Ist die Diagnose Schizophrenie noch sinnvoll?

 

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Zusammenfassung

Am Vergleich von 130 bevölkerungsbezogenen Erstaufnahmen von Schizophrenie, Depression und „gesunden” Kontrollen ab Krankheitsbeginn und am Verlauf von 107 Erstepisoden von Schizophrenie über 11,2 Jahre werden Trennbarkeit und Gemeinsamkeiten von psychotischen, depressiven und manischen Syndromen analysiert. Depression und Schizophrenie beginnen mit identischen, meist depressiven Prodromi. Depression bleibt häufigstes Syndrom im Verlauf der Schizophrenie. Bei Zunahme depressiver und ängstlicher Symptome steigt, bei Abnahme sinkt das Psychoserisiko. Depressive Syndrome sind integraler Bestandteil der Schizophrenie. Die Diagnose Schizophrenie sollte durch ein vierdimensionales Konstrukt mit überwiegend spezifischer Therapieindikation je Dimension ersetzt werden.

Abstract

To analyse what psychotic, depressive and manic syndromes have in common and what separates them, we compared 130 population-based first-admission cases of schizophrenia and depression from illness onset until first admission and 130 „healthy” controls. We also studied 107 first-episode cases of schizophrenia over 11.2 years. Illness onset in depression and schizophrenia is marked by identical symptoms, mostly depressive in type. Throughout the course of schizophrenia depression is the most frequent symptom. Psychosis risk increases when depressive and anxiety symptoms increase and decreases when these symptoms decrease. The depressive syndrome is an integral part of schizophrenia. Schizophrenia diagnosis should be replaced by a four-dimensional construct, with each dimension associated with a mainly specific indication for therapy.

