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Fortschr Neurol Psychiatr 2001; 69(SH2): 113-119
DOI: 10.1055/s-2001-16541
Georg Thieme Verlag Stuttgart · New York

Strategien der pharmakologischen Langzeitbehandlung schizophrener Störungen

Strategies of Long-Term Medication in SchizophreniaW. Gaebel
  • Klinik und Poliklinik für Psychiatrie und Psychotherapie der Heinrich-Heine-Universität Düsseldorf
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Publication History

Publication Date:
21 August 2001 (online)

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Zusammenfassung:

Schizophrene Psychosen sind rezidivierende Erkrankungen. Hauptziel neuroleptischer Langzeitbehandlung ist die Rezidivprophylaxe, deren Wirksamkeit empirisch gut belegt ist. Verschiedene Behandlungsstrategien einschließlich der Verfügbarkeit neuer Neuroleptika mit günstigerem Wirkungs-/Nebenwirkungs-Profil erlauben eine individuell angepasste Langzeitbehandlung. Zumeist von den wissenschaftlich-medizinischen Fachgesellschaften entwickelte Praxisleitlinien geben entsprechende Behandlungsempfehlungen vor.

Strategies of Long-Term Medication in Schizophrenia:

Schizophrenia is a relapsing disorder. The main goal of neuroleptic long-term treatment is relapse prevention, which is empirically well proven. Availability of different kinds of treatment strategies including new antipsychotic drugs with improved risk/benefit profile allow long-term treatment to be individually tailored. Treatment guidelines developed mainly by the scientific medical societies can help the practitioner in making the right decisions.

