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Schizophrenie und bipolare Störung

Behandlung kognitiver Beeinträchtigungen

Schizophrenia and bipolar disorder

Treatment of cognitive impairments

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Zusammenfassung

Bei mehr als der Hälfte der Patienten mit Schizophrenie und bei einer Subgruppe der Patienten mit bipolarer Störung ist das neurokognitive und sozialkognitive Leistungsniveau beeinträchtigt. Der Grad der Beeinträchtigung variiert dabei von Person zu Person. Eine Verbesserung kognitiver Beeinträchtigungen führt zu einer höheren subjektiven Lebensqualität und einem höheren psychosozialen Funktionsniveau und zwar in deutlich höherem Ausmaß als die erfolgreiche Behandlung anderer Symptome. Daher ist es sinnvoll, eine verminderte kognitive Leistung in der Behandlung nicht nur zu erkennen und zu berücksichtigen, sondern auch einen Therapieversuch anzubieten. Hierzu zeigt die vorliegende systematische Übersicht praxisrelevante Behandlungsoptionen auf. Kognitive Trainingsprogramme erbringen aktuell die besten, wenn auch nur moderate Ergebnisse. Auch physische Aktivität ist trotz der im Vergleich geringeren Datenlage als nützlich einzuschätzen. Die gezielte Psychopharmakotherapie und die nichtinvasive Neurostimulation befinden sich noch in der Erprobung, zeigen aber mitunter eine vielversprechende Perspektive. Auch wenn zahlreiche nützliche Behandlungsoptionen für kognitive Defizite bei Schizophrenie und bipolarer Störung zur Verfügung stehen, ist in Zukunft auf noch effektivere Interventionsmöglichkeiten zu hoffen.

Abstract

More than half of the patients diagnosed with schizophrenia and a subgroup of patients diagnosed with bipolar disorder show impairment in neurocognitive and social cognitive performance. The degree of impairment varies from person to person. An improvement of cognitive impairment results in increased subjective quality of life and increased psychosocial functioning, to a much greater extent than successful treatment of other symptoms. Therefore, it is reasonable to not only recognize and bear decreased cognitive functioning in mind but also to offer specific treatment of impairments. The systematic review article in hand provides an overview of practice relevant treatment options in this respect. At present, cognitive remediation therapy shows the best treatment results, although only with moderate effect sizes. Physical activity can also be considered beneficial, even with the smaller number of studies available. Specific psychopharmacotherapy and non-invasive neurostimulation are still being assessed in clinical trials but show a promising perspective. Even though there are various beneficial treatment options to improve cognitive impairment potentially apparent in schizophrenia and bipolar disorder, future research will hopefully bring about even more effective interventions.

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  1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland

    P. Riedel,  M. N. Smolka &  M. Bauer

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P. Riedel und M. N. Smolka geben an, dass kein Interessenkonflikt besteht. M. Bauer gibt an, beratend für Janssen, Lundbeck und Neuraxpharm tätig gewesen zu sein sowie Vortragshonorare von Lilly, Servier und Neuraxpharm erhalten zu haben.

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Riedel, P., Smolka, M.N. & Bauer, M. Schizophrenie und bipolare Störung. Nervenarzt 89, 784–795 (2018). https://doi.org/10.1007/s00115-018-0500-x

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  • DOI: https://doi.org/10.1007/s00115-018-0500-x

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