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Frontalhirn pp 337-361 | Cite as

Neuropsychologische Therapie der Frontalhirnstörungen: Therapieprogramme

  • S. Gauggel

Zusammenfassung

Dieses Kapitel beschäftigt sich mit der psychologischen Behandlung von hirngeschädigten Patienten, die eine Störung exekutiver Funktionen aufweisen. Patienten mit solchen Störungen können häufig ihr Leben nicht mehr zielgerichtet organisieren und kontrollieren. Sie sind nicht mehr in der Lage zu entscheiden, welche Handlungen zum Erreichen eines bestimmten Zieles notwendig und zweckmäßig sind (Channon u. Crawford 1999). Sie haben Schwierigkeiten beim Planen und Problemlösen (Goel et al. 1997), es fehlt ihnen an Voraussicht und Einsicht in die vorhandenen Defizite (Jurado et al. 1998; Sherer et al. 1998). Zusammenhänge zwischen längerfristigen Zielen und Schritten, die zum Erreichen dieser Ziele notwendig sind, werden nicht mehr erfasst (Channon u. Crawford 2000). Dadurch gelingt auch eine realistische Planung der Zukunft nicht mehr. Sie erscheinen in ihrem Denken eingeengt, es mangelt ihnen an Ideen. Sie lernen nicht aus den gemachten Erfahrungen und Fehlern, die sie wiederum nur noch selten entdecken und meistens auch nicht korrigieren (Hart et al. 1998). Dadurch erscheinen die Patienten in ihrem Verhalten rigide und uneinsichtig. Verstärkt wird dieser Eindruck noch dadurch, dass die Patienten zwar richtig angeben können, was in einer bestimmten Situation getan werden muss, sich aber bei der Ausführung nicht an die genannten Schritte halten. Besonders gravierend ist der Umstand, dass sie Aussagen anderer Personen nicht kritisch hinterfragen und dadurch leicht beeinflusst und gelenkt werden können. In extremen Fällen reagieren die Patienten vorschnell und unüberlegt auf irrelevante Ereignisse oder Geschehnisse in der Umgebung (Lhermitte 1986; Lhermitte et al. 1986; Shallice et al. 1989). In vielen Fällen sind die Betroffenen auch in ihrem emotionalen Erleben verändert (Prigatano 1992; Stuss et al. 1992). Ihre emotionale Beteiligung ist verringert und Emotionen können nicht mehr in dem Ausmaß wie früher gezeigt werden. Teilweise sind sie gleichbleibend freundlich, ja geradezu euphorisch. Vereinzelt neigen sie aber auch zu aggressiven Handlungen (Blair u. Cipolotti 2000), sind schnell aufbrausend und können sexuell enthemmt sein (Grafman et al. 1996; Hawkins u. Trobst 2000; Simpson et al. 1999).

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  • S. Gauggel

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