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Der Nervenarzt

, Volume 89, Issue 3, pp 276–282 | Cite as

Differenzialindikation für die Psychotherapie bei Psychosen

Gibt es empirisch begründbare Kriterien?
  • S. Klingberg
  • K. Hesse
Leitthema
  • 449 Downloads

Zusammenfassung

Die wesentliche Aufgabe dieses Beitrags besteht darin zu prüfen, ob der gegenwärtige Forschungsstand zur Psychotherapie bei schizophrenen Störungen empirisch begründete Aussagen darüber erlaubt, welche Patienten in besonderer Weise von welchem Psychotherapieangebot profitieren. Methodologisch kann diese Aufgabe als die Frage nach Moderatoren des Therapieerfolgs angesehen werden. Zur Beantwortung dieser Frage wird zuerst der Stand der Wirksamkeitsforschung für schizophrene Störungen zusammengefasst. Dann werden Studien zum Vergleich aktiver Psychotherapieverfahren beschrieben. Empirische Studien zu Fragen der Routineversorgung in Deutschland liegen nicht vor. Es erscheint jedoch gerechtfertigt, zunächst die Kombination von kognitiver Verhaltenstherapie (KVT) und Familieninterventionen zu empfehlen. Bei anderer Präferenz der Betroffenen und/oder fehlender Passung des Therapiemodells zum Patienten, können andere Verfahren vorgeschlagen werden. Studien, in denen Erfolgsprädiktoren der KVT dargestellt werden, zeigen, dass bessere Krankheitseinsicht, weibliches Geschlecht, höheres Bildungsniveau und ein Alter >21 Jahre auf einen besseren Verlauf der KVT hinweisen. Insgesamt sind die Möglichkeiten zur Differenzialindikation sehr limitiert und es ist ein erheblicher Forschungsbedarf festzustellen.

Schlüsselwörter

Schizophrenie Familienintervention Kognitive Verhaltenstherapie Psychoedukation Antipsychotika 

Differential indication for psychotherapy in psychosis

Are there evidence-based criteria?

Abstract

The major objective of this paper is to discuss the available evidence on the question as to which patients benefit most from psychotherapy in psychotic disorders and the question of which kind of psychotherapy. From a methodological perspective, this task can be seen as the question of moderators of treatment success. To answer this question, the status of efficacy research on psychotherapeutic interventions in schizophrenia is summarized in a first step. Secondly, studies comparing different active psychotherapeutic approaches are discussed. There are no studies available on routine psychotherapeutic care. However, there appears to be a rationale for recommending a combination of cognitive behavioural therapy (CBT) and family therapy. If patients prefer other approaches or if the treatment model does not suit the patient, other approaches should be offered. There is evidence for CBT that insight into psychosis, female gender, a higher level of education, and age >21 are indicators of a better course in CBT. Overall, the options for differential indications are highly limited and considerably more research is required.

Keywords

Schizophrenia Family intervention Cognitive behavioral therapy Psychoeducation Antipsychotics 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Klingberg und K. Hesse sind Autoren von Therapiemanualen und bieten Kurse zur Kognitiven Verhaltenstherapie bei Psychosen an.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Universitätsklinik für Psychiatrie und PsychotherapieTübingenDeutschland

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