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Fortschr Neurol Psychiatr 2007; 75(8): 463-472
DOI: 10.1055/s-2007-959157
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Unbehandelte Posttraumatische Belastungsstörungen bei schizophrenen Störungen: eine Hypothek auf die Zukunft?

Untreated PTSD in Schizophrenia - Unrecognized Risk Factor for Recovery and Course of Illness?R.  Vauth1 , E.  Nyberg1
  • 1Psychiatrische Poliklinik des Universitätsspitals Basel/Schweiz
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Publication History

Publication Date:
23 March 2007 (online)

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Zusammenfassung

In den vergangenen Jahren ist der Zusammenhang von Posttraumatischen Belastungsstörungen (PTBS) und schizophrenen Erkrankungen v. a. unter 3 Aspekten näher beforscht worden: (a) Einmal kann PTBS als Folge der Erfahrung psychotischer Positivsymptome und von ungünstigen Behandlungserfahrungen auftreten. (b) Weiter kann sich eine PTBS als Vulnerabilitätsfaktor für Ausbruch und Rückfall schizophrener Erkrankungen auswirken. (c) Schließlich kann sich eine PTBS als Chronifizierungsfaktor schizophrener Symptome auswirken; die mit PTBS assoziierte Meidung der Auseinandersetzung mit erkrankungsbezogenen oder biografischen traumatisierenden Erfahrungen begünstigt einen auf Leugnung der Erkrankung ausgerichteten „Sealing over”-Stil der Krankheitsverarbeitung; hierdurch kann eine PTBS damit indirekt zu unzureichender Compliance und Inanspruchnahme psychiatrischer Hilfsangebote sowie zur Entwicklung sekundärer Suchterkrankungen und Depressionen beitragen. Vorhandene empirische Befunde zu diesen Aspekten werden zusammengefasst, ihre methodischen Schwächen diskutiert, einschließlich der Kontroverse um eine Erweiterung des DSM IV A1-Trauma-Kriteriums und die möglichen Implikationen für (Früh-)Diagnostik, Therapie und Verlauf konkretisiert, um künftige Forschung anzuregen.

Abstract

More recently research has focused on post-traumatic stress disorder (PTSD) as comorbide condition of schizophrenia. Current literature focussing the relationship between PTSD and schizophrenia is reviewed. Evidence is found in support of psychosis as a precondition for development of PTSD, PTSD as vulnerability factor for psychosis as well as psychosis and PTSD both as part of a spectrum of responses to a traumatic event. PTSD may be regarded as risk factor for worse outcome in schizophrenia: Internal stress of reexperiencing the trauma may enhance vulnerability to relapse of illness and proneness to anxiety avoiding coping style with psychosis by adoption of a “sealing over” style, lowering service utilization and compliance. Risk for development of alcohol misuse, cannabis misuse or benzodiazepine misuse and depression may be higher, also worsening the course of schizophrenia. Methodological shortcomings of current studies, ongoing debates on extending DSM-IV criterion A1 definition to psychotic or treatment experiences and implications for clinical assessment and cognitive-behavioural treatment of PTSD in schizophrenia are discussed.

Schlüsselwörter

Posttraumatische Belastungsstörung - Schizophrenie - Ersterkrankung - Trauma - Behandlung - Compliance - Epidemiologie - Kognitive Verhaltenstherapie - A-Kriterium

Key words

schizophrenia - Post Traumatic Stress Disorder - PTSD - recovery - psychosocial adaptation - first episode psychosis - compliance - cognitive-behaviour therapy - criterion A1

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PD Dr. med. Dipl.-Psych. Roland Vauth

Psychiatrische Poliklinik des Universitätsspitals Basel

Claragraben 95

CH-4005 Basel, Schweiz

Email: rvauth@uhbs.ch

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