Literatur

  • 1 Altamura A C, Barnas C, Bitter I, Fleischhacker W, Gaebel W, Hirsch S, Kissling W, Küfferle B, Möller H J, Naber D, Pickar D, Pullen I, Tollefson G D. Treatment of schizophrenic disorders: Algorithms for acute pharmacotherapy.  International Journal of Psychiatry in Clinical Practice. 1997;  1 25-30
    PubMedSearch in Google Scholar
  • 2 Andrews S, Vaughan K, Harvey R, Andrews GT. A survey of practising psychiatrists' views on the treatment of schizophenia.  Br J Psychiatry. 1986;  149 357-364
    PubMedSearch in Google Scholar
  • 3 American Psychiatric Association .Practice Guideline for the Treatment of Patients with Schizophrenia. Washington: APA 1997
    Search in Google Scholar
  • 4 Barnes T RE, Milavic G, Curson D A, Platt S D. Use of the social behavior assessment schedule (SBAS) in a trial of maintenance antipsychotic therapy in schizophrenic outpatients: Pimozide vs fluphenazine.  Soc Psychiat. 1983;  18 193-199
    PubMedSearch in Google Scholar
  • 5 Bassett A, Addington D. Canadian clinical practice guidelines for the treatment of schizophrenia.  The Canadian Journal of Psychiatry. 1998;  43 (suppl. 2) 25-40
    PubMedSearch in Google Scholar
  • 6 Bleuler M, Huber G, Gross G, Schüttler R. Der langfristige Verlauf schizophrener Psychosen.  Nervenarzt. 1976;  47 477-481
    PubMedSearch in Google Scholar
  • 7 Brown G W, Bone M, Dalison B, Wing J K. Schizophrenia and social care. Oxford: University Press 1966
    Search in Google Scholar
  • 8 Chiles J A, Sterchi D, Hyde T, Herz M I. Intermittent medication for schizophrenic outpatients: Who is eligible?.  Schizophrenia Bulletin. 1989;  15 117-121
    PubMedSearch in Google Scholar
  • 9 Christison G W, Kirch D G, Wyatt R J. When symptoms persist: Choosing among alternative somatic treatments for schizophrenia.  Schizophrenia Bulletin. 1991;  17 217-245
    PubMedSearch in Google Scholar
  • 10 Cheung H K. Schizophrenics full remitted on neuroleptics for 3 to 5 years - to stop or continue drugs?.  Brit J Psychat. 1981;  138 490-494
    CrossrefPubMedSearch in Google Scholar
  • 11 Davis J M. Maintenance therapy and the natural course of schizophrenia.  J Clin Psychiatry. 1985;  11 18-21
    PubMedSearch in Google Scholar
  • 12 Davis J M, Schaffer C B, Killian G A, Kinard C, Chan C. Important issues in the drug treatment of schizophrenia.  Schizophrenia Bulletin. 1980;  6 70-87
    PubMedSearch in Google Scholar
  • 13 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) .Praxisleitlinien in Psychiatrie und Psychotherapie. Band 1. Behandlungsleitlinie Schizophrenie.  Redaktion: Gaebel W, Fallkai P Darmstadt: Steinkopff 1998
    Search in Google Scholar
  • 14 Dietmaier O. Interaktionen. In: Riederer P, Laux G, Pöldinger W (Hrsg.). Neuro-Psychopharmaka. Ein Therapie-Handbuch. Band 4: Neuroleptika Wien: Springer 1988: 177-196
    Search in Google Scholar
  • 15 Frances A, Docherty J P, Kahn D A. The expert consensus guidelines series. Treatment of schizophrenia. Schizophrenia Bulletin.  J Clin Psychiatry. 1996;  57 (suppl. 12B) 1-58
    PubMedSearch in Google Scholar
  • 16 Gaebel W. Tardive Dyskinesien unter Neuroleptika-Behandlung.  Deutsches Ärzteblatt. 1993;  90 1041-1046
    PubMedSearch in Google Scholar
  • 17 Gaebel W. Intermittent medication - an alternative?.  Acta Psychiatrica Scand. 1994;  89 (suppl. 382) 33-38
    PubMedSearch in Google Scholar
  • 18 Gaebel W. Internationale Leitlinien der Schizophreniebehandlung. In: Möller HJ, Müller N (Hrsg.). Stellenwert atypischer Neuroleptika Heidelberg: Springer 1999a
    Search in Google Scholar
  • 19 Gaebel W. Long-term treatment in schizophrenia - for whom and how long? Commentary. In: WPA (Hrsg.). Evidence & Experience in Psychiatry London: Wiley 1999b
    Search in Google Scholar
  • 20 Gaebel W, Awad A G. Prediction of neuroleptic treatment outcome in schizophrenia - concepts and methods. Wien: Springer 1994
    Search in Google Scholar
  • 21 Gaebel W, Frick U, Köpcke W, Linden M, Müller P, Müller-Spahn F, Pietzcker A, Tegeler J. Early neuroleptic intervention in schizophrenia: Are prodromal symptoms valid predictors of relapse.  Brit J Psychiatry. 1993;  163 (suppl. 21) 8-12
    PubMedSearch in Google Scholar
  • 22 Gaebel W, Jänner M, Frommann N, Pietzcker A, Köpcke W, Linden M, Müller P, Müller-Spahn F, Tegeler J. Prodromal States in Schizophrenia.  Comprehensive Psychiatry. 2000;  41 (suppl. 1) 76-85
    PubMedSearch in Google Scholar
