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Schizophrenie und Depression

Schizophrenia and depression

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Zusammenfassung

Hintergrund

Der Vergleich der von Psychopharmaka noch unbeeinflussten Entwicklung von Symptomen und sozialer Rollenkompetenz schizophren und unipolar depressiv Erkrankter mit gesunden Kontrollen gibt Aufschluss über den Frühverlauf beider Krankheiten.

Stichproben und Methoden

Drei Stichproben wurden mit IRAOS und mehreren Querschnittsinstrumenten zur Symptomatik, funktionellen Beeinträchtigung und sozialen Behinderung untersucht und verglichen.

Ergebnisse

In frühen Stadien überlappen sich Symptom- und Beeinträchtigungsmuster von Schizophrenie und schwerer Depression. Erst im weiteren Verlauf entwickeln sich mit dem Auftreten psychotischer Symptome beide Krankheiten auseinander. Depressive Symptome erreichen ihr Maximum in der ersten und in nachfolgenden psychotischen Episoden und sinken mit der Remission wieder ab. Depressive Patienten berichten für die Zeit vom Erkrankungsbeginn bis zur Erstaufnahme über mehr funktionelle Beeinträchtigung und soziale Behinderung als schizophren Erkrankte, was auf Unterschiede kognitiver Bewertung zurückzuführen ist.

Schlussfolgerung

Aufgrund der Symptomentwicklung und der früh auftretenden sozialen Beeinträchtigung scheint eine Früherkennung von Schizophrenie oder Depression möglich zu sein. Eine frühe diagnostische Unterscheidung und Vorhersage von Psychose- vs. Depressionsrisiko ist in der präpsychotischen Prodromalphase wegen Überlappung von Symptomatik und Beeinträchtigungsmustern nicht aussichtsreich.

Summary

Background

Comparison of symptom-related and social role development between patients with schizophrenia, major depression and healthy controls provided insights into the untreated early course of the two disorders.

Samples and methods

Symptoms, functional impairment and social disability were assessed and compared using the IRAOS and several other cross-sectional instruments in three samples.

Results

At the early illness stages there was considerable overlap in the symptom patterns and impairments presented by persons with schizophrenia and severe depression.The two disorders did not diverge until later in the early illness course with the onset of psychotic symptoms. Depressive symptoms showed a maximum in the first psychotic episode and relapse episodes and decreased with the remitting episode. Due to differences in cognitive appraisal depressed patients reported more functional impairment and social disability than patients with schizophrenia did.

Conclusion

The early course of symptoms and social impairment in schizophrenia and depression seems to offer an opportunity to distinguish these disorders from variants of normal development fairly early. However, early diagnostic distinction and prediction of psychosis versus depression risk at the prepsychotic prodromal stage do not seem promising due to the broad overlap in symptoms and impairment.

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Notes

  1. Die relativ hohen Prävalenzraten depressiver Symptome in der gesunden Vergleichsgruppe haben damit zu tun, dass es sich um kumulative Werte durchschnittlich über mehr als 8 Jahre handelt. Nicht nur Diagnosen, sondern auch Einzelsymptome wie depressive Verstimmung sind erfasst worden. Die Raten sind deshalb mit den Diagnose- oder Krankheitsprävalenzraten aus Bevölkerungsstudien nicht vergleichbar.

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  1. Arbeitsgruppe Schizophrenieforschung am Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland

    K. Maurer, G. Trendler, M. Schmidt, W. an der Heiden, R. Könnecke &  H. Häfner

  2. Arbeitsgruppe Schizophrenieforschung, Zentralinstitut für Seelische Gesundheit, J5, 68159, Mannheim, Deutschland

    H. Häfner

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  1. K. Maurer
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Additional information

Nach dem Vortrag gleichen Titels von H. Häfner auf der Tagung „Affekt und Kognition“ der Gesellschaft zur Förderung empirisch begründeter Therapieansätze bei schizophrenen Menschen, Münsterlingen (CH), 11.–12. November 2004

Die ABC-Schizophreniestudie wurde und wird von der Deutschen Forschungsgemeinschaft (DFG) im Rahmen des Sonderforschungsbereichs 258 am Zentralinstitut für Seelische Gesundheit vom 1. Januar 1987 bis 31. Dezember 1998, vom 1. Januar 1999 bis 30. September 2002 und ab 1.1.2005 bis 31.12.2007 im Einzelverfahren gefördert.

The ABC study was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) as part of the Special Research Branch (Sonderforschungsbereich) 258 at the Central Institute of Mental Health from January 1, 1987 to December 31, 1998. From January 1, 1999 to September 30, 2002 it was funded by the DFG as an independent project, and that funding will continue from January 1, 2005 to December 31, 2007.

This paper was written within the framework of the German Research Network on Schizophrenia and was funded by the German Federal Ministry for Education and Research BMBF (grant 01GI 0236).

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Maurer, K., Trendler, G., Schmidt, M. et al. Schizophrenie und Depression. Nervenarzt 77, 809–822 (2006). https://doi.org/10.1007/s00115-005-1920-y

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