Literatur

• 1 Kendel R E, Brockington I F. The identification of disease entities and the relationship between schizophrenic and affective psychoses.  Br J Psychiatry. 1980;  137 324-331
  PubMedGoogle Scholar
• 2 Berner P, Katschnig H, Lenz G. Polydiagnostic approach in research on schizophrenia. In: Freedman AM (ed) Science, practice and social policy: Issues in classifying mental disorders. New York; Human Sciences Press 1986 dt.: Bleuler M. Die schizophrenen Geistesstörungen im Lichte langjähriger Kranken- und Familiengeschichten. Stuttgart: Thieme, 1972
  Google Scholar
• 3 Angst J, Cassano G. The mood spectrum: improving the diagnosis of bipolar disorder. Review.  Bipolar Disord. 2005;  7, Suppl 4 4-12
  CrossrefPubMedGoogle Scholar
• 4 Marneros A, Deister A, Rohde A, Steinmeyer E M, Jünemann H. Long-term outcome of schizoaffective and schizophrenic disorders: A comparative study. Part I: Definitions, methods, psychopathological and social outcome.  Eur Arch of Psychiatr Neurol Sci. 1989;  238 118-125
  PubMedGoogle Scholar
• 5 Jaeger M, Bottlender R, Strauss A, Moeller H J. Fifteen-year follow-up of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition depressive disorders: the prognostic significance of psychotic features.  Compr Psychiatry. 2005;  46 (5) 322-327
  CrossrefPubMedGoogle Scholar
• 6 Marengo J, Harrow M, Herbener E S, Sands J. A prospective longitudinal 10-year study of schizophrenia's three major factors and depression.  Psychiatry Research. 2000;  97 61-77
  CrossrefPubMedGoogle Scholar
• 7 Haefner H, Maurer K, Löffler W, Riecher-Rössler A. The influence of age and sex on the onset and early course of schizophrenia.  Br J Psychiatry. 1993;  162 80-86
  PubMedGoogle Scholar
• 8 Heiden W an der, Könnecke R, Maurer K, Ropeter D, Häfner H. Depression in a long-term course of schizophrenia. Special Issue Schizophrenia and Depression.  Eur Arch Psych Clin Neurosci. 2005;  255 174-184
  PubMedGoogle Scholar
• 9 Angst J, Dobler-Mikola A. The Zurich Study - A prospective epidemiological study of depressive, neurotic and psychosomatic syndromes. IV: Recurrent and nonrecurrent brief depression.  Eur Arch Psychiatr Clin Neurol Sci. 1985;  234 408-416
  PubMedGoogle Scholar
• 10 Hanssen M, Bak M, Bijl R, Vollebergh W, Os J van. Outcome of self-reported psychotic experiences in the general population: a prospective study. In: Hanssen M (ed) A continuous psychosis phenotype: from description to prediction. Maastricht; M S S Hanssen 2004: 95-107
  Google Scholar
• 11 Os J Van, Verdoux H, Maurice-Tison S, Gay B, Liraud F, Salamon R, Bourgeois M. Self-reported psychosis-like symptoms and the continuum of psychosis.  Soc Psychiatry Psychiatr Epidemiol. 1999;  34 459-463
  CrossrefPubMedGoogle Scholar
• 12 Os J Van, Gilvarry C, Bale R, Horn E van, Tattan T, White I, Murray R M. on behalf of the UK700 Group . A comparison of the utility of dimensional and categorical representations of psychosis.  Psychol Med. 1999;  29 595-606
  CrossrefPubMedGoogle Scholar
• 13 Wittchen H U, Höfler M, Liebe R, Spauwen J, Os J Van. Depressive und psychotische Symptome in der Bevölkerung - Eine prospektiv-longitudinale Studie (EDSP) an 2500 Jugendlichen und jungen Erwachsenen. Paper presented at the DGPPN Congress Berlin, Nov. 24 - 27. (abstract published in Nervenarzt).  Nervenarzt. 2004;  75, Suppl 2 87
  PubMedGoogle Scholar
• 14 Tsuang M T, Fleming J A. Long-term outcome of schizophrenia and other psychoses. In: Häfner H, Gattaz WF, Janzarik W (eds) Search for the causes of schizophrenia. Berlin, Heidelberg; Springer 1987: 88-97
  Google Scholar
• 15 Kendler K S, Karkowski-Shuman L, Walsh D. The risk for psychiatric illness in siblings of schizophrenics: the impact of psychotic and non-psychotic affective illness and alcoholism in parents.  Acta Psychiatr Scand. 1996;  94 49-55
  PubMedGoogle Scholar
• 16 Maier W, Lichtermann D, Franke P, Heun R, Falkai P, Rietschel M. The dichotomy of schizophrenia and affective disorders in extended pedigrees.  Schizophr Res. 2002;  57 259-266
  CrossrefPubMedGoogle Scholar
• 17 Erlenmeyer-Kimling L, Rock D, Squires-Wheeler E, Roberts S, Yang J. Early life precursors of psychiatric outcomes in adulthood of subjects at risk for schizophrenia or affective disorders.  Psychiatry Res. 1991;  39 239-256
  CrossrefPubMedGoogle Scholar
• 18 Mirsky A F, Ingraham L J, Jugelmass S. Neuropsychological assessment of attention and ist pathology in the Israeli cohort.  Schizopr Bull. 1995;  21 193-204
  PubMedGoogle Scholar
• 19 Erlenmeyer-Kimling L, Adamo U H, Rock D, Roberts S A, Bassett A S, Squires-Wheeler E, Cornblatt B A, Endicott J, Paper S, Gottesmann I I. The New York high-risk project.  Arch Gen Psychiatry. 1997;  54 1096-1102
  PubMedGoogle Scholar
• 20 Lichtenstein P, Yip B, Björk C, Pawitan Y, Hultman C. Evidence of shared genetic etiology in schizophrenia and bipolar disorder: A study of first and second degree relatives in Sweden. Abstract of the XIII^th Biennial Winter Workshop on Schizophrenia Research, Davos, 2006.  Schizophr Res. 2006;  81, Suppl 3
  CrossrefPubMedGoogle Scholar
• 21 Berrettini W. Evidence for shared susceptibility in bipolar disorder and schizophrenia.  Am Med Genet. 2003;  123 C 59-64
  PubMedGoogle Scholar
