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Evidenzbasierte Psychotherapie bei schizophrenen Psychosen

Evidence-based psychotherapy of schizophrenic psychoses

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Zusammenfassung

Auf der Basis des wissenschaftlichen Kenntnisstandes wird dargestellt, dass Psychotherapie wichtiger Bestandteil einer wirksamen und leitliniengerechten Behandlung bei Schizophrenien ist. Zunächst werden Aspekte der methodisch hochwertigen britischen NICE-Guideline für das Gebiet der Psychosenpsychotherapie vorgestellt. Uneingeschränkte Empfehlungen werden hier für die kognitive Verhaltenstherapie und Familieninterventionen gegeben. Hernach werden empirisch begründbare Ansatzpunkte für die Psychosenpsychotherapie dargestellt, wobei insbesondere auf das kognitive Modell des Wahns eingegangen wird. Weiterhin werden störungsspezifische Strategien der Beziehungsgestaltung herausgearbeitet, die auf den Umgang mit Symptomen wie Misstrauen oder Affektverflachung eingehen. Abschließend werden die evidenzbasierten Therapiestrategien zur Rückfallverhütung und zur Symptomreduktion skizziert. Es bleibt das Fazit, dass Psychosenpsychotherapie kein Evidenzproblem, aber ein Implementierungsproblem hat.

Summary

On the basis of the scientific state of knowledge it is outlined that psychotherapy is an important part of an efficacious and guideline-compliant treatment of schizophrenia. Firstly, aspects of the methodologically sound British National Institute for Health and Clinical Excellence (NICE) guidelines regarding the field of psychosis psychotherapy are presented in which cognitive behavioral therapy and family interventions are recommended without restrictions. Afterwards, empirically substantiated starting points for psychosis psychotherapy are described, taking particular account of the cognitive model of delusions. Furthermore, disorder-specific strategies of building the therapeutic relationship are identified, which take account of symptoms, such as mistrust or affective flattening. Finally, the evidence-based therapeutic strategies for relapse prevention and symptom reduction are delineated. In conclusion, psychosis psychotherapy does not have an evidence problem but an implementation problem.

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Authors and Affiliations

  1. Universitätsklinik für Psychiatrie und Psychotherapie, Calwerstr. 14, 72076, Tübingen, Deutschland

    S. Klingberg & A. Wittorf

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  1. S. Klingberg
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  2. A. Wittorf
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Correspondence to S. Klingberg.

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Klingberg, S., Wittorf, A. Evidenzbasierte Psychotherapie bei schizophrenen Psychosen. Nervenarzt 83, 907–918 (2012). https://doi.org/10.1007/s00115-012-3553-2

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