Pharmakotherapie der therapieresistenten Schizophrenie

Viele schizophrene Patienten sprechen auf die Behandlung mit dem ersten Antipsychotikum nicht an, selbst bei adäquater Therapie. Oft sind mehrere Therapieversuche nötig, um die Symptomatik genügend zu verbessern. Je nach Ausgangslage und Zielsymptomatik (Positiv- oder Negativsymptomatik, depressive Symptome) erreicht man ein optimales Behandlungsergebnis über verschiedene Behandlungsstrategien, z. B. Dosiserhöhung, Kombination oder Augmentation.

Kernaussagen

• Behandlungsresistenz sollte nach standardisierten Kriterien definiert werden.

• Verschiedene Faktoren, insbesondere die Compliance, beeinflussen das Auftreten von Therapieresistenz entscheidend.

• Eine Monotherapie sollte immer präferiert werden.

• Clozapin ist Behandlung der ersten Wahl bei Therapieresistenz und die Therapie sollte engmaschig überwacht werden.

• Falls Clozapin nicht verwendet werden kann, sollte ein anderes Antipsychotikum der 2. Generation verwendet werden – vorzugsweise Risperidon oder Olanzapin.

• Ein Wechsel des Antipsychotikums sollte immer auf ein Präparat mit einem anderen Rezeptorbindungsprofil erfolgen.

• Eine Kombination von Clozapin mit einem anderen Präparat der 2. Generation (z. B. Aripiprazol) kann im Einzelfall sinnvoll sein.

• Die Augmentation sollte nach der Zielsymptomatik erfolgen (z. B. Negativsymptome).

• Besonders bei der Kombination von 2 Antipsychotika sollten Nebenwirkungen engmaschig kontrolliert werden.

• In besonders schweren Fällen kann eine EKT zur Verbesserung der Symptomatik führen.

• Generell gibt es wenig Evidenz für behandlungsresistente Patienten.

Schlüsselwörter

Schizophrenie - Therapieresistenz - Pharmakotherapie - Clozapin

Publikationsverlauf

Publikationsdatum:
07. Mai 2019 (online)

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