J Nerv Ment Dis.
2001;
189
278-287
31
Wykes T, Steel C, Everitt B et al.
Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor.
Schizophrenia Bull.
2008;
34
523-537
32
Zimmermann G, Favrod J, Trieu V et al.
The effect of cognitive behavioural treatment on schizophrenia spectrum disorders: a meta-analysis.
Schizophr Res.
2005;
77
1-9
33 APA: American Psychiatric Association .Practice guideline for the treatment of patients with schizophrenia. 2. Aufl. Arlington, VA: Author; 2004
34 DGPPN: Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (Hrsg.).. S3 Praxisleitlinien in Psychiatrie und Psychotherapie. Redaktion: Wolfgang Gaebel und Peter Falkai. Band 1 Behandlungsleitlinie Schizophrenie. Darmstadt: Steinkopff; 2006
35 NICE: National Institute for Health and Clinical Excellence .Schizophrenia. Care interventions in the treatment and management of schizophrenia in primary and secondary care (update). National Clinical Practice Guideline Number 82. London: Author; 2009
36
Ueland T, Rund B R.
A controlled randomized treatment study: the effects of a cognitive remediation program on adolescents with early onset psychosis.
Acta Psychiat Scand.
2004;
109
70-74
37
Ueland T, Rund B R.
Cognitive remediation for adolescents with early onset psychosis: a 1-year follow-up study.
Acta Psychiat Scand.
2005;
111
193-201
38
Wykes T, Newton E, Landau S et al.
Cognitive remediation therapy (CRT) for young early onset patients with schizophrenia: an exploratory randomized controlled trial.
Schizophr Res.
2007;
94
221-230
39 Asarnow R F, Nuechterlein K H. Manual and computer program for the forced-choice, partial report span of apprehension test (version 3.4). Los Angeles, CA: UCLA; 1992
40 Heaton R, Chelune G, Talley J. et al .Wisconsin Card Sorting Test. Manual, Revised and Expanded. Odessa, FL: Psychological Resources; 1993
41 Klingberg S, Wittorf A, Sickinger S et al. Behandlungsmanual der POSITIVE-Studie. Unveröffentlichtes Manuskript; 2007
42
Klingberg S, Wittorf A, Bechdolf A et al.
Research into the feasibility of cognitive behavioural therapy in the treatment of psychotic disorders.
Psychother Psych Med.
2009;
59
141-148
43
Pitschel-Walz G, Leucht S, Bäuml J et al.
The effect of family interventions on relapse and rehospitalisation in schizophrenia – a meta-analysis.
Schizophrenia Bull.
2001;
27
73-92
44 Pitschel-Walz G. Die Einbeziehung der Angehörigen in die Behandlung schizophrener Patienten und ihr Einfluss auf den Krankheitsverlauf. Frankfurt am Main: Lang; 1997
45
Birchwood M J, Smith J V, Cochrane R.
Specific and non-specific effects of educational intervention for families living with schizophrenia. A comparison of three methods.
Brit J Psychiat.
1992;
160
806-814
46 Seiffge-Krenke I. Chronisch kranke Jugendliche und ihre Familien: Das Dilemma zwischen altersgemäßer Entwicklung und Krankheitsanpassung. In: Oerter R, Hagen C, Röper G, Hrsg Klinische Entwicklungspsychologie – Ein Lehrbuch.. Weinheim: Beltz; 1999: 691-727
47 Bechdolf A, Büch A, Pohlmann B et al. Modified cognitive behavior therapy (mCBT) – Manual für die Behandlung von Jugendlichen mit persistierenden psychotischen Symptomen. Unveröffentlichtes Manuskript; 2007
PD Dr. Andreas Bechdolf MSc.
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Uniklinik Köln
Kerpener Str. 62
50937 Köln
Email: andreas.bechdolf@uk-koeln.de