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PSYCH up2date 2024; 18(06): 493-508
DOI: 10.1055/a-2299-0927
Schizophrenien und andere psychotische Störungen

Therapieresistente Schizophrenie

Elias Wagner
,
Alkomiet Hasan
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Im Behandlungsmanagement der Schizophrenie kann in bis zu einem Drittel der Fälle eine pharmakologische Therapieresistenz (TRS) vorkommen. Sie hat eine multifaktorielle Genese und ist mit verschiedenen Risikofaktoren assoziiert. Nach Ausschluss einer Pseudotherapieresistenz erfolgt die Standardtherapie mit Clozapin als Mittel der Wahl; im Falle eines nicht ausreichenden Ansprechens auf Clozapin kommt die Elektrokonvulsionstherapie infrage.
Kernaussagen

  • Die pharmakologische Therapieresistenz ist ein hoch prävalentes Phänomen in der klinischen Praxis und ist multidimensional definiert.

  • Man unterscheidet eine primäre Therapieresistenz von einer sekundären Therapieresistenz.

  • Multiple Faktoren von Pseudotherapieresistenz (v.a. Non-Adhärenz) sind unbedingt auszuschließen, bevor eine Therapieresistenz diagnostiziert werden kann.

  • Clozapin ist das effektivste und auch einzige für die Indikation der Therapieresistenz zugelassene Antipsychotikum.

  • Situationen, in denen Patient:innen auf eine mindestens 3-monatige Behandlung mit Clozapin mit Serumspiegeln im therapeutischen Referenzbereich nicht ansprechen, werden als Ultra-Therapieresistenz bezeichnet.

Schlüsselwörter

Therapieresistenz - Schizophrenie - Clozapin - Pseudotherapieresistenz - Management


Publication History

Article published online:
18 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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