  • 23 Gaebel W, Klimke A, Klieser E. Kombination von Clozapin mit anderen Psychopharmaka. In: Naber D, Müller-Spahn F (Hrsg.). Clozapin. Pharmakologie und Klinik eines atypischen Neuroleptikums Berlin - Heidelberg - New York: Springer 1994: 43-58
    Search in Google Scholar
  • 24 Gaebel W, Jänner M, Frommann N, Pietzcker A, Köpcke W, Linden M, Müller P, Müller-Spahn F, Tegeler J. First vs multiple episode schizophrenia: Two-year outcome of intermittent and maintenance medication strategies. Schizophrenia Research 2001 in press
    Search in Google Scholar
  • 25 Gilbert D A, Altshuler K Z, Rago W V, Shon S P, Crismon M L, Toprac M G, Rush A J. Texas medication algorithm project: Definitions, rationals and methods to develop medication algorithms.  J Clin Psychiatry. 1998;  59 (7) 345-351
    PubMedSearch in Google Scholar
  • 26 Glazer W M, Kane J M. Depot neuroleptic therapy: An underutilized treatment option?.  J Clin Psychiatry. 1992;  53 426-433
    PubMedSearch in Google Scholar
  • 27 Glenthøj B, Hemmingsen R, Allerup P, Bolwig T G. Intermittent versus continuous neuroleptic treatment in a rat model.  Eur J Pharmacolog. 1990;  190 275-286
    PubMedSearch in Google Scholar
  • 28 Goldberg S C. Negative and deficit symptoms in schizophrenia do respond to neuroleptics.  Schizophren Bull. 1985;  11 453-456
    PubMedSearch in Google Scholar
  • 29 Green M F. Schizophrenia from a neurocognitive perspective. Probing the impenetrable darkness. Boston: Allyn and Bacon 1998
    Search in Google Scholar
  • 30 Grimshaw J M, Russell I T. Effect of clinical guidelines on medical practice: A systematic review of rigorous evaluations.  The Lancet. 1993;  342 1317-1322
    CrossrefPubMedSearch in Google Scholar
  • 31 Harding C M, Brooks G W, Ashikaga T, Strauss J S, Breier A. The Vermont longitudinal study of persons with severe mental illness. I. Methodology, study sample, and overall status 32 years later.  Am J Psychiatry. 1987;  144 728-726
    PubMedSearch in Google Scholar
  • 32 Hartmann W, Kind J, Meyer J E, Müller P, Steuber H. Neuroleptic drugs and the prevention of relapse in schizophrenia: A workshop report.  Schizophren Bull. 1980;  6 536-543
    PubMedSearch in Google Scholar
  • 33 Hegarty J D, Baldessarini R J, Tohen M, Waternaux C, Oepen G. One hundred years of schizophrenia: A meta-analysis of the outcome literature.  Am J Psychiatry. 1994;  151 1409-1416
    PubMedSearch in Google Scholar
  • 34 Helmchen H. Forschungsaufgaben bei psychiatrischer Langzeitmedikation.  Nervenarzt. 1978;  49 534-538
    PubMedSearch in Google Scholar
  • 35 Herz M I, Melville Ch. Relapse in schizophrenia.  American Journal of Psychiatry. 1980;  137 801-805
    PubMedSearch in Google Scholar
  • 36 Hogarty G E, Goldberg S C, Schooler N R, Ulrich R F. Drug and sociotherapy in the aftercare of schizophrenic patients I. One-year relapse rates.  Arch Gen Psychiatry. 1973;  28 54-64
    PubMedSearch in Google Scholar
  • 37 Hogarty G E, Goldberg S C, Schooler N R, Ulrich R F. Drug and sociotherapy in the aftercare of schizophrenic patients. II. Two-year relapse rates.  Arch Gen Psychiatry. 1974;  31 603-608
    PubMedSearch in Google Scholar
  • 38 Hogarty G E, Ulrich R F, Mussare F, Arishgueta N. Drug discontinuation among long term, successfully maintained schizophrenic outpatients.  Dis Nerv Syst. 1976;  37 494-500
    PubMedSearch in Google Scholar
  • 39 Hogarty G E, Schooler N R, Ulrich R, Mussare F, Ferro P, Herron E. Fluphenazine and social therapy in the aftercare of schizophrenic patients: Relapse analysis of a two-year controlled study of fluphenazine decanoate and fluphenazine hydrochloride.  Arch Gen Psychiatry. 1979;  36 1283-1294
    CrossrefPubMedSearch in Google Scholar
  • 40 Jeste D V, Potkin S G, Sinha S, Feder S, Wyatt R. Tardive dyskinesia - reversible and persistent.  Archives of General Psychiatry. 1979;  36 585-590
    PubMedSearch in Google Scholar
  • 41 Kane J M, Marder S R. Psychopharmacologic treatment of schizophrenia.  Schizophrenia Bull. 1993;  19 287-302
    PubMedSearch in Google Scholar
  • 42 Kane J M, Rifkin A, Quitkin F, Nayak D, Ramoslorenzi J. Fluphenazine versus placebo in patients with remitted, acute first-episode schizophrenia.  Arch Gen Psychiatry. 1982;  39 70-73
    PubMedSearch in Google Scholar
  • 43 Kissling W. Guidelines for neuroleptic relapse prevention in schizophrenia. Berlin - Heidelberg - New York: Springer 1991
    Search in Google Scholar
