Psychopharmakotherapie von T Impulskontrollstörungen bei Kindern und Jugendlichen mit und ohne Intelligenzminderung

Zusammenfassung

Die Prävalenz für Impulskontrollstörungen im Kindes-und Jugendalter liegt zwischen 4 und 9%. Dagegen weisen Intelligenz-geminderte Kinder eine um das 3-4fache höher liegende Wahrscheinlichkeit für impulsiv aggressives Verhalten auf. Ohne eine effiziente Therapie ist die Teilhabe dieser Kinder und Jugendlichen am gesellschaftlichen Leben beeinträchtigt bzw. gefährdet. Störungsspezifische pharmakotherapeutische Interventionen müssen in eine sozio- und psychotherapeutische Gesamtstrategie eingebettet sein und entwicklungspharmakologische Aspekte berücksichtigen. Während sich bei geistig behinderten Kindern und Jugendlichen fremdaggressives Verhalten gut durch das konventionelle Neuroleptikum Zuclopenthixol beeinflussen lässt, ist bei ausgeprägtem selbstverletzenden Verhalten das Atypikum Risperidon zu präferieren. Antiepileptika, Antidepressiva und Anxiolytika erweitern sinnvoll das pharmakologische Spektrum. Auch Stimulanzien erwiesen sich in Monotherapie oder in Kombination mit Atypika bei normal intelligenten bzw. leicht Intelligenz-geminderten Kindern mit expansiven Verhaltensstörungen als effektiv und nebenwirkungsarm. Sowohl mit konventionellen als auch mit atypischen Neuroleptika lassen sich aggressive Impulskontrollstörungen bei Kindern und Jugendlichen effektiv beeinflussen.

Summary

The quoted prevalence of disruptive behaviour among children and adolescents varies widely between 4 and 9 percent. Disruptive behaviour as well as self-injurious behaviour occurs in 12 to 36 percent of individuals with mental retardation who reside in institutional settings. The principles of treatment are the same as for persons without mental retardation, but modification of techniques may be necessary according to the individual patient’s developmental level, and especially communication skills. Psychopharmacological, psychotherapeutic and educational interventions should be coordinated within an overall treatment.

There is some evidence that the conventional antipsychotic zuclopenthixol has any positive effect on destructive behaviour. Few studies have described the succesfull use of the atypical antipsychotic risperidone to control severe self-injurious behaviour and other behaviour problems in a variety of diagnoses. Anticonvulsants, antidepressants and anxiolytic medications may also find an important place in the treatment of some individuals with disruptive behaviour. Stimulants alone or in combination with atypical neuroleptics are also effective for aggression related behaviour.

Both conventional and atypical neuroleptics effectively influence aggressive disruptive behaviour in children and adolescents with or without subaverage intelligence.

Schlüsselwörter

Impulskontrollstörung - Psychopharmakotherapie - klassische Neuroleptika - atypische Neuroleptika

Keywords

Disruptive behaviour - psychopharmacotherapy - conventional neuroleptics - atypical neuroleptics

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