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Bedeutung von Psychotherapie in der Versorgung von Menschen mit schizophrenen Störungen in Deutschland

Wie evidenzbasiert ist die Praxis?

Evidence basis of psychotherapy for schizophrenia patients in Germany

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Zusammenfassung

Fragestellung

Es ist wenig darüber bekannt, in welchem Ausmaß evidenzbasierte Psychotherapie in der Routineversorgung zur Behandlung von Menschen mit Schizophrenie in Deutschland angewandt wird.

Methode

Es wird zunächst ein Literaturüberblick zur Wirksamkeit verschiedener psychotherapeutischer Verfahren im Rahmen der Behandlung schizophrener Erkrankungen gegeben. Dann wird anhand einer systematischen Literaturrecherche und der Analyse mehrerer Datensätze eine Bestandsaufnahme des Implementierungsgrades von Psychotherapie in der Behandlungspraxis schizophrener Störungen vorgenommen.

Ergebnisse

Die „Efficacy“ kognitiver Verhaltenstherapie in der Behandlung schizophrener Störungen kann als gut belegt gelten. Die wenigen vorliegenden Daten zum Implementierungsgrad lassen auf eine erhebliche Evidenzlücke in der Behandlungspraxis schließen.

Diskussion

Implementierungshemmnisse werden benannt und diskutiert. Forschungsbedarf besteht v. a. hinsichtlich versorgungsepidemiologischer Daten und langfristig angelegter „Effectiveness-Studien“.

Summary

Background

Little is known about the degree of implementation of evidence-based psychotherapy in routine care of people with schizophrenia in Germany.

Method

First, results of studies on the efficacy of psychotherapy in the treatment of schizophrenia are summarised. Second, the degree of implementation of psychotherapeutic practices in the routine care of schizophrenics is assessed through a systematic literature search and analyses of several data sets.

Results

There is substantial evidence for the efficacy of cognitive-behavioural interventions in the treatment of schizophrenia. The paucity of data on the degree of implementation suggests a wide gap between evidence and practice.

Conclusions

Barriers to implementation are outlined and discussed. There is a need for more studies on epidemiological and long-term effectiveness of health care.

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Abb. 1

Notes

  1. Die Auffassung von Psychotherapie als alleinige Behandlungsmethode der Wahl („stand-alone“) für schizophrene Erkrankungen entspricht nicht mehr dem Evaluationsstand evidenzbasierter Therapie schizophrener Störungen, wird aber nichtsdestotrotz noch vereinzelt und vehement propagiert [31]

Literatur

  1. Barrowclough C, Haddock G, Tarrier N et al. (2001) Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. Am J Psychiatry 158:1706–1713

    Article  PubMed  CAS  Google Scholar 

  2. Bebbington P, Brewin CR, Marsden L et al. (1996) Measuring the need for psychiatric treatment in the general population: the community version of the MRC Needs for Care Assessment. Psychol Med 26:229–236

    Article  PubMed  CAS  Google Scholar 

  3. Bellack A S (2004) Skills training for people with severe mental illness. Psychiatr Rehabil J 27:375–391

    Article  PubMed  Google Scholar 

  4. Birchwood M, Spencer E (2001) Early intervention in psychotic relapse. Clin Psychol Rev 21:1211–1226

    Article  PubMed  CAS  Google Scholar 

  5. Birchwood M, Iqbal Z, Chadwick P et al. (2000) Cognitive approach to depression and suicidal thinking in psychosis. 1. Ontogeny of post-psychotic depression. Br J Psychiatry 177:516–521

    Article  PubMed  CAS  Google Scholar 

  6. Brenner HD, Roder V, Hodel B et al. (1994) Integrated psychological therapy for schizophrenic patients. Hogrefe, Toronto

  7. Buckley PF, Noffsinger SG, Smith DA et al. (2003) Treatment of the psychotic patient who is violent. Psychiatr Clin North Am 26:231–272

    Article  PubMed  Google Scholar 

  8. Burns T (2004) E-interview. Psychiatr Bull 28:352

    Article  Google Scholar 

  9. Burns T, Fioritti A, Holloway F et al. (2001) Case management and assertive community treatment in Europe. Psychiatr Serv 52:631–636