• 22 Segurado R, Detera-Wadleigh S D, Levinson D F, Lewis C M, Gill M, Nurnberger J I, Craddock N, Paulo J R De, Baron M, Gershon E S, Ekholm J, Cichon S, Turecki G, Claes S, Kelsoe J R, Schofield P R, Badenshop R F, Forissette J, Coon H, Blackwood D, McInnes L A, Foroud T, Edenberg H J, Reich T, Rice J P, Goate A, McInnis M G, McMahon F J, Badner J A, Goldin L R, Bennett P, Willour V L, Zandi P P, Liu J, Gilliam C, Juo S H, Berrettini W H, Yoshikawa T, Peltonen L, Lonnqvist J, Nothen M M, Schumacher J, Windemuth C, Rietschel M, Propping P, Maier W, Alda M, Grof P, Rouleau G A, Del-Favero J, Broeckhoven Cmendlewicz J Van, Adolfsson R, Spence M A. Genome scan meta-analysis of schizophrenia and bipolar disorder, part II: Bipolar disorder.  Am J Hum Genet. 2003;  73 49-62
  CrossrefPubMedGoogle Scholar
• 23 Lewis C M, Levinson D F, Wise L H, DeLisi L E, Straub R E, Hovtta I, Williams N M, Schwab S G, Pulver A E, Faraone S V. et al . Genome scan meta-analysis of schizophrenia and bipolar disorder, part II: Schizophrenia.  Am J Hum Genet. 2003;  73 34-48
  CrossrefPubMedGoogle Scholar
• 24 Maier W, Höfgen B, Zobel A, Rietschel M. Genetic models of schizophrenia and bipolar disorder - overlapping inheritance or discrete genotypes?.  Eur Arch Psychiatr Clin Neursci. 2005;  255 159-166
  CrossrefPubMedGoogle Scholar
• 25 Schulze T G, Ohlraun S, Czerski P M, Schumacher J, Kassem L, Deschner M, Gross M, Tullius M, Heidman V, Kovalenko S, Jamra R A, Becker T, Leszcynska-Rodziewicz A, Hauser J, Illig T, Klopp N, Wellek S, Cichon S, Henn F A, McMahon F J, Maier W, Propping P, Nothen M M, Rietschel M. Genotypephenotype studies in bipolar disorder schowing association beween the DAOA/G30 locus and persecutory delusions: a first step toward a molecular genetic classification of psychiatrc phenotypes.  Am J Psychiatry. 2005;  162 2101-2108
  CrossrefPubMedGoogle Scholar
• 26 Vita A, Peri L De, Silenzi C, Dieci M. Brain morphology in first-episode schizophrenia: A meta-analysis of quantitative magnetic resonance imaging studies.  Schizophr Res. 2006;  82, 1 75-88
  CrossrefPubMedGoogle Scholar
• 27 Lenzenweger M F, Dworkin R H. The dimensions of schizophrenia phenomenology. Not one or two, at least three, perhaps four.  Br J Psychiatry. 1996;  168 432-440
  PubMedGoogle Scholar
• 28 Liddle P F. The symptoms of chronic schizophrenia: a re-examination of the positive-negative dichotomy.  Br J Psychiatry. 1987;  151 145-151
  PubMedGoogle Scholar
• 29 Liddle P F. Schizophrenic syndromes, cognitive performance and neurological dysfunction.  Psychol Med. 1987;  17 49-57
  PubMedGoogle Scholar
• 30 Liddle P F, Barnes T RE. Syndromes of chronic schizophrenia.  Br J Psychiatry. 1990;  157 558-561
  PubMedGoogle Scholar
• 31 McGorry P D, Bell R C, Dudgeon P L, Jackson J H. The dimensional structure of first episode psychosis: an exploratory factor analysis.  Psychol Med. 1998;  28 935-947
  CrossrefPubMedGoogle Scholar
• 32 Ruggeri M, Koeter M, Schene A, Bonetto C, Vazquez-Barquero J L, Becker T, Knapp M, Knudsen H C, Tansella M, Thornicroft G. Factor solution of the BPRS-expanded version in schizophrenic outpatients living in five European countries.  Schiophr Res. 2005;  75 107-117
  PubMedGoogle Scholar
• 33 Bebbington P, Kuipers E. Schizophrenia and psychosocial stresses. In: Hirsch SR, Weinberger DR (eds) Schizophrenia, 2^nd ed. Oxford; Blackwell Publishing 2003: 613-636
  Google Scholar
• 34 Dohrenwend B P, Shrout P E, Link B G, Skodol A E, Stueve A. Life events and other possible psychosocial risk factors for episodes of schizophrenia and major depression: A case-control study. In: Mazure CM (ed) Does stress cause psychiatric illness?. Washington, D. C.; American Psychiatric Press 1995: 43-65
  Google Scholar
• 35 Lawrie S, McIntosch A, Nadeem Z. Schizophrenia.  Clin Evid. 2005;  14 1306-1330
  PubMedGoogle Scholar
• 36 Os J Van, Delespaul P. Toward a world consensus on prevention of schizophrenia.  Dialogues Clin Neursci. 2005;  7 53-67
  PubMedGoogle Scholar
• 37 Krabbendam L, Hanssen M, Bak M, Os J Van. Psychotic features in the general population. Risk factors for what?. In: Gattaz WF, Häfner H (eds) Search for the Causes of Schizophrenia, Vol V. Darmstadt; Steinkopff 2004: 54-78
  Google Scholar
• 38 Stefanis N C, Hanssen M, Smirnis N K, Avramopoulos D A, Evdokimidis I K, Stefanis C N, Verdoux H, Os J Van. Evidence that three dimensions of psychosis have a distribution in the general population.  Psychol Med. 2002;  32 347-358
  PubMedGoogle Scholar
• 39 Myin-Germeys I, Spauwen J, Jacobs N, Lieb R, Wittchen H U, Os J Van. The aetiological continuum of psychosis. In: Gattaz WF, Häfner H (eds) Search for the Causes of Schizophrenia, Vol V. Darmstadt; Steinkopff 2004: 342-366
  Google Scholar
• 40 Löffler W, Häfner H. Dimensionen der schizophrenen Symptomatik. Vergleichende Modellprüfung an einem Erstepisodensample.  Nervenarzt. 1999;  70/5 416-429
  PubMedGoogle Scholar

1 In der vorliegenden Analyse wird die Beobachtungszeit aller Patienten auf 134 Monate ab Aufnahme festgelegt. Diese Zeit ist durch die Verlaufsdauer bis zur ersten Nachuntersuchung, d. h. durch den Patienten mit der kürzesten Beobachtungszeit begrenzt. In früheren Analysen mit 136 Monaten Verlaufsdauer wurde in Kauf genommen, dass für zwei Patienten ab Monat 135 keine Informationen mehr zur Verfügung standen.

Prof. Dr. Dr. Dres. h. c. Heinz Häfner

Leiter der Arbeitsgruppe Schizophrenieforschung, Zentralinstitut für Seelische Gesundheit, J 5

68159 Mannheim

Email: heinz.haefner@zi-mannheim.de