Zwang und Schizophrenie

Zusammenfassung

Die Koexistenz schizophrener und Zwangsstörungen wird seit Jahrzehnten diskutiert. Die vorliegende Arbeit gibt einen Überblick über diejenigen Studien, die entsprechende empirisch fundierte Ergebnisse unter fünf Gesichtspunkten zusammen fassen: Zwangssymptome bei Schizophreniekranken, schizophrene Psychosen bei Zwangspatienten, Schizophrenie-Spektrum-Störungen und Zwangssymptome, neurobiologische Befunde bei Zwang und Psychose und atypische Neuroleptika und Zwangsinduktion. Im Rahmen einer MEDLINE-Recherche wurden alle relevanten Arbeiten von 1960 - 2004 in die Übersicht aufgenommen. Obwohl nach streng wissenschaftlichen Kriterien nur wenige empirisch solide Studien vorliegen, scheinen gerade aktuellere Untersuchungen zu bestätigen, dass eine Koexistenz von Zwang und Schizophrenie doch nicht so selten ist. Die enge Verwandtschaft der dysfunktionalen neuronalen Zirkel bei Zwang und Schizophrenie bleibt bemerkenswert und rechtfertigt das weitere wissenschaftliche Interesse, zumal die differenzialdiagnostischen Probleme und therapeutischen und prognostischen Konsequenzen unbestritten sind. Die Literaturübersicht fasst differenzialdiagnostische Überlegungen und entsprechende therapeutische Implikationen betreffs der atypischen Neuroleptika und Selektiven Serotonin-Wiederaufnahmehemmer (SSRI) zusammen. Künftige double-blind, randomisierte und plazebo-kontrollierte Studien großer Patientenpopulationen mit präziseren diagnostischen Zuordnungen sind notwendig, um einen möglichen schizo-obsessiven Subtyp einer Schizophrenie bzw. schizotypen Subtyp einer Zwangsstörung identifizieren und einen entsprechenden therapeutischen Algorithmus ableiten zu können.

Abstract

Co-occurence of psychotic and obsessive-compulsive symptoms has been recognized for decades. This paper reviews published reports from five perspectives: schizophrenia with obsessive-compulsive symptoms, obsessive-compulsive disorder (OCD) with psychotic symptoms, schizophrenia-spectrum-personality disorder with obsessive-compulsive symptoms, obsessive-compulsive symptoms induced by atypical antipsychotics and similarities of functional neural circuits theory in OCD and schizophrenia. A MEDLINE search was conducted to identify relevant articles from 1960 until 2004. Only a few systematic data that explore the nature and significance of such occurrence have been published. More recent studies using systematic diagnostic criteria suggest that the rate of occurrence may not be rare at all. In schizophrenia, a similar dorsolateral prefrontal cortex circuit shares anatomic substrates similar to those of the OCD orbitofrontal circuit. Exploring the interface of schizophrenic and obsessive-compulsive symptoms is important for diagnostic clarity and could have important implications for treatment and long-term prognosis. The review emphasizes the different origins and natural course of co-occurrence of schizophrenic and obsessive-compulsive symptoms and their various outcome under atypical antipsychotics and selective serotonin reuptake inhibitors (SSRI). Further double-blind, randomized, placebo-controlled investigations in larger cohorts of schizophrenic and OCD patients are needed in order to identify a schizo-obsessive schizophrenia and a schizotypal subtype of obsessive compulsive disorder and to substantiate the algorithm for treatment.

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