Nenadić Igor, Falkenberg Irina, Mehl Stephanie, Kircher Tilo
Klinik für Psychiatrie und Psychotherapie, Philipps Universität Marburg & Universitätsklinikum Gießen und Marburg (UKGM), Rudolf-Bultmann-Straße 8, 35039, Marburg, Deutschland.
Nervenarzt. 2025 Jan;96(1):5-14. doi: 10.1007/s00115-024-01790-7. Epub 2024 Dec 19.
Despite classical conceptions of schizophrenia as a progressive illness with a high chronification, current long-term follow-up studies show a higher proportion of remission, possibly also a higher proportion of recovery than previously assumed. The heterogeneity of clinical courses is also reflected in different trajectories of cognitive and biological (e.g., imaging) variables, in which many of those affected show remission. Early clinical intervention during the first weeks and months following the onset of psychosis are decisive not only for early remission but also possibly for the long-term outcome. The treatment and reduction of somatic comorbidities are promising approaches in addition to a differentiated core treatment to positively influence the course of the illness even years after the disease. The identification of additional predictors, e.g., based on biological parameters, can together with machine learning approaches contribute to optimization of an individualized core treatment.
尽管传统观念认为精神分裂症是一种具有高慢性化的进行性疾病,但目前的长期随访研究表明,缓解的比例更高,恢复的比例可能也比之前设想的更高。临床病程的异质性也反映在认知和生物学(如影像学)变量的不同轨迹上,其中许多患者会出现缓解。在精神病发作后的最初几周和几个月内进行早期临床干预不仅对早期缓解至关重要,而且可能对长期预后也很关键。除了进行差异化的核心治疗外,治疗和减少躯体合并症是有前景的方法,甚至在疾病发生数年之后也能对疾病进程产生积极影响。识别额外的预测因素,例如基于生物学参数的预测因素,并结合机器学习方法,有助于优化个体化的核心治疗。