    Article  PubMed  CAS  Google Scholar 

  10. Chong SA, Lee C, Bird L et al. (2004) A risk reduction approach for schizophrenia: the early psychosis intervention programme. Ann Acad Med Singapore 33:630–635

    PubMed  CAS  Google Scholar 

  11. Cook JA, Razzano L (2002) Vocational rehabilitation for persons with schizophrenia: Recent research and implications for practice. Schizophr Bull 26:87–103

    Google Scholar 

  12. Corcoran C, Malaspina D, Hercher L (2005) Prodromal interventions for schizophrenia vulnerability: the risks of being “at risk”. Schizophr Res 73:173–184

    Article  PubMed  Google Scholar 

  13. Cormac I, Jones C, Campbell C et al. (2004) Cognitive behaviour therapy for schizophrenia. Cochrane Database of Systematic Reviews, Chichester

  14. Cuijpers P, Van Straten A, Smit F (2005) Preventing the incidence of new cases of mental disorders: a meta-analytic review. J Nerv Ment Dis 193:119–125

    Article  PubMed  Google Scholar 

  15. Davis J, Chen N (2005) Old versus new: weighing the evidence between the first- and second-generation antipsychotics. Eur Psychiatry 20:7–14

    Article  PubMed  Google Scholar 

  16. Dickerson FB, Lehman AF (2006) Evidence-based psychotherapy for schizophrenia. J Nerv Ment Dis 194:3–9

    Article  PubMed  Google Scholar 

  17. Dickerson FB, Tenhula WN, Green-Paden LD (2005) The token economy for schizophrenia: review of the literature and recommendations for future research. Schizophr Res 75:405–416

    Article  PubMed  Google Scholar 

  18. Drake RE, Mueser KT, Torrey WC et al. (2000) Evidence-based treatment of schizophrenia. Curr Psychiatry Rep 2:393–397

    Article  PubMed  CAS  Google Scholar 

  19. Dyck DG, Hendryx MS, Short RA et al. (2002) Service use among patients with schizophrenia in psychoeducational multiple-family group treatment. Psychiatr Serv 53:749–754

    Article  PubMed  Google Scholar 

  20. Gleeson J, Larsen TK, Mcgorry P (2003) Psychological treatment in pre- and early psychosis. J Am Acad Psychoanal Dyn Psychiatry 31:229–245

    Article  PubMed  Google Scholar 

  21. Granholm E, Anthenelli R, Monteiro R et al. (2003) Brief integrated outpatient dual-diagnosis treatment reduces psychiatric hospitalizations. Am J Addict 12:306–313

    Article  PubMed  Google Scholar 

  22. Gumley A, O’Grady M, McNay L et al. (2003) Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy. Psychol Med 33:419–431

    Article  PubMed  CAS  Google Scholar 

  23. ten Have M, de Graaf R, Vollebergh W et al. (2004) What depressive symptoms are associated with the use of care services? Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). J Affect Disord 80:239–248

    Article  Google Scholar 

  24. Henry C, Ghaemi SN (2004) Insight in psychosis: a systematic review of treatment interventions. Psychopathology 37:194–199

    Article  PubMed  Google Scholar 

  25. Hornung WP, Kieserg A, Feldmann R et al. (1996) Psychoeducational training for schizophrenic patients: background, procedure and empirical findings. Patient Educ Couns 29:257–268

    Article  PubMed  CAS  Google Scholar 

  26. Iqbal Z, Birchwood M, Chadwick P et al. (2000) Cognitive approach to depression and suicidal thinking in psychosis. 2. Testing the validity of a social ranking model. Br J Psychiatry 177:522–528

    Article  PubMed  CAS  Google Scholar 

  27. Jacobi F, Wittchen H-U, Müller N et al. (2002) Estimating the prevalence of mental and somatic disorders in the community: aims and methods of the German National Health Interview and Examination Survey. Int J Methods Psychiatr Res 11:1–19

    Article  PubMed  Google Scholar 

  28. Jacobi F, Hoyer J, Wittchen H-U (2004) Seelische Gesundheit in Ost und West: Analysen auf der Grundlage des Bundesgesundheitssurveys. Z Klin Psychol Psychother 33:251–260

