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Psychologische Interventionen bei Personen mit erhöhtem Psychoserisiko

Psychological interventions in people at-risk for first episode psychosis

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Zusammenfassung

Mit der indizierten Prävention bei Personen mit erhöhtem Psychoserisiko verbindet sich die Hoffnung, eine manifeste psychotische Erkrankung hinauszuzögern oder sogar den Übergang in das Vollbild der Erkrankung zu verhindern. Aber auch die Remission der Risikosymptomatik, das psychosoziale Funktionsniveau und die Lebensqualität sind weitere Zielgrößen. Kognitive Verhaltenstherapie kann zurzeit als der am besten evaluierte und statistisch abgesicherte Einzeltherapieansatz bezüglich der Psychoseprävention gelten. Grundsätzlich ist die Behandlung von Personen mit erhöhtem Psychoserisiko mit dem Risiko verbunden, fälschlich-identifizierte Personen potenziellen Nebenwirkungen auszusetzen. Daher sollte immer die Behandlung mit dem besten Risiko-Nutzen-Verhältnis gewählt werden. Folglich sollte vor einer intensiveren Behandlung zunächst das Monitoring in Früherkennungszentren, gefolgt von einer angepassten Psychoedukation erwogen werden. Die Datenlage im Hinblick auf die Psychoedukation von Risikopersonen ist zwar ermutigend, aber noch nicht ausreichend. Methodische Aspekte, Schwerpunkte und Unterschiede in den evaluierten Ansätzen werden diskutiert.

Abstract

Indicated prevention in individuals at clinical high risk for first episode psychosis is hoped to delay the onset of the disorder or even prevent the transition to full-blown psychosis. Remission of at-risk symptoms, psychosocial functioning and quality of life are secondary outcomes. According to current evidence cognitive behavioral therapy can be considered the best evaluated stand alone therapy approach for the prevention of psychosis. The treatment of persons at risk for first episode psychosis is associated with the risk of exposing falsely identified persons to potential side effects; therefore, treatment with the best risk-benefit ratio should be chosen. Consequently, monitoring within specialized early recognition centers should be considered first, followed by a customized psychoeducation. The data on psychoeducation of people at risk for psychosis are encouraging but still not sufficient. Methodological issues and differences of the evaluated approaches are discussed.

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Authors and Affiliations

  1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    Hendrik Müller

  2. Vivantes Klinikum Am Urban, Berlin, Klinik für Psychiatrie, Psychotherapie, Psychosomatik, Akademisches Lehrkrankenhaus, Charité-Universitätsmedizin, Berlin, Deutschland

    Andreas Bechdolf

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  2. Andreas Bechdolf
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Correspondence to Hendrik Müller.

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Müller, H., Bechdolf, A. Psychologische Interventionen bei Personen mit erhöhtem Psychoserisiko. Psychotherapeut 58, 344–351 (2013). https://doi.org/10.1007/s00278-013-0996-2

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