Die Krankheit Schizophrenie ist auch heute noch eine schwere psychische Krankheit mit sehr unterschiedlicher Prognose. Einen günstigen Effekt auf den Verlauf der Krankheit und der Prognose hat die frühzeitige Diagnose und Behandlungsbeginn mit einem Neuroleptikum.

Leider zeigt die Schizophrenie im Krankheitsverlauf über viele Jahre hinweg eine uncharakteristische, pseudoneurasthenische oder depressive Prodromalphase, die häufig nicht erkannt oder falsch diagnostiziert wird. Jeder unklare Leistungsknick in der Adoleszenz oder im jungen Erwachsenenleben, unerklärlicher sozialer Rückzug, Auffälligkeiten im Verhalten, aber auch läppisches, uneinfühlbares Verhalten von Schulkindern sollte den Verdacht auch auf die Möglichkeit legen, es könnte sich um eine beginnende Schizophrenie handeln. Die frühe Diagnose ermöglicht die rechtzeitige Behandlung, die einer Chronifizierung vorbeugt, wie sie bei vielen Erstdiagnostizierten bereits vorliegt. Bei Früherkennung und frühzeitiger Behandlung ist die Prognose der Krankheit Schizophrenie deutlich besser.

Der Verlauf der Krankheit Schizophrenie ist sehr unterschiedlich. Bleuler unterschied >10 Verlaufstypen!

  • Akuter Beginn
  • Schleichender Beginn
  • Schubweiser Verlauf (mit Residuum)
  • Phasischer Verlauf (ohne Residuum mit vollständiger Remission zwischen den Schüben
  • Chronifizierender Verlauf
  • Mit Residuum
    • DD: postpsychotische Depression oder postpsychotischer Erschöpfungszustand –> kann Monate bestehen, klingt aber im Ggs. zum Residuum wieder ab!!!

Ferner gibt es die Unterscheidung von Verlauf und Prognose nach Typ:

  • Hebeprenie eher ungünstig
  • Katatonie eher günstig

Die ICD-10 unterscheidet:

  • Kontinuierlich F20.x0
  • Episodisch mit zunehmenden „negativen“ Symptomen in den Krankheitsintervallen F20.x1
  • Episodisch mit anhaltenden, aber nicht zunehmenden „negativen“ Symptomen in den Intervallen F20.x2
  • Episodisch remittierend F20.x3
  • Unvollständige Remission F20.x4
  • Vollständige Remission F20.x5
  • Sonstiger Verlauf F20.x8
  • Verlauf unsicher, Beobachtungszeitraum < 1 Jahr F20.x9

Die Schizophrenie ist mit einer hohen Suizid-Rate (10%) belegt. Dies sollte man bei der Therapie-Gestaltung und der Festlegung der Erwartungshorizonte immer im Bewusstsein haben.

Je akuter und dramatischer der Beginn der Symptomatik undje klarer der situative Auslöser, umso besser ist im allgemeinen die Prognose!

Durch die moderne Behandlung gibt es heute wesentlich bessere Verläufe als früher:

  • Kaum noch maligne Verläufe
  • Der Grossteil der Patienten ist wieder in die Gesellschaft integrierbar und ohne dauerhafte Unterbringung
  • Allerdings bleiben 50% ungünstiger Verläufe mit Rezidiven und Residualsymptomatik und erheblichen Störungen der sozialen Integration!

Sprungmarke

 

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