Augmentation von Clozapin mit Ziprasidon

Zusammenfassung

Hintergrund: In Fällen therapieresistenter Schizophrenie werden zunehmend oft atypische Antipsychotika kombiniert. Methodik: Wir berichten über einen schizophrenen Patienten, dessen Erkrankung sich gegenüber Olanzapin, Risperidon und Quetiapin resistent erwies, unter Clozapin aber teilremittierte. Weil Nebenwirkungen die Zuverlässigkeit der Einnahme gefährdeten, wurde mit Ziprasidon augmentiert. Ergebnisse: Positiv- und Negativsymptomatik wurden gut kontrolliert, trotz einer transienten Hyperprolaktinämie war die subjektive Zufriedenheit sehr hoch. Diskussion: Die berichtete Kombinationsbehandlung erscheint neurobiologisch sinnvoll, kann Nebenwirkungen reduzieren und sollte hinsichtlich Nutzen und Risiken mit prospektiven Studien untersucht werden.

Abstract

Objectives: In cases of treatment-resistant schizophrenic psychoses combined application of atypical antipsychotic drugs is an often-used strategy. Method: We report the case of a 35-year old man with paranoid schizophrenia, whose symptoms turned out to be resistant to the application of olanzapine, risperidone and quetiapine. After switch to clozapine paranoid delusions remitted, but schizophrenic negative symptoms persisted and side effects limited the patient's compliance. Augmentation with ziprasidone allowed a reduction of the clozapine dose and ameliorated the affective deficits. Results: Positive and negative symptoms were well controlled. In spite of a transient hyperprolactinaemia and sexual dysfunction the patient was highly content. Discussion: The combined application of ziprasidone and clozapine follows a neurobiological rationale, seems able to reduce side effects, and should be further evaluated with respect to risk and benefit in prospective studies.

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