Download PDF
Fortschr Neurol Psychiatr 2013; 81(5): 276-283
DOI: 10.1055/s-0032-1330507
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Spezialisierte Behandlungsangebote für erstmals schizophren Erkrankte: Konzepte und Ergebnisse

Specialised Treatment in First Episode Schizophrenia: Concepts and Results
W. Wölwer
1   Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf
,
V. Toeller
1   Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf
,
S. Klingberg
2   Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen
,
W. Gaebel
1   Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf
› Author Affiliations
Further Information

Publication History

Publication Date:
21 May 2013 (online)

    Permissions and Reprints

Zusammenfassung

Vielfältige Evidenz legt nahe, dass Patienten in der frühen Phase einer psychotischen Erkrankung eine spezielle Behandlungsstrategie benötigen, die ihren speziellen Bedürfnissen und Problemen in dieser „kritischen“ Phase gerecht wird. Die vorliegende Übersicht fasst diese Evidenz zusammen und stellt Frühbehandlungsansätze vor, wie sie international bereits in sehr unterschiedlicher Ausgestaltung aufgebaut wurden, sich in Deutschland jedoch erst vereinzelt im Pilotstadium befinden. Bisherige Evaluationsergebnisse weisen auf eine überlegene Wirksamkeit solcher Frühbehandlungsansätze gegenüber herkömmlicher Standardbehandlung sowohl in Bezug auf das klinische Ergebnis als auch in Bezug auf die Gesamtkosten der Behandlung. Offene Fragen bestehen jedoch vor allem noch bezüglich der Spezifität und der Nachhaltigkeit solcher Effekte sowie der wirksamen Behandlungskomponenten. Bevor ähnliche Angebote in Deutschland auf breiter Basis aufgebaut werden, sollte eine Konsentierung der unverzichtbaren Charakteristika und somit zu entsprechenden Qualitätsindikatoren erfolgen.

Abstract

Multifaceted evidence suggests that patients in the early phase of a psychotic disorder need a specific treatment strategy meeting their specific needs and problems in this “critical” phase of the disorder. The present review summarises this evidence and presents early treatment approaches according to already internationally established different models, while in Germany comparable concepts are only in a pilot stage. Previous evaluation studies showed a superior efficacy of such early treatment approaches compared to conventional standard treatment in terms of both clinical outcome and in relation to the total costs of treatment. Questions remain, however, especially with regard to the specificity and durability of such effects, and with regard to the effective treatment components. Before similar programmes can be broadly established in Germany, a consensus on their indispensable characteristics and appropriate quality indicators should be achieved.

Schlüsselwörter

Schizophrenie - kritische Phase - Frühbehandlung - Adhärenz - Erstmanifestation

Key words

schizophrenia - critical period - early intervention - adherence - first episode psychosis
 

