LVR-Klinikum Düsseldorf Hospital of the Heinrich-Heine University ...

LVR-KLINIKUM DÜsseLDORF – hOsPITaL OF The heINRIch-heINe UNIVeRsITY DÜsseLDORF
to unspecific (prodromal) symptoms that (can) progress to
the full-blown clinical picture of schizophrenia. Accordingly,
prodromes have a predictive and (potentially) interventionguiding
function. This was also empirically investigated
within the context of the 2-year study. In addition, the
effectiveness of benzodiazepines as early intervention
medication for relapse prophylaxis was compared with
that of antipsychotic drugs. It was shown that prodromal
symptoms are superior regarding their relapse-predictive
validity, but that further research is necessary to use them
effectively for relapse prediction and early intervention.
The (intermittent) use of benzodiazepines in addition to
antipsychotic drugs appears to be an additional treatment
option.
Biological principles of illness relapses
Director: W. Gaebel, W. Wölwer, J. Brinkmeyer
Project period: 1999–2005
Financing: FMER funding 01 GI 9932/01 GI 0232
Besides the prodromal symptoms detected during
the disease course, also biological components of the
VSC models were assessed for risk characterisation
using questionnaire-based neuropsychological and
neurophysiological (see section on the Research Group
Experimental Psychopathology), neurobiochemical and brain
morphometric indicators. These factors were assessed
also in the long-term disease course with respect to their
relation to the appearance of prodromal symptoms and
relapses. The main interests were: a) the predictive value
of these components regarding relapse risk and outcome,
especially after discontinuation of treatment, and b) their
modifiability by the pharmacological and psychological
treatment regimens used in the study. In cooperation with
a research group on prodromal symptoms before firstepisode
schizophrenia in the framework of the Competence
Network of Schizophrenia, the risk pattern for relapses
(relapsing disorder) was compared with the risk pattern
for first-episode schizophrenia (employing the same
methods of investigation). When characterised by means
of neuropsychological indicators of vulnerability, patients
with first-episode schizophrenia (after initial treatment)
showed clear deficits in all test methods employed. The
profile was qualitatively very similar to that of persons with
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a (markedly) increased risk for first-episode schizophrenia.
However, persons after first-episode schizophrenia had
quantitatively more pronounced impairments. During the
course of the first year of long-term treatment, persons with
first-episode schizophrenia were characterised by slight
improvements in cognitive functions, but a severe reduction
compared to healthy controls was noted in nearly all areas
tested. Using neuropsychological parameters, relapses or
worsening of symptoms could be equally well predicted
as by tests employing prodromal signs and symptoms
(with prodromal signs and symptoms also permitting a
time-related prediction). Similar results were obtained
with neurophysiological tests (especially P300 latency and
amplitude) as indicators of vulnerability. But not only the
persons with increased vulnerability had an increased risk
of relapse or clinical worsening (compared to the remaining
persons), so did those with a higher degree of stress
exposure or decreased coping skills (as would have been
expected according to the VSC model), especially when these
factors co-occurred in an individual.
Psychological intervention strategies in the relapse
prophylaxis of first-episode schizophrenia
Director: G. Buchkremer, S. Klingberg (University
Department of Psychiatry and Psychotherapy of Tübingen);
W. Gaebel, W. Wölwer, B. Conradt (Department of
Psychiatry and Psychotherapy of the LVR Clinic, Düsseldorf
– Hospital of the Heinrich-Heine University, Düsseldorf);
Schaub (Psychiatric Department of the Ludwig-Maximilian
University, Ludwig-Maximilian University Munich);
M. Wagner (Department of Psychiatry and Psychotherapy,
University of Bonn); A. Bechdolf (Department of Psychiatry
and Psychotherapy, University of Cologne)
Project period: 1999–2005
Financing: FMER funding 01 GI 9932/01 GI 0232
In accordance with the VSC concept, in addition
to pharmacotherapeutic long-term treatment
psychotherapeutic interventions are urgently indicated
for relapse prophylaxis in persons with first-episode
schizophrenia. This project dealt with the question whether
there were differences between short- and long-term
interventions in the two-year relapse rate. Short-term
intervention consisted of psychoeducation over eight weeks,