Prävention psychotischer Störungen

Music therapy in the early detection and indicated prevention in persons at risk of bipolar disorders: State of knowledge and potential

Bipolar disorders are among the most severe mental illnesses. The onset of the disorder is frequently preceded by phases with subsyndromal symptoms. In Germany, psychiatric early detection centres provide prevention services for help-seeking young people which focus on risk research. This article considers how music therapy contributes to the indicated prevention of bipolar disorders in preparation for a qualitative research study. The article presents a narrative literature review on research into early detection and prediction in bipolar disorders and approaches to prevention. The rationale for the use of music therapy in this context is discussed, with consideration of research questions leading to the next stage of the study.

The Concept of Schizophrenia: From Unity to Diversity

After over 100 years of research without clarifying the aetiology of schizophrenia, a look at the current state of knowledge in epidemiology, genetics, precursors, psychopathology, and outcome seems worthwhile. The disease concept, created by Kraepelin and modified by Bleuler, has a varied history. Today, schizophrenia is considered a polygenic disorder with onset in early adulthood, characterized by irregular psychotic episodes and functional impairment, but incident cases occur at all ages with marked differences in symptoms and social outcome. Men’s and women’s lifetime risk is nearly the same. At young age, women fall ill a few years later and less severely than men, men more rarely and less severely later in life. The underlying protective effect of oestrogen is antagonized by genetic load. The illness course is heterogeneous and depressive mood the most frequent symptom. Depression and schizophrenia are functionally associated, and affective and nonaffective psychoses do not split neatly. Most social consequences occur at the prodromal stage. Neither schizophrenia as such nor its main symptom dimensions regularly show pronounced deterioration over time. Schizophrenia is neither a residual state of a neurodevelopmental disorder nor a progressing neurodegenerative process. It reflects multifactorial CNS instability, which leads to cognitive deficits and symptom exacerbations.

[Prediction of psychoses]

BACKGROUND

The worldwide established early detection and prevention centers for psychosis follow the modern program of predictive, preventive and personalized medicine.

OBJECTIVES

If primary prevention is to succeed, the individual risk of the disease has to be estimated correctly and the psychosis onset has to be accurately predicted. Accordingly, this article presents the current possibilities for prediction.

MATERIALS AND METHODS

An overview on the recent prediction analyses in clinical high risk for psychosis research is provided.

RESULTS

The previously identified high-risk criteria achieve a considerable predictive power, which can be further enhanced by their combined use as well as other strategies of risk enrichment and risk stratification.

CONCLUSIONS

Clinical prediction already allows risk-adapted prevention measures and is currently being enhanced even further by additional biological brain diagnostics.