    Article  Google Scholar 

  29. Jacobi F, Wittchen H-U, Hölting C et al. (2004) Prevalence, comorbidity and correlates of mental disorders in the general population: Results from the German Health Interview and Examination Survey (GHS). Psychol Med 34:597–611

    Article  PubMed  CAS  Google Scholar 

  30. Joy CB, Adams CE, Rice K (2004) Crisis intervention for severe mental illness (Cochrane Review). Update Software, Oxford

  31. Karon BP (2003) The tragedy of schizophrenia without psychotherapy. J Am Acad Psychoanal Dyn Psychiatry 31:89–119

    Article  PubMed  Google Scholar 

  32. Klingberg S, Buchkremer G, Holle R et al. (1999) Therapy effects of psychoeducational psychotherapy for schizophrenic patients: results of a 2-year follow-up. Eur Arch Psychiatry Clin Neurosci 249:66–72

    Article  PubMed  CAS  Google Scholar 

  33. Krabbendam L, Janssen I, Bak M et al. (2002) Neuroticism and low self-esteem as risk factors for psychosis. Soc Psychiatry Psychiatr Epidemiol 37:1–6

    Article  PubMed  Google Scholar 

  34. Kurtz MM (2003) Neurocognitive rehabilitation for schizophrenia. Curr Psychiatry Rep 5:303–310

    Article  PubMed  Google Scholar 

  35. Lee C, McGlashan TH, Woods SW (2005) Prevention of schizophrenia: can it be achieved? CNS Drugs 19:193–206

    Article  PubMed  Google Scholar 

  36. Lehman AF, Lieberman JA, Dixon LB et al. (2004) Practice guideline for the treatment of patients with schizophrenia, 2nd edn. Am J Psychiatry 161:1–56

    Article  PubMed  Google Scholar 

  37. Liberman RP, Glynn S, Blair KE et al. (2002) In vivo amplified skills training: promoting generalization of independent living skills for clients with schizophrenia. Psychiatry 65:137–155

    PubMed  Google Scholar 

  38. Malmberg L, Fenton M (2004) Individual psychodynamic psychotherapy and psychoanalysis for schizophrenia and severe mental illness. Cochrane Database of Systematic Reviews, Chichester

  39. McFarlane WR, Dixon L, Lukens E et al. (2003) Family psychoeducation and schizophrenia: a review of the literature. J Marital Fam Ther 29:223–245

    Article  PubMed  Google Scholar 

  40. Mojtabai R, Nicholson RA, Carpenter BN (1998) Role of psychosocial treatments in management of schizophrenia: a meta-analytic review of controlled outcome studies. Schizophr Bull 24:569–587

    PubMed  CAS  Google Scholar 

  41. Müller DR, Roder V, Brenner HD (2006) Effektivität des Integrierten Psychologischen Therapieprogramms für schizophren Erkrankte: Eine Metaanalyse über 28 unabhängige Studien. Nervenarzt (im Druck)

    Google Scholar 

  42. Nose M, Barbui C, Gray R et al. (2003) Clinical interventions for treatment non-adherence in psychosis: meta-analysis. Br J Psychiatry 183:197–206

    Article  PubMed  Google Scholar 

  43. Penn DL, Mueser KT, Tarrier N et al. (2004) Supportive therapy for schizophrenia: possible mechanisms and implications for adjunctive psychosocial treatments. Schizophr Bull 30:101–112

    PubMed  Google Scholar 

  44. Penn DL, Waldheter EJ, Perkins DO et al. (2005) Psychosocial treatment for first-episode psychosis: a research update. Am J Psychiatry 162:2220–2232

    Article  PubMed  Google Scholar 

  45. Perkins DO (2004) Evaluating and treating the prodromal stage of schizophrenia. Curr Psychiatry Rep 6:289–295

    Article  PubMed  Google Scholar 

  46. Pilling S, Bebbington P, Kuipers E et al. (2002) Psychological treatments in schizophrenia: II. Meta-analyses of randomized controlled trials of social skills training and cognitive remediation. Psychol Med 32:783–791