  • Literatur

  • 1 Mossaheb N, Wiesegger G, Amminger GP et al. Early recognition and intervention for schizophrenia. Nervenarzt 2006; 77: 23-24, 27-30, 32-24
    CrossrefPubMedGoogle Scholar
  • 2 Eranti SV, Maccabe JH, Bundy H et al. Gender difference in age at onset of schizophrenia: a meta-analysis. Psychol Med 2013; 43: 155-167
    CrossrefPubMedGoogle Scholar
  • 3 Fusar-Poli P, Borgwardt S, Bechdolf A et al. The Psychosis High-Risk State: A Comprehensive State-of-the-Art Review. Arch Gen Psychiatry 2012; 1-14 DOI: 10.1001/jamapsychiatry.2013.269. [Epub ahead of print]
    PubMedGoogle Scholar
  • 4 Häfner H, Nowotny B, Löffler W et al. When and how does schizophrenia produce social deficits?. Eur Arch Psychiatry Clin Neurosci 1995; 246: 17-28
    CrossrefPubMedGoogle Scholar
  • 5 Schaffner N, Schimmelmann BG, Niedersteberg A et al. Versorgungswege von erstmanifesten psychotischen Patienten – eine Übersicht internationaler Studien. Fortschr Neurol Psychiatr 2011; 80: 72-78
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Marshall M, Lewis S, Lockwood A et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 2005; 62: 975-983
    Google Scholar
  • 7 Coldham EL, Addington J, Addington D. Medication adherence of individuals with a first episode of psychosis. Acta Psychiatr Scand 2002; 106: 286-290
    CrossrefPubMedGoogle Scholar
  • 8 Schennach-Wolff R, Jäger M, Seemüller F et al. Attitude towards adherence in patients with schizophrenia at discharge. J Psychiatr Res 2009; 43: 1294-1301
    CrossrefPubMedGoogle Scholar
  • 9 Gaebel W, Riesbeck M, Wölwer W et al. Maintenance treatment with risperidone or low-dose haloperidol in first-episode schizophrenia: 1-year results of a randomized controlled trial within the German Research Network on Schizophrenia. J Clin Psychiatry 2007; 68: 1763-1774
    Google Scholar
  • 10 Schimmelmann BG, Conus P, Schacht M et al. Predictors of service disengagement in first-admitted adolescents with psychosis. J Am Acad Child Adolesc Psychiatry 2006; 45: 990-999
    CrossrefPubMedGoogle Scholar
  • 11 Robinson D, Woerner MG, Alvir JM et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry 1999; 56: 241-247
    CrossrefPubMedGoogle Scholar
  • 12 Meister K, Burlon M, Rietschel L et al. Dual diagnosis psychosis and substance use disorders in adolescents – part 1. Fortschr Neurol Psychiatr 2010; 78: 81-89
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Romm KL, Rossberg JI, Berg AO et al. Depression and depressive symptoms in first episode psychosis. J Nerv Ment Dis 2010; 198: 67-71
    CrossrefPubMedGoogle Scholar
  • 14 Maurer K, Trendler G, Schmidt M et al. Schizophrenie und Depression. Nervenarzt 2006; 77: 809-822
    Google Scholar
  • 15 Birchwood M. Pathways to emotional dysfunction in first-episode psychosis. Br J Psychiatry 2003; 182: 373-375
    CrossrefPubMedGoogle Scholar
  • 16 Tarrier N, Khan S, Cater J et al. The subjective consequences of suffering a first episode psychosis: trauma and suicide behaviour. Soc Psychiatry Psychiatr Epidemiol 2007; 42: 29-35
    CrossrefPubMedGoogle Scholar
  • 17 McGorry PD, Killackey E, Yung A. Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry 2008; 7: 148-156
    PubMedGoogle Scholar
  • 18 Cannon TD, Cadenhead K, Cornblatt B et al. Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Arch Gen Psychiatry 2008; 65: 28-37
    CrossrefPubMedGoogle Scholar
  • 19 Fusar-Poli P, Bonoldi I, Yung AR et al. Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry 2012; 69: 220-229
    CrossrefPubMedGoogle Scholar
  • 20 Birchwood M, Todd P, Jackson C. Early intervention in psychosis. The critical period hypothesis. Br J Psychiatry Suppl 1998; 172: 53-59
    CrossrefPubMedGoogle Scholar
