J. Klosterkötter

A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in patients with schizophrenia

Objective:  Although the efficacy of cognitive‐behavioural therapy (CBT) in schizophrenia has been established in a number of studies, no information is available on the differential efficacy of CBT in comparison with patient psychoeduction (PE).

Impulsiveness in obsessive–compulsive disorder: results from a family study

Objective:  Although obsessive–compulsive disorder (OCD) is usually conceptualized as an anxiety disorder some studies suggested it to be a deficit of impulse control. The purpose of this study was to assess impulsiveness in OCD families and compare it to control families.

A randomized comparison of group cognitive‐behavioural therapy and group psychoeducation in acute patients with schizophrenia: outcome at 24 months

Objective:  We compared the effects of a brief group cognitive‐behavioural therapy (CBT) and a group psychoeducational (PE) programme in acute patients with schizophrenia 2 years after treatment. At 6‐month follow‐up, the CBT group had shown significantly less re‐hospitalization rates and on a descriptive level higher compliance with medication.

Reduced subjective quality of life in persons at risk for psychosis

Objective:  Subjective quality of life (sQoL) and potentially contributing factors were investigated in individuals putatively in an early (EIPS) or late initial prodromal state (LIPS) and healthy controls (HC).

Obsessive–compulsive symptoms in at‐risk mental states for psychosis: associations with clinical impairment and cognitive function

Obsessive–compulsive symptoms (OCS) constitute a major comorbidity in schizophrenia. Prevalence estimations of OCS for patients with at‐risk mental states (ARMS) for psychosis vary largely. It is unclear how ARMS patients with or without comorbid OCS differ regarding general psychosocial functioning, psychotic and affective symptoms and neurocognitive abilities.

Perceived parental rearing in subjects with obsessive―compulsive disorder and their siblings

Lennertz L, Grabe HJ, Ruhrmann S, Rampacher F, Vogeley A, Schulze‐Rauschenbach S, Ettelt S, Meyer K, Kraft S, Reck C, Pukrop R, John U, Freyberger HJ, Klosterkötter J, Maier W, Falkai P, Wagner M. Perceived parental rearing in subjects with obsessive–compulsive disorder and their siblings.

Prävention psychotischer Störungen

ZusammenfassungDie psychotischen Störungen bieten das erste Beispiel dafür, dass sich die Prädiktions- und Präventionsprogrammatik der modernen Medizin auch erfolgreich auf zentrale psychiatrische Erkrankungen anwenden lässt. In den letzten 20 Jahren konnten Kriterien für die Erfassung des Hochrisikostadiums vor dem erstmaligen Erkrankungsausbruch herausgearbeitet und ihre Vorhersagekraft für drohende Psychoseentwicklungen bestätigt werden. Die Rat- und Hilfesuchenden in den Früherkennungs- und Präventivzentren lassen sich mithilfe dieses Instrumentariums frühen oder späten Abschnitten des Hochrisikostadiums und bestimmten Risikostufen zuordnen, die schon eine weitgehend individuelle Auswahl geeigneter Präventivmaßnahmen erlauben. Die Interventionsangebote zielen auf Verbesserung der Risikosymptomatik, Vermeidung psychosozialer Behinderungen und vor allem auf die Verhinderung oder zumindest doch Verzögerung des Psychoseausbruchs ab. Wirkungsnachweise liegen bisher für neu entwickelte Psychotherapieverfahren, neuroprotektive Substanzen und Antipsychotika in Niedrigdosierung vor. Bevor sie zur Anwendung kommen, sind in jedem Einzelfall sorgfältige Nutzen-Risiko-Abwägungen vorzunehmen.SummaryPsychotic disorders set the first example that prediction and prevention programs of modern medicine can also be successfully applied to central psychiatric disorders. In the last 20 years criteria for the detection of high-risk states prior to the first onset of the disease have been worked out and the predictive power for the transition into psychosis has been confirmed. In the centers for early recognition and prevention, persons seeking help and advice can now be classified into individuals in an early or late high-risk stage by means of newly developed instruments. New possibilities of risk stratification ensure a more individualized selection of appropriate preventive measures. The interventions provided aim at improving risk symptoms, preventing psychosocial disabilities and in particular preventing or at least delaying the onset of psychosis. Proof of efficacy is so far available for newly developed psychotherapeutic methods, neuroprotective agents and low dosage antipsychotics. Prior to administration careful risk-benefit analyses have to be carried out for each individual case.Psychotic disorders set the first example that prediction and prevention programs of modern medicine can also be successfully applied to central psychiatric disorders. In the last 20 years criteria for the detection of high-risk states prior to the first onset of the disease have been worked out and the predictive power for the transition into psychosis has been confirmed. In the centers for early recognition and prevention, persons seeking help and advice can now be classified into individuals in an early or late high-risk stage by means of newly developed instruments. New possibilities of risk stratification ensure a more individualized selection of appropriate preventive measures. The interventions provided aim at improving risk symptoms, preventing psychosocial disabilities and in particular preventing or at least delaying the onset of psychosis. Proof of efficacy is so far available for newly developed psychotherapeutic methods, neuroprotective agents and low dosage antipsychotics. Prior to administration careful risk-benefit analyses have to be carried out for each individual case.