  • 44 König P, Laux G. Kontrolluntersuchungen. In: Riederer P, Laux G, Pöldinger W (Hrsg.). Neuro-Psychopharmaka. Ein Therapie-Handbuch. Band 4: Neuroleptika Wien: Springer 1998: 177-196
    Search in Google Scholar
  • 45 Lehman A F, Steinwachs D M. , and the Survey Co-Investigators of the PORT Project . Translating research into practice: The schizophrenia Patient Outcomes Research Team (PORT). Treatment Recommendations.  Schizophrenia Bulletin. 1988a;  24 (suppl. 1) 1-10
    PubMedSearch in Google Scholar
  • 46 Lehman A F, Steinwachs D M. , and the Survey Co-Investigators of the PORT Project . Patterns of usual care for schizophrenia: Initial results from the schizophrenia Patient Outcomes Research TEAM (PORT) Client Survey.  Schizophrenia Bulletin. 1988b;  24 11-20
    PubMedSearch in Google Scholar
  • 47 Marder S R, Hubbard J W, Van Putten T, Midha K K. Pharmacokinetics of long-acting injectable neuroleptic drugs: Clinical implications.  Psychopharmacology. 1989;  98 433-439
    CrossrefPubMedSearch in Google Scholar
  • 48 Marder S R, Midha K K, Van Putten T, Aravagiri M, Hawes E M, Hubbard J W, McKay G, Mintz J. Plasma levels of fluphenazine in patients receiving fluphenazine decanoate: Relationship to clinical response.  Brit J Psychiatry. 1991;  158 658-665
    PubMedSearch in Google Scholar
  • 49 May P RA, Goldberg S C. Prediction of schizophrenic patients' response to pharmacotherapy. In: Lipton MA, Dimascio A, Killam KF (eds.). Psychopharmacology: A generation of progress New York: Raven Press 1978: 1139-1153
    Search in Google Scholar
  • 50 Maynard A, Bloor K. Building castles on sands or quicksands?.  British Journal of Psychiatry. 1998;  173 (suppl. 36) 12-18
    PubMedSearch in Google Scholar
  • 51 McEvoy J P, Scheifler P L, Frances A. The expert consensus guidelines series. Treatment of Schizophrenia 1999.  J Clin Psychiatry. 1999;  60 (suppl. 36) 1-80
    PubMedSearch in Google Scholar
  • 52 Möller H J. Aktuelle Bewertung neuer/atypischer Neuroleptika.  Nervenarzt. 2000a;  71 329-344
    CrossrefPubMedSearch in Google Scholar
  • 53 Möller H J. Neue bzw. atypische Neuroleptika bei schizophrener Negativsymptomatik. Ergebnisse und methodische Probleme der Evaluation.  Nervenarzt. 2000b;  71 345-353
    CrossrefPubMedSearch in Google Scholar
  • 54 National Advisory Mental Health Council . Health Care Reform for Americans With Severe Mental Illnesses: Report of the National Advisory Mental Health Council.  American Journal of Psychiatry. 1993;  150 1447-1465
    PubMedSearch in Google Scholar
  • 55 Osser D N, Zarate C A. Consultant for the pharmacotherapy of schizophrenia.  Psychiatric Annals. 1999;  29 (5) 252-267
    PubMedSearch in Google Scholar
  • 56 Peuskens J, De Hert M. Good medical practice. Antipsychotics. Effects and side-effects. Kopenhagen: Lundbeck 1997
    Search in Google Scholar
  • 57 Pietzcker A, Gaebel W, Köpcke W, Linden M, Müller P, Müller-Spahn F, Tegeler J. Continuous versus maintenance neuroleptic longterm treatment in schizophrenia - 2-year results of a German multicenter study.  J Psychiat Res. 1993;  27 (4) 321-399
    PubMedSearch in Google Scholar
  • 58 Rifkin A, Quitkin F, Rabiner C J, Klein D F. Fluphenazine decanoate, fluphenazine hydrochloride given orally and placebo in remitted schizophrenis. I. Relapse rates after one year.  Arch Gen Psychiatry. 1977;  34 43-47
    PubMedSearch in Google Scholar
  • 59 Stephens J H. Long-term prognosis and follow-up in schizophrenia.  Schizophrenia Bull. 1978;  4 25-48
    PubMedSearch in Google Scholar
  • 60 Tsuang M T, Woolson R F, Fleming J A. Long-term outcome of major psychoses. I. Schizophrenia and affective disorders compared with psychiatrically symptom-free surgical conditions.  Arch Gen Psychiatry. 1979;  39 1295-1301
    PubMedSearch in Google Scholar
  • 61 Wyatt R J, Damiani L M, Henter I D. First episode schizophrenia. Early intervention and medication discontinuation in the context of course and treatment.  British Journal of Psychiatry. 1998;  172 (suppl. 33) 77-83
    PubMedSearch in Google Scholar
  • 62 Zarate C A, Daniel D G, Kinon B J, Litman R E, Naber D, Pickar D, Sato M. Algorithms for the treatment of schizophrenia.  Psychopharmacological Bulletin. 1995;  3 461-464
    PubMedSearch in Google Scholar

Prof. Dr. med. Wolfgang Gaebel

Direktor der Klinik und Poliklinik
für Psychiatrie und Psychotherapie
der Heinrich-Heine-Universität Düsseldorf
Rheinische Kliniken Düsseldorf

Bergische Landstraße 2

40629 Düsseldorf