iCal
Raum:
Saal A8 (Stream/on Demand)
Topic:
Wissenschaftliches Programm
Topic 03: Psychotische Störungen, F2
Stream/on Demand
English programme
Format:
State-of-the-Art-Symposium
Dauer:
90 Minuten
Besonderheiten:
Q&A-Funktion
13:30 Uhr
Non-pharmacological interventions in schizophrenia: state of the art and further directions
P. Falkai (München, DE)
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Autor:in:
P. Falkai (München, DE)
Beside the established pharmacological treatments in schizophrenia, psychoeducation is well established as a second independent column for improving the acute and especially long-term outcome of schizophrenia. This presentation will contain a state-of-the-art update on the non-pharmacologic approaches for schizophrenia.
There are several well controlled studies demonstrating that psychoeducation in inpatients and their relatives reduces the likeliness of a relapse and improves the long-term outcome of schizophrenia in terms of positive and negative symptoms.
One of the underestimated areas of treatment is the use of Cognitive Behavioural Therapy (CBT) and lately also the Metacognitive Training (MCT) in resistant schizophrenia, especially if positive symptoms prevail. Another fruitful way to augment the treatment of schizophrenia is non-invasive brain stimulation: For rTMS the literature is non-conclusive but overall hints at a significant improvement of negative symptoms in small-scale studies. TDCS, another recent development based on a few pilot studies reveals a good option in treatment resistant positive as well as negative symptoms. A third way to improve the long-term outcome of schizophrenia is the modification of lifestyle including nutrition and physical exercise. Several meta-analyses demonstrate the beneficial effect of exercise on function, positive as well as negative symptoms and brain structure in multi-episode schizophrenia.
Finally, the question arises whether the targeted substitution of the daily nutrition might be a way to improve the neuronal plasticity conveying cognitive dysfunction in schizophrenia.
14:15 Uhr
Pharmacotherapy for people with schizophrenia: weighing the options
C. Correll (Berlin/New York, US)
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Autor:in:
C. Correll (Berlin/New York, US)
Introduction:
Despite pharmacologic advancements, schizophrenia remains one of the most debilitating mental disorders that is associated with significant functional impairment, requiring carefully chosen interventions tailored to the patient’s treatment stage and response pattern.
Method:
This presentation will contain a state-of-the-art update on the pharmacologic approaches for schizophrenia, from the first episode to multi-episode and treatment refractoriness, acutely and for maintenance/relapse prevention with an emphasis on meta-analytic summaries and large trials, as well as novel entities in development.
Results/Discussion
Increasing knowledge has been gained from first-episode research regarding the efficacy and safety of antipsychotics in this vulnerable population that need to be tailored to phase-specific issues around the diagnosis, engagement, adherence and coordinated specialty care to address both symptoms and improve/preserve psychosocial functioning. Chronic schizophrenia remains a challenge, as currently available treatments are limited to antidopaminergic agents that have insufficient effects on cognitive dysfunction and negative symptoms. While relevant tolerability improvements have been made, efficacy differences among antipsychotics remain mostly small and unpredictable for individuals. In contrast, adverse effect differences are larger and easier to predict based on the individual antipsychotic. Novel mechanism medications are being developed for total/positive symptoms, negative symptoms and cognition are being explored, but data have not been robust enough to lead to indications of non-dopaminergic agents, with the likely exception if muscarinic agonists. Insufficient or refractory treatment response poses particular difficulties. Many treatments strategies have been tried with varying, mostly lacking or inconsistent success. To date, only clozapine has an evidence base for superior efficacy in treatment refractory patients. Novel technologies are hoped to help identify mechanisms and markers of illness development, type and treatment response, which will facilitate personalized medicine approaches.