Prävention einer ersten psychotischen Episode

 

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Zusammenfassung

Gegenstand und Ziel: Psychotische Störungen gehören aufgrund ihres frühen Beginns und ihren langfristigen Konsequenzen zu den teuersten psychischen Erkrankungen in Europa. Prävention könnte die gesellschaftlichen Kosten und die immense Belastung für Patienten und Familien signifikant reduzieren. Neurobiologische Befunde deuten auf eine glutamaterge Dysfunktion und ein Redoxungleichgewicht in der Pathophysiologie der Schizophrenie. Wir vermuten, dass Interventionen, die auf soziale Funktionen und glutamaterge /oxidative Signalwege abzielen, die Übergangsraten signifikant reduzieren würden. Material und Methoden: Unsere Studie ist eine randomisierte, placebokontrollierte 18-monatige Studie (6-Monate Intervention; 12 Monate Nachuntersuchung) mit 200 Probanden, die ein klinisch erhöhtes Risiko für Psychosen haben. Wir werden in einem 2x2-faktoriellen Design die präventiven Effekte einer kognitiv-behavioralen und sozial-kognitiven Intervention (IPPI) mit einer pharmakologischen Intervention mit einem pro-glutamatergen, neuroprotektiven Medikament (N-Acetylcystein) vergleichen. Ergebnisse und klinische Relevanz: Die Ergebnisse dieser Studie sollen zu neuen, gut verträglichen präventiven Interventionen führen.

Summary

Objective: Psychotic disorders are among the most expensive brain-related disorders in Europe, due mainly to their onset early in life and their long-term disabling courses. Prevention is expected to significantly reduce the societal costs and the immense burden for the patients and their families. Neurobiological evidence implicates glutamatergic dysfunction and redox imbalance in the pathophysiology of schizophrenia. We hypothesize that interventions targeting social functioning and glutamatergic /oxidative pathways already in at-risk states would significantly reduce transition rates. Material and methods: Our study is a randomized, placebo-controlled, 18- month trial (six months intervention; 12 months follow-up), involving 200 subjects at-risk for psychosis. We will compare in a 2x2 factorial design the preventive effects of a cognitive-behavioural and social-cognitive intervention (IPPI) to a pharmacological intervention with a pro-glutamatergic, neuroprotective drug (N-Acetylcysteine). Results and clinical relevance: The results of this study are expected to provide new and well-tolerated preventive interventions.

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