Vulnerability-stress-coping model: implications for the treatment of first-episode schizophrenia

Abstract

Objectives

According to the vulnerability-stress-coping (V-S-C-) model, the probability of occurrence of a schizophrenic episode depends on the degree of imbalance between vulnerability factors, stressors, and protectors. The present study aims at investigating the effects of psychotherapy and antipsychotic medication on the interaction of these factors and their contribution to course and outcome.

Methods

Within the German Research Network on Schizophrenia (Wölwer et al. 2003, Eur Arch Psychiatr Clin Neurosci 253: 321-329) a multi-center study on the optimization of long-term treatment in n=159 first-episode schizophrenia (ICD-10 F20) was recently finished (Gaebel et al. 2004, Eur Arch Psychiatr Clin Neurosci 254: 129-140). Risperidone and low-dose haloperidol were compared in a two-year randomized double-blind study within the framework of psychological interventions. In the second treatment year continued neuroleptic treatment was compared with stepwise drug withdrawal substituted by prodrome-based early intervention (intermittent treatment). Vulnerability indicators were cognitive and motor functioning (e.g. TMT-A/-B), neuromorphology (MRI) and -physiology (EEG). Stress was monitored by means of the occurrence of stressful life events, family atmosphere and catecholamine-levels in blood, coping competence was assessed with several questionnaires (e.g. SVF, FSKN).

Results

Although no relapse (according to predefined criteria) occurred in the first treatment year under study treatment, direct treatment effects on vulnerability, on stress or on coping competence were rare if detectable at all.

Conclusions

Results will be discussed with respect to the validity of the contemporary V-S-C-Model as etiopathogenetic concept as well as with respect to consequences in regard to treatment and prevention.