    Article  PubMed  CAS  Google Scholar 

  47. Pompili M, Girardi P, Ruberto A et al. (2004) Toward a new prevention of suicide in schizophrenia. World J Biol Psychiatry 5:201–210

    Article  PubMed  Google Scholar 

  48. Puschner B, Haug S, Häfner S et al. (2004) Einfluss des Behandlungssettings auf den Gesundungsverlauf: Stationäre vs. ambulante Psychotherapie. Psychotherapeut 49:182–192

    Article  Google Scholar 

  49. Puschner B, Born A, Gießler A et al. (2005) Compliance-Interventionen in der medikamentösen Behandlung Schizophrenie-Erkrankter: Befunde aktueller Übersichtsarbeiten. Psychiatr Prax 32:62–67

    Article  PubMed  Google Scholar 

  50. Rector NA, Beck AT (2001) Cognitive behavioral therapy for schizophrenia: an empirical review. J Nerv Ment Dis 189:278–287

    Article  PubMed  CAS  Google Scholar 

  51. Robinson DG, Woerner MG, McMeniman M et al. (2004) Symptomatic and functional recovery from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry 161:473–479

    Article  PubMed  Google Scholar 

  52. Rosenheck R, Tekell J, Peters J et al. (1998) Does participation in psychosocial treatment augment the benefit of clozapine? Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia. Arch Gen Psychiatry 55:618–625

    Article  PubMed  CAS  Google Scholar 

  53. Tarrier N, Lewis S, Haddock G et al. (2004) Cognitive-behavioural therapy in the first-episode and early schizophrenia: 18-month follow-up of a randomised controlled trial. Br J Psychiatry 184:231–239

    Article  PubMed  Google Scholar 

  54. Tsuang J, Fong TW (2004) Treatment of patients with schizophrenia and substance abuse disorders. Curr Pharm Des 10:2249–2261

    Article  PubMed  CAS  Google Scholar 

  55. Turkington D, Dudley R, Warman D et al. (2005) Cognitive-behavioral therapy for schizophrenia: a review. J Psychiatr Pract 10:5–16

    Article  Google Scholar 

  56. Twamley EW, Jeste DV, Bellack AS (2003) A review of cognitive training in schizophrenia. Schizophr Bull 29:359–382

    PubMed  Google Scholar 

  57. Vauth R (2004) Kriseninterventionsstrategien bei psychotischen Störungen. In: Riecher-Rössler A, Berger P, Yilmaz T et al. (Hrsg) Psychiatrisch-psychotherapeutische Krisenintervention. Hogrefe, Göttingen, S 219–234

  58. Vauth R, Corrigan PW, Dietl M et al. (2005) Cognitive strategies versus self-management skills as adjunct to vocational rehabilitation. Schizophr Bull 31:55–66

    Article  PubMed  Google Scholar 

  59. Zammit S, Allebeck P, Andreasson S et al. (2002) Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ 325:1199–1201

    Article  PubMed  Google Scholar 

  60. Zygmunt A, Olfson M, Boyer CA et al. (2002) Interventions to improve medication adherence in schizophrenia. Am J Psychiatry 59:1653–1664

    Article  Google Scholar 

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Danksagung

Wir danken Dr. Hans Kordy, Forschungsstelle für Psychotherapie, Universität Heidelberg, für die Erlaubnis, Daten aus der TRANS-OP-Studie für diese Arbeit zu nutzen.

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Authors and Affiliations

  1. Psychiatrische Poliklinik, Universitätsspital Basel, Basel, Schweiz

    R. Vauth

  2. Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Deutschland

    F. Jacobi

  3. Abteilung Psychiatrie II, Universität Ulm, Ludwig-Heilmeyer-Straße 2, 89312, Günzburg

    B. Puschner & T. Becker

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  1. B. Puschner
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  2. R. Vauth
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  3. F. Jacobi
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  4. T. Becker
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Correspondence to B. Puschner.

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Puschner, B., Vauth, R., Jacobi, F. et al. Bedeutung von Psychotherapie in der Versorgung von Menschen mit schizophrenen Störungen in Deutschland. Nervenarzt 77, 1301–1309 (2006). https://doi.org/10.1007/s00115-006-2102-2

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