  • 21 Pompili M, Serafini G, Innamorati M et al. Suicide risk in first episode psychosis: a selective review of the current literature. Schizophr Res 2011; 129: 1-11
    CrossrefPubMedGoogle Scholar
  • 22 Wiersma D, Nienhuis FJ, Slooff CJ et al. Natural course of schizophrenic disorders: a 15-year followup of a Dutch incidence cohort. Schizophr Bull 1998; 24: 75-85
    CrossrefPubMedGoogle Scholar
  • 23 Remington G. Rational pharmacotherapy in early psychosis. Br J Psychiatry Suppl 2005; 48: S77-S84
    PubMedGoogle Scholar
  • 24 Barnes TR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2011; 25: 567-620
    Google Scholar
  • 25 Marshall M, Lockwood A, Lewis S et al. Essential elements of an early intervention service for psychosis: the opinions of expert clinicians. BMC Psychiatry 2004; 4: 17-24
    CrossrefPubMedGoogle Scholar
  • 26 McGorry P, Addington J, Amminger P et al. International early psychosis writing group: International clinical practice guidelines for early psychosis. British Journal of Psychiatry 2005; 48: 120-124
    PubMedGoogle Scholar
  • 27 Bertolote J, McGorry P. Early intervention and recovery for young people with early psychosis: consensus statement. Br J Psychiatry Suppl 2005; 48: S116-S119
    PubMedGoogle Scholar
  • 28 WPA. World Psychiatric Association. Guidelines for Psychiatrists on Early Intervention in Psychosis. WPA Committee for Education Letter to all WPA Member Societies; 2010
    PubMedGoogle Scholar
  • 29 NICE. National Institute for Health & Clinical Excellence. Schizophrenia The Nice Guidelines on Core Interventions and Management of Schizophrenia in Adults in Primary and Secondary Care. London: The British Psychological Society and The Royal College of Psychiatrists; 2010
    PubMedGoogle Scholar
  • 30 DGPPN. Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde. Behandlungsleitlinie Schizophrenie. Darmstadt: Steinkopf; 2006
    Google Scholar
  • 31 McGorry PD, Edwards J, Mihalopoulos C et al. EPPIC: an evolving system of early detection and optimal management. Schizophr Bull 1996; 22: 305-326
    Google Scholar
  • 32 DoH. Department of Health. The Mental Health Policy Implementation Guide. Retrieved 08.01.2012 London: 2001 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009350
    PubMedGoogle Scholar
  • 33 DoH, Department of Health. The NHS plan: a summary. Retrieved 08.01.2012 London: 2000 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4010198
    PubMedGoogle Scholar
  • 34 Shiers D, Smith J. Early Intervention in Psychosis: A Briefing for Service Planners. Retrieved from 2010 www.earlypsychosis.org.nz/PDF/eip-briefing.pdf
    PubMedGoogle Scholar
  • 35 Petersen L, Jeppesen P, Thorup A et al. A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. Brit Med J 2005; 331: 602-605
    CrossrefPubMedGoogle Scholar
  • 36 Johannessen JO, McGlashan TH, Larsen TK et al. Early detection strategies for untreated first-episode psychosis. Schizophr Res 2001; 51: 39-46
    CrossrefPubMedGoogle Scholar
  • 37 Sahlmann MM, Vieten AB, Sheldrick AJ et al. Früherkennung und Frühbehandlung bei Patienten mit erhöhtem Schizophrenierisiko in Deutschland. Gesundheitswesen 2010; 72: 771-775
    Google Scholar
  • 38 French P, Smith J, Shiers D et al. Promoting Recovery in Early Psychosis: A Practice Manual. Wiley-Blackwell; 2010
    CrossrefGoogle Scholar
  • 39 Waldheter E, Penn D. A Psychological Treatment to Facialitate Recovery in Early Psychosis – The Graduate Recovery Program: (GRIP). Saarbrücken: VDM Verlag Dr. Müller; 2009
    Google Scholar
  • 40 Dodgson G, McGowan C. Early intervention service models. In: French P, Smith J, Shiers D, et al. (Hrsg) Promoting recovery in early psychosis: A practice manual. Oxford: Wiley-Blackwell; 2010: 45-52
    CrossrefGoogle Scholar
