Zusammenfassung
Antipsychotischen Substanzen kommt in der Behandlung bipolarer affektiver Störungen ein bedeutender klinischer Stellenwert zu. Trotz des gut dokumentierten antimanischen Effektes klassischer Antipsychotika ist der Einsatz dieser Substanzen, nicht zuletzt wegen des weitgehenden Fehlens stimmungsstabilisierender Eigenschaften und des erhöhten Risikos für Spätdyskinesien bei affektiven Patienten, mit einer Reihe von Nachteilen verbunden. Mit Entwicklung der neuen, sog. atypischen Antipsychotika ist die Pharmakotherapie der bipolaren Störung um vielversprechende Dimensionen erweitert worden. Gut untersucht wurden die thymoleptischen Eigenschaften von Clozapin, Risperidon und Olanzapin. Für Clozapin und Olanzapin werden ausgeprägtere antimanische als antidepressive Eigenschaften vermutet, Risperidon hingegen dürfte eine stärkere antidepressive als antimanische Wirkkomponente aufweisen. Dieser Artikel bietet einen Überblick über die vorliegenden Studien zur Wirksamkeit atypischer Antipsychotika in der Indikation der bipolaren Störung, darüber hinaus werden mögliche Arzneimittelinteraktionen zwischen Antipsychotika und anderen stimmungsstabilisierenden Pharmaka auf Basis des Cytochrom-P450-Systems diskutiert. Zusammenfassend ist anzunehmen, dass atypische Antipsychotika wertvolle Optionen in der Pharmakotherapie der bipolaren Störung darstellen. Zur Evaluierung des Stellenwertes einzelner Substanzen in dieser Indikation bedarf es jedoch weiterer kontrollierter Untersuchungen.
Abstract
Antipsychotics are commonly used in the treatment of bipolar affective disorder. The use of conventional antipsychotic agents, though effective as antimanic agents, is associated with a number of limitations such as their acute side effect profile and their unsufficient mood stabilizing activity. In addition, exposure to conventional neuroleptics poses a risk for the development of tardive dyskinesia, especially in mood disorder patients. Growing evidence suggests that the novel, so-called atypical neuroleptics may offer a number of advantages in the treatment of bipolar disorder, including their thymoleptic activity and minimal risk for acute and long-term extraypyramidal symptoms. Clinical experience with clozapine and olanzapine as mood stabilizers suggests greater antimanic than antidepressant properties, while risperidone may have greater antidepressant properties with some liability for triggering or exacerbating mania. The mood stabilizing properties of further atypical drugs are currently under investigation. This review focuses on the use of atypical antipsychotics in the treatment of bipolar disorder. We also present an overview concerning potential pharmakokinetic interactions based on the cytochrome P450 enzyme system when antipsychotics are combined with other mood stabilizing compounds. In conclusion, atypical antipsychotics should come to play an increasingly important role in the acute and long-term management of bipolar disorder, but there is a clear need for further controlled trials in this indication.
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Prof. Dr. Ch. Barnas
Klinische Abteilung für Allgemeine Psychiatrie · Univ.-Klinik für Psychiatrie
Währinger Gürtel 18-20
1090 Wien
Österreich
