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Übersichtsarbeit · Review Article

Liberale Akzeptanz als kognitiver Mechanismus bei Psychose: Eine 2-Stufen-Theorie der Pathogenese schizophrener Positivsymptome

Moritz Sa · Lüdtke T.a · Pfuhl G.b · Balzan R.c · Andreou C.d

Author affiliations

a Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; b Department of Psychology, UiT, The Arctic University of Norway, Tromsø, Norway; c School of Psychology, Flinders University Adelaide, Adelaide, SA, Australia; d Zentrum für Gender Research und Früherkennung, Universität Basel, Universitäre Psychiatrische Kliniken, Basel, Schweiz

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Article / Publication Details

First-Page Preview
Abstract of Übersichtsarbeit · Review Article

Published online: March 30, 2017
Issue release date: May 2017

Number of Print Pages: 11
Number of Figures: 1
Number of Tables: 0

ISSN: 1016-6262 (Print)
eISSN: 1423-0402 (Online)

For additional information: https://www.karger.com/VER

Abstract

Positivsymptome wie Wahn und Halluzinationen stellen definierende Symptome einer (schizophrenen) Psychose dar. In dieser Übersichtsarbeit wird ein 2-stufiges heuristisches Modell für die Entstehung und Aufrechterhaltung psychotischer Positivsymptome vorgelegt. Im Kern der Theorie steht die Hypothese, dass von Psychose betroffene Menschen eine erniedrigte Entscheidungsschwelle aufweisen, die zu einer frühzeitigen Annahme von Hypothesen führt (liberale Akzeptanz). Im Unterschied zu nichtpsychotischen Personen ist die Konfidenz in falsche Urteile bei Betroffenen, als Folge dieser liberalen Akzeptanz, erhöht. Postuliert werden 2 Stufen der Wahnentwicklung. Auf Stufe 1 (Wahnentstehung) ist die subjektive Wahrscheinlichkeit für akzeptierte Hypothesen bei Menschen mit Psychose zunächst vergleichsweise gering. Wahnhafte Ideen sind in diesem Stadium häufig nicht voll entfaltet bzw. fragil und können zwischen 2 sich gegenseitig ausschließenden Ansichten oszillieren («doppelte Buchführung»). Im Zuge der 2. Stufe (Überzeugung, Aufrechterhaltung) verfestigen sich die flüchtigen wahnhaften Ideen zu falschen Überzeugungen aufgrund eines 2-gliedrigen Konsolidierungsprozesses - indem einerseits Gegenbeweise ignoriert und andererseits Belege zugunsten der Leithypothese einen Verarbeitungsvorteil erhalten (Bestätigungstendenz). Alternative Hypothesen rücken in den Hintergrund. Aufrechterhaltend für eine Wahnidee sind vielfältige psychologische Faktoren und Motive, wie die Kongruenz des Wahns mit dem emotionalen Befinden, persönliche Bedeutsamkeit und die temporäre Steigerung des Selbstwertgefühls sowie das Spannen eines Erklärungsrahmens für ein breites Spektrum von Beschwerden zur Reduktion kognitiver Dissonanz. Aus unserer Sicht können viele Formen von Halluzinationen und Erstrangsymptomen (z.B. Gedankeneingebung) ebenfalls durch liberale Akzeptanz erklärt werden. Diese Symptome basieren unseres Erachtens nicht zwingend auf fehlerhaften oder abnormalen Wahrnehmungen, sondern repräsentieren eine Fehlinterpretation von (teilweise) normalen sensorischen Phänomenen, die sich von einem (normalen) «Als-ob»-Gefühl bis hin zu einer wahnhaften Überzeugung steigern. Im Einklang mit dem erläuterten Modell werden Positivsymptome durch Interventionen wie das metakognitive Training (MKT) verringert, die Betroffene dazu anhalten, mehr Informationen zu sammeln und ihre Urteilssicherheit zu reduzieren (Säen von Zweifel). Die antipsychotische Wirkung von Antipsychotika/Neuroleptika wird im Rahmen der Theorie zum Teil durch ihre Eigenschaft erklärt, Zweifel zu induzieren. Die Bedeutung der Emotionsregulation bei der Reduktion von Positivsymptomen wird ebenfalls aufgezeigt, und zukünftige Forschungsrichtungen sowie offene Fragen diskutiert.

© 2017 S. Karger GmbH, Freiburg


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Article / Publication Details

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Abstract of Übersichtsarbeit · Review Article

Published online: March 30, 2017
Issue release date: May 2017

Number of Print Pages: 11
Number of Figures: 1
Number of Tables: 0

ISSN: 1016-6262 (Print)
eISSN: 1423-0402 (Online)

For additional information: https://www.karger.com/VER


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