  • 41 Fowler D, Hodgekins J, Howells L et al. Can targeted early intervention improve functional recovery in psychosis? A historical control evaluation of the effectiveness of different models of early intervention service provision in Norfolk 1998–2007. Early Intervention in Psychiatry 2009; 3: 282-288
    CrossrefPubMedGoogle Scholar
  • 42 Lambert M, Bock T, Moritz S et al. Der Arbeitsbereich Psychosen: Behandlungskonzept, Forschung und Lehre. Zentrum für Psychosoziale Medizin am Universitätsklinikum Hamburg-Eppendorf; 2007
    Google Scholar
  • 43 Malla A. Early Intervention Services for psychotic disorders: Expectations, benefits, challenges. IRIS Commissioner Conference. , October 2009 2009
    PubMedGoogle Scholar
  • 44 Harvey PO, Lepage M, Malla A. Benefits of enriched intervention compared with standard care for patients with recent-onset psychosis: a metaanalytic approach. Can J Psychiatry 2007; 52: 464-472
    PubMedGoogle Scholar
  • 45 Bird V, Premkumar P, Kendall T et al. Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry 2010; 197: 350-356
    CrossrefPubMedGoogle Scholar
  • 46 Kuipers E, Holloway F, Rabe-Hesketh S et al. An RCT of early intervention in psychosis: Croydon Outreach and Assertive Support Team (COAST). Soc Psychiatry Psychiatr Epidemiol 2004; 39: 358-363
    CrossrefPubMedGoogle Scholar
  • 47 Craig TK, Garety P, Power P et al. The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. Brit Med J 2004; 329: 1067
    CrossrefPubMedGoogle Scholar
  • 48 Grawe RW, Falloon IR, Widen JH et al. Two years of continued early treatment for recent-onset schizophrenia: a randomised controlled study. Acta Psychiatr Scand 2006; 114: 328-336
    CrossrefPubMedGoogle Scholar
  • 49 McCrone P, Knapp M. Economic evaluation of early intervention services. Br J Psychiatry Suppl 2007; 51: S19-S22
    PubMedGoogle Scholar
  • 50 Cullberg J, Mattsson M, Levander S et al. Treatment costs and clinical outcome for first episode schizophrenia patients: a 3-year follow-up of the Swedish “Parachute Project” and two comparison groups. Acta Psychiatr Scand 2006; 114: 274-281
    Google Scholar
  • 51 Mihalopoulos C, McGorry PD, Carter RC. Is phase-specific, community-oriented treatment of early psychosis an economically viable method of improving outcome?. Acta Psychiatr Scand 1999; 100: 47-55
    CrossrefPubMedGoogle Scholar
  • 52 Mihalopoulos C, Harris M, Henry L et al. Is early intervention in psychosis cost-effective over the long term?. Schizophr Bull 2009; 35: 909-918
    CrossrefPubMedGoogle Scholar
  • 53 McCrone P, Craig TK, Power P et al. Cost-effectiveness of an early intervention service for people with psychosis. Br J Psychiatry 2010; 196: 377-382
    CrossrefPubMedGoogle Scholar
  • 54 McCrone P, Park A, Knapp M. Economic Evaluation of Early Intervention (EI) Services: Phase IV Report. 2010
    PubMedGoogle Scholar
  • 55 Marshall M, Rathbone J. Early intervention for psychosis. Cochrane Database Syst Rev 2011; Juni 15: CD004718
    PubMedGoogle Scholar
  • 56 Catts SV, Evans RW, O'Toole BI et al. Is a national framework for implementing early psychosis services necessary? Results of a survey of Australian mental health service directors. Early Interv Psychiatry 2010; 4: 25-30
    CrossrefPubMedGoogle Scholar
  • 57 Bertelsen M, Jeppesen P, Petersen L et al. Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Arch Gen Psychiatry 2008; 65: 762-771
    CrossrefPubMedGoogle Scholar
  • 58 Gafoor R, Nitsch D, McCrone P et al. Effect of early intervention on 5-year outcome in non-affective psychosis. Br J Psychiatry 2010; 196: 372-376
    CrossrefPubMedGoogle Scholar
  • 59 Friis S. Early specialised treatment for first-episode psychosis: does it make a difference?. Br J Psychiatry 2010; 196: 339-340
    CrossrefPubMedGoogle Scholar