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Klinische Prognose schizophrener Patienten mit Cannabisabhängigkeit

Zwischen Nihilismus und Hoffnung

Clinical prognosis of schizophrenic patients with cannabis addiction

Between nihilism and hope

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Zusammenfassung

Schizophrene Patienten mit komorbidem persistierendem Cannabiskonsum (SCH+CAN) zeigen häufig einen ungünstigen Krankheitsverlauf und gelten als schwierig zu behandeln. Entsprechend resigniert reagieren manche Therapeuten. Dem stehen mittlerweile mehrfach replizierte Befunde von SCH+CAN-Patienten bezüglich einer höheren kognitiven Leistungsfähigkeit und geringeren Auffälligkeiten der Hirnstruktur verglichen mit abstinenten schizophrenen Patienten entgegen. Interpretiert wird dies als Hinweis einer durchschnittlich geringeren Vulnerabilität einer Subgruppe von Patienten, die primär durch das propsychotische Potenzial von Cannabis erkrankte. Die relativ guten kognitiven Leistungen wären Resultat der geringen Vulnerabilität. Folglich wäre die negative Haltung gegenüber den Patienten ungerechtfertigt. Denn eine geringe Vulnerabilität ist ferner mit einem günstigen soziorehabilitativen Outcome schizophrener Erkrankungen assoziiert. Voraussetzung dafür ist aber, dass die Patienten in adäquaten therapeutischen Settings behandelt werden und dass sie den Substanzkonsum beenden.

Summary

Comorbid substance use disorders in schizophrenia are mostly associated with an unfavorable course of the disease and with difficulties in clinical management. Therefore, some therapists tend to react to these patients in a resigned manner. However, there is growing evidence for higher cognitive functioning and less severe deficits in brain morphology of these patients compared to patients without cannabis use. A common interpretation refers to relatively low vulnerability for psychosis in some of these patients, who mainly became schizophrenic because of the propsychotic properties of cannabis. Low vulnerability is reflected by a higher cognitive functioning; therefore, the pessimistic view of therapists seems unjustified for at least a subgroup of young patients. Provided that patients are treated in adequate therapeutic settings and that they stop using cannabis, a lower vulnerability may be associated with overall better socio-rehabilitative outcome parameters.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Schnell Autor gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren

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  1. Medical School Hamburg, Am Kaiserkai 1, 20457, Hamburg, Deutschland

    T. Schnell

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Auf Wunsch sind die Daten unveröffentlichter Studien, die in der vorliegenden Arbeit zitiert werden, beim Autor erhältlich.

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Schnell, T. Klinische Prognose schizophrener Patienten mit Cannabisabhängigkeit. Nervenarzt 85, 1084–1092 (2014). https://doi.org/10.1007/s00115-013-3926-1

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