Weisbrod M, Aschenbrenner S, Pfüller U, Kaiser S, Roesch-Ely D
Sektion Experimentelle Psychopathologie und Neurophysiologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg.
Abteilung für Psychiatrie und Psychotherapie, SRH Klinikum, Karlsbad-Langensteinbach.
Fortschr Neurol Psychiatr. 2014 Mar;82(3):128-34. doi: 10.1055/s-0034-1365920. Epub 2014 Mar 10.
Schizophrenia is a chronic disorder, which severely limits the social and occupational functioning. Employment, education, relationships, housing and health are among the most frequently stated life and treatment goals among persons suffering from schizophrenia. Rehabilitation for persons with schizophrenia aims at preservation and improvement of psychosocial functions in areas such as work, social relationship and independent living skills, promotes recovery-oriented interventions and, therefore, serves the central goals of affected persons. Cognitive functioning, education, negative symptoms, social support and skills, age, work history, and rehabilitation service to restore community functioning have proven to be strong predictors for successful psychiatric rehabilitation. It makes sense to concentrate on these predictors when improvement of psychiatric rehabilitation is targeted. Cognitive remediation produces moderate improvements in cognitive performance and, when combined with functional training and embedded in comprehensive psychiatric rehabilitation, also enhances functional outcome. Germany provides a highly differentiated system of psychosocial support for schizophrenic patients. However, the "German disease" with different care providers being in charge in subsequent stages of recovery hampers efficient organisation of psychiatric rehabilitation. Improvement of overall organisation, i.e., configuration of interfaces, understanding of the complex interactions of measures, design of disease specific programmes, research and economic evaluation constitute major challenges in the field of psychiatric rehabilitation.
精神分裂症是一种慢性疾病，严重限制社会和职业功能。就业、教育、人际关系、住房和健康是精神分裂症患者最常提及的生活和治疗目标。精神分裂症患者的康复旨在维护和改善工作、社会关系及独立生活技能等方面的心理社会功能，促进以康复为导向的干预措施，因此服务于患者的核心目标。认知功能、教育程度、阴性症状、社会支持与技能、年龄、工作经历以及恢复社区功能的康复服务已被证明是精神科康复成功的有力预测因素。当目标是改善精神科康复时，专注于这些预测因素是有意义的。认知矫正能使认知表现有适度改善，并且与功能训练相结合并融入全面的精神科康复时，还能提高功能结局。德国为精神分裂症患者提供了高度差异化的心理社会支持体系。然而，在康复后续阶段由不同护理提供者负责的“德国病”阻碍了精神科康复的有效组织。改善整体组织，即界面配置、对措施复杂相互作用的理解、针对特定疾病项目的设计、研究和经济评估，是精神科康复领域的主要挑战。
