Kognitives Training mit schizophrenen Patienten
Abstract
Die Mehrzahl der schizophrenen Patienten manifestiert leichte bis schwere neuropsychologische Funktionsdefizite. Im Rahmen von kognitiven Trainingsprogrammen werden einzelne oder mehrere neuropsychologische Funktionen durch Üben und Wiederholen trainiert. Es liegen mittlerweile positive Effektivitätsbefunde für kognitive Trainings bei Schizophrenie vor. Trainingsansätze, die kognitives Training mit anderen rehabilitativen Maßnahmen wie Problemlösetrainings oder Motivationsförderung kombinieren, scheinen stärkere Effekte auf soziale und berufliche Funktionsmerkmale schizophrener Patienten zu haben als solche, die ausschließlich auf Üben basieren. Das Outcome kognitiver Trainingsprogramme wird von der Trainingsintensität, der Ausbildungsqualifikation der Trainer und der Motivation der Patienten beeinflusst. Ausgangspunkt einer individualisierten Trainingsplanung stellt eine ausführliche neuropsychologische Diagnostik dar. Es wird eine Reihe spezifischer kognitiver Trainingsprogramme zur Behandlung schizophrener Patienten vorgestellt, die im letzten Jahrzehnt entwickelt wurden.
The majority of schizophrenia patients show moderate to severe neuropsychological dysfunction. Within cognitive training programs single or multiple neuropsychological domains are trained by using drill and practice exercises. By now, evidence has accumulated indicating effectiveness of cognitive training in schizophrenia. Remediation programs that combine cognitive training with other rehabilitative strategies such as problem solving training or motivation enhancement show stronger effects on parameters of social and vocational functioning compared to those which are exclusively based on drill and practice. The effect of cognitive training is moderated by treatment intensity, therapist qualifications, and patient motivation. Individualized cognitive training necessitates a detailed testing of neuropsychological functioning. Specific cognitive training programmes for schizophrenia patients developed in the last decade are presented.
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