WC2G ACUTE SYMPTOMATIC TREATMENT EFFECTS IN PERSONS CLINICALLY AT RISK FOR PSYCHOSIS

S. Ruhrmann1 *, B. Hoppmann1, S. Theysohn2, H. Picker1, K.-U. Kuhn2, F. Schultze-Lutter1, M. Wagner2, A. Bechdolf1, H.-J. Moller3, W. Gaebel4, W. Maier2, J. Klosterkotter1. 1Dept. of Psychiatry & Psychotherapy, Univ. of Cologne, Cologne, Germany, 2Dept. of Psychiatry & Psychotherapy, Univ. of Bonn, Bonn, Germany, 3Dept. of Psychiatry & Psychotherapy, Univ. of Munich, Munich, Germany, 4Dept. of Psychiatry & Psychotherapy, Univ. of Dusseldorf, Dusseldorf, Germany Presenting author contact: stephan.ruhrmann@uk-koeln.de

Le développement de l’inventaire de dépistage ERIraos: un outil global d’appréciation du risque d’évolution psychotique

RésuméL’organisation du dépistage de patients relevant de programmes d’intervention précoce doit pouvoir s’appuyer sur des outils fiables et validés. Au sein des centres du réseau allemand de compétence sur la schizophrénie (Kompetenznetz Schizophrenie), un ensemble d’instruments permettant de déceler précocement la schizophrénie a été proposé: l’inventaire de détection précoce ERIraos. Cet outil est conçu autour d’une stratégie de dépistage s’articulant en deux étapes. La première s’appuie sur uneChecklist à 17 items utilisable par les médecins généralistes, les psychologues, les enseignants. La seconde étape se déroule dans un centre d’intervention précoce, des spécialistes y effectuant un examen approfondi à l’aide d’un outil à 110 items. Cet examen comporte également l’évaluation par des modules spécifiques de plusieurs facteurs de risque de psychose comme les antécédents familiaux, les retards du développement dans l’enfance et les abus des substances. Cet article présente des résultats préliminaires obtenus avec ces instruments. La fréquence des 17 symptômes de laChecklist va croissant de la phase prodromique précoce à la phase prodromique avancée et des symptômes plus spécifiques surviennent au cours de cette évolution. Les 17 items sont regroupés par une analyse factorielle autour de 5 facteurs: psychose, dépression, désorganisation, repli sur soi et dysphorie. En plus des symptômes prodromiques, la majorité des patients dépistés (82.6%) rapporte au moins un facteur de risque associé (en moyenne: 1,7 facteurs de risque): 68% présentent des traits schizotypiques, 53% rapportent une consommation d’alcool ou de toxiques, 24% des carences ou des retards du développement dans l’enfance, 21% des antécédents de complications obstétricales ou périnatales et 10% des antécédents familiaux de schizophrénie ou d’autres troubles psychotiques au premier degré de leur parenté. Ces résultats restent préliminaires et seule la disponibilité d’une quantité plus importante de données sur la transition vers la psychose permettra de déterminer la valeur prédictive d’ERIraos.AbstractAdequate identification of patients for early intervention programmes requires reliable and valid assessment tools. Within the German Schizophrenia Network (Kompetenznetz Schizophrenie) a set of schedules for early detection of schizophrenia has been proposed: the Early Recognition Inventory ERIraos. ERIraos is a two-step procedure with a 17-item checklist used at step 1 by GPs, psychologists, teachers, while a comprehensive 110-item symptom list is applied at early intervention centres at the expert level. In addition, ERIraos allows the assessment of several risk factors for psychosis such as familial load, childhood deficiencies, alcohol and drug use by special modules. Some preliminary results are presented here. The frequency of the 17 checklist symptoms increases from the early to the late prodrome, and more specific symptoms occur over time. The 17 checklist symptoms are grouped by factor analysis to 5 factors (psychotic, depressive, disorganised, withdrawn, dysphoric). In addition to prodromal symptoms, most patients (86.2%) report at least one additional risk factor (mean: 1.7 risks). 68% demonstrate some schizotypal features, 53% report alcohol and/or drug consumption, 24% demonstrate some deficiency or delay in childhood development, 21% report definite obstetric or birth complications, and 10% have a family history of schizophrenia or some schizophrenia-like diagnosis in first degree relatives. So far, the results are of a preliminary nature, and when sufficient information on psychotic transitions is available, the predictive value of ERIraos will be determined.

Prädiktion von Psychosen

ZusammenfassungHintergrundDie weltweit entstandenen Früherkennungs- und Präventivzentren für Psychosen folgen dem modernen Programm der prädiktiven, präventiven und personalisierten Medizin.FragestellungWenn Primärprävention gelingen soll, müssen zuvor das individuelle Erkrankungsrisiko richtig eingeschätzt und der Psychoseausbruch treffsicher vorhergesagt werden können. Dementsprechend stellt der Beitrag die heutigen Prädiktionsmöglichkeiten dar.Material und MethodeEs wird eine Übersicht über die bisherigen Prädiktionsanalysen in klinischen Hochrisikostadien für Psychosen gegeben.ErgebnisseDie bisher herausgearbeiteten Hochrisikokriterien erreichen eine beachtliche Vorhersagekraft, die sich durch ihre kombinierte Verwendung sowie weitere Strategien der Risikoanreicherung und Risikostratifizierung noch steigern lässt.SchlussfolgerungenDie klinische Prädiktionsleistung ermöglicht bereits risikoadaptierte Präventionsangebote und wird derzeit durch hirnbiologische Zusatzdiagnostiken noch weiter gesteigert.SummaryBackgroundThe worldwide established early detection and prevention centers for psychosis follow the modern program of predictive, preventive and personalized medicine.ObjectivesIf primary prevention is to succeed, the individual risk of the disease has to be estimated correctly and the psychosis onset has to be accurately predicted. Accordingly, this article presents the current possibilities for prediction.Materials and methodsAn overview on the recent prediction analyses in clinical high risk for psychosis research is provided.ResultsThe previously identified high-risk criteria achieve a considerable predictive power, which can be further enhanced by their combined use as well as other strategies of risk enrichment and risk stratification.ConclusionsClinical prediction already allows risk-adapted prevention measures and is currently being enhanced even further by additional biological brain diagnostics.