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Fortschr Neurol Psychiatr 2012; 80(9): 501-511
DOI: 10.1055/s-0032-1312853
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Anwendung der EKT bei pharmakoresistenter Schizophrenie

Use of ECT in Drug-Refractory Schizophrenia – A Survey of the Current Literature
F.-G. Lehnhardt
,
C. Konkol
,
J. Kuhn
Further Information

Publication History

Publication Date:
15 June 2012 (online)

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Zusammenfassung

Die Elektrokonvulsionstherapie (EKT) hat seit ihrer Einführung in den 30er-Jahren des vergangenen Jahrhunderts ihren Stellenwert als effektives und evidenzbasiertes somatisches Therapieverfahren in der Behandlung affektiver und schizophrener Störungen behaupten können. Im Vergleich zu den affektiven Erkrankungen wird die EKT bei Schizophrenie in den westlichen Industrienationen deutlich seltener eingesetzt. Entsprechend ist die Studienlage zur Wirksamkeit und Verträglichkeit sowie zu den Stimulationsparametern des Verfahrens unter dieser Indikation als vergleichsweise unbefriedigend anzusehen. Ergebnisse aus den hier berücksichtigten aktuellen Therapiestudien, Metaanalysen und Übersichtsarbeiten lassen bei akuten schizophrenen Episoden auf eine relativ gute Evidenz für eine höhere Wirksamkeit der kombinierten pharmakologischen und elektrokonvulsiven Behandlung gegenüber der jeweiligen Monotherapie schließen. Als klinische Einflussfaktoren für ein Ansprechen auf die EKT gelten neben Wahn und Halluzination auch affektive und katatone Begleitsymptome sowie eine kurze Episodendauer. In den gängigen Therapie-Algorithmen nationaler und internationaler Leitlinien psychiatrischer Fachgesellschaften kommt der EKT als Augmentationsstrategie in der Behandlung pharmakoresistenter Schizophrenien in der Akutphase die größte Bedeutung zu. In Anbetracht der Häufigkeit therapierefraktärer Verläufe schizophrener Psychosen besteht ein Bedarf an weiteren sorgfältig kontrollierten und randomisierten Therapiestudien, um die vielversprechende Behandlungsoption EKT bei Schizophrenie auf ein fundiertes Evidenzniveau zu bringen.

Abstract

Since its introduction in the 1930 s, electroconvulsive therapy (ECT) has maintained an important role as an efficacious and evidence-based somatic treatment option in affective or schizophrenic diseases. As opposed to major depressive disorder, ECT is commonly used to a substantially lesser extent for patients with schizophrenia in the USA, UK and most parts of Europe. Accordingly there is comparably little evidence regarding the clinical effectiveness and tolerability of ECT in schizophrenia. Recent clinical studies, meta-analyses and surveys point to the combination of ECT and antipsychotic medication as being advantageous in the treatment of schizophrenia, particularly in those patients who have shown inadequate responses to psychotropic medication alone. Clinical features considered to be predictive for ECT outcome are delusions, hallucinations, presence of affective and catatonic symptoms and absence of negative symptoms as well as a short duration of the current episode. National and international guidelines suggest ECT as an augmentation strategy in treatment-refractory schizophrenia in acute exacerbation and continuation therapy. Considering the fact that a substantial part of schizophrenic patients does not respond sufficiently to pharmacotherapy there still is a lack of well designed, controlled and randomised clinical trials to improve evidence for the promising role of ECT in schizophrenia.

Schlüsselwörter

Elektrokonvulsionstherapie - Schizophrenie - Therapieresistenz - Augmentationsstrategie

Key words

electroconvulsive therapy - schizophrenia - treatment resistance - augmentation strategy
 

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