[Cognitive behavioral treatment of schizophrenia - ways towards differential indication]

Cognitive-behavioral treatment of schizophrenia is increasingly manifold and sophisticated. The empirical evidence for the efficacy with respect to relapse prevention is most convincing for family psychoeducation. Furthermore, treatment programs for patients and relatives could show efficacy in randomized controlled intervention studies. These programs are designed to improve the patients cooperation and medication compliance, to enhance skills to manage early signs of relapse and to give support in stress management. Work with relatives aims at easing the burden of care, improving the knowledge concerning the illness and enhancing the coping skills of the relatives. A randomized clinical trial of our group could show a significant reduction of the readmission rate by a combined patient and relative-focused intervention. Even five years after completion of therapy we observed a clinical meaningful effect. We found that a favorable prognosis and good social adaptation was a positive predictor of treatment success. However, further research should investigate differential effects in more detail. Symptom reduction is another important issue of cognitive-behavioral treatments. The cognitive therapy of persistent positive symptoms resistant to neuroleptic treatment has recently attracted attention. Three work groups in Great Britain could show independently that positive symptoms could be reduced significantly by strategies of cognitive-behavioral treatment. However, treatment strategies for the reduction of negative symptoms remain to be developed and evaluated. With respect to the implementation of the mentioned treatment strategies in the routine care there are several problems that will be outlined finally.