Indizierte Prävention psychotischer Störungen

Zusammenfassung

Eine Frühintervention in der Prodromalphase einer psychotischen Störung zielt auf die Prävention der manifesten Erkrankung ab. Unklar ist die tatsächliche Effektivität spezifischer klinischer Interventionen. In dieser Übersichtsarbeit wurde eine systematische Literatursuche via PubMed und MEDLINE zwischen Januar 2000 und Juni 2011 anhand der Kombination der Schlüsselwörter „psychosis“, „high risk OR prodrome“ und „intervention“ durchgeführt und die Literatursuche durch eine gezielte weiterführende Literaturrecherche ergänzt. Zur Frühintervention bei Personen mit erhöhtem Psychoserisiko konnten in der Literatur elf klinische Studien, einige Übersichtsarbeiten und eine formale Metaanalyse identifiziert werden. Hinsichtlich einer medikamentösen Intervention liegt eine vorläufige Evidenz für Risperidon, Olanzapin und Amisulprid vor. Im Hinblick auf die untersuchten psychotherapeutischen Verfahren sprechen die Ergebnisse am ehesten für eine integrierte psychotherapeutische Intervention und für eine kognitive Verhaltenstherapie. Nach kritischer Betrachtung der Datenlage gibt es Hinweise darauf, dass eine Frühintervention bei Personen mit erhöhtem Psychoserisiko wirksam sein könnte.

Summary

Several studies on patients with “at risk mental state” reported transition to psychosis rates of 20 to 40%. Therefore, early and effective therapeutic interventions during in the prodromal phase are highly desirable. However, at present there is considerable uncertainty with regard to effective and evidence-based early intervention modalities. We conducted a systematic literature search via PubMed and MEDLINE using a combination of the keywords „psychosis“, „prodrome OR high risk“ and „intervention“ between January 2000 and June 2011. With regard to early intervention in the prodromal state of psychosis, we identified eleven clinical studies, several review articles and one meta-analysis. Considering pharmacological treatment in the prodromal phase, there is some preliminary evidence for medication with risperidone, olanzapine and amisulpride. With respect to psychotherapeutic interventions, the present clinical trials argue for an integrative psychotherapeutic treatment and cognitive behavioral therapy. In conclusion, there is preliminary evidence indicating that clinical interventions during the prodromal phase might be effective in preventing manifest psychosis.

Schlüsselwörter

Prodrom - Psychose - Frühbehandlung - Schizophrenie

Keywords

Prodrome - psychosis - early intervention - schizophrenia

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