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DOI: 10.1055/s-2008-1038142
Die „Hirnstörung” Schizophrenie und ihre Entwicklung[1]
Schizophrenia as a Brain Disorder and its DevelopmentPublication History
Publication Date:
07 May 2008 (online)

Zusammenfassung
Die Schizophrenie ist eine psychische Erkrankung, die mit funktionellen und strukturellen Abweichungen des Gehirns verbunden ist. Neben globalen Defiziten, wie einer Reduktion des Gesamthirnvolumens und einer Erweiterung des Ventrikelsystems, finden sich umschriebene Veränderungen insbesondere im Bereich der grauen Substanz des Frontallappens. Betrachtet man mögliche Zuflüsse zu diesen Veränderungen, so sind diese teilweise vulnerabilitätsassoziiert, teilweise assoziiert mit dem Ausbruch der Erkrankung und in Teilen verbunden mit dem Verlauf der Erkrankung und den hiermit assoziierten Handlungsoptionen. Es wird postuliert, dass die neurobiologischen Veränderungen der Schizophrenie in verschiedenen Stadien der Erkrankung (Prodrom, Erstmanifestation und rezidivierender Verlauf) unterschiedlich sind. Hierbei wird davon ausgegangen, dass eine Hypofunktion des GABAergen Systems ein wesentlicher Bestandteil der Basisvulnerabilität der Erkrankung ist, dass im nächsten Schritt eine Destabilisierung des glutamatergen Systems und hier insbesondere des NMDA-Rezeptor-Systems vorliegt, um zu einer Erstmanifestation einer Schizophrenie zu führen. Beim Übergang zum rezidivierenden Verlauf sind diese Mechanismen auf Dauer destabilisiert, so dass eine Rückbildung der Veränderungen in funktioneller und struktureller Hinsicht erschwert ist. Diese pathophysiologischen Überlegungen können zur Entwicklung kausal-präventiver pharmakotherapeutischer Maßnahmen führen.
Abstract
Schizophrenia is a psychiatric disease associated with functional und structural brain abnormalities. Beside global deficits, like a reduction of the whole brain volume and an enlargement of the ventricular system, there are circumscribed changes especially in the gray matter of the frontal lobe. Regarding possible causes for these changes some are related to the vulnerability of the disease, some to the manifestation of the disorder and some are very likely related to the course of the illness and the associated treatment options. It is hypothesised that the neurobiological changes of schizophrenia are different in each stage of the illness ranging from the prodromal state, over the first manifestation of the illness up to the relapsing course. It is assumed, that the hypofunction of the gabaergic system is essential to the vulnerability of the disorder, while a destabilisation of the glutamatergic system especially of the NMDA-receptor-system forms the next step to first break schizophrenia. When the illness develops into a relapsing course these mechanisms are destabilised, which inhibits the recovery from functional und structural changes. The outlined pathophysiological hypotheses are used to discuss possible causal pharmacological treatment options.
Schlüsselwörter
Schizophrenie - Neurobiologie - Hirnentwicklung
Key words
schizophrenia - neurobiology - brain development
1 Mit freundlicher Unterstützung durch die Deutsche Forschungsgemeinschaft (Fa 241/2-3)
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1 Mit freundlicher Unterstützung durch die Deutsche Forschungsgemeinschaft (Fa 241/2-3)
Prof. Dr. med. Peter Falkai
Zentrum Psychosoziale Medizin, Abteilung für Psychiatrie und Psychotherapie, Georg-August-Universität
von-Siebold-Straße 5
37075 Göttingen
Email: pfalkai@gwdg.de