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Psychiatrie und Psychotherapie up2date 2007; 1(01): 25-44
DOI: 10.1055/s-2006-951882
Schizophrenien und andere psychotische Störungen

Pharmakotherapie therapieresistenter schizophrener Störungen

Gerhard Gründer
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Trotz der Häufigkeit von Patienten mit schizophrenen Störungen, die auf eine Pharmakotherapie nicht ausreichend ansprechen, ist die Datenlage hinsichtlich einer adäquaten Therapie erschreckend schwach. Therapieresistenz bei schizophrenen Störungen ist dann gegeben, wenn zwei durchgeführte pharmakotherapeutische Behandlungen, wovon eines der Antipsychotika ein SGA sein soll, nicht zu einer Besserung der Symptome führen. Bei Therapieresistenz ist die Wirksamkeit für keine Substanz besser belegt als für Clozapin. Dennoch erscheint es wegen des Agranulozytoserisikos und der teilweise erheblichen Nebenwirkungen gerechtfertigt, zunächst ein weiteres SGA auszuprobieren. Bei der medikamentösen Therapie können durch Blockade oder Induktion bestimmter Isoenzyme des CYP-Systems die Plasmaspiegel der Antipsychotika oder der anderer Medikamente erhöht oder erniedrigt sein. Im Regelfall sollte bei therapieresistenten Patienten die Therapie unter Kontrolle der Plasmakonzentration durchgeführt werden. Die weitere Behandlung dieser Patientengruppe ist meist durch ein Ausprobieren verschiedener nicht evaluierter Kombinationstherapien gekennzeichnet. Nur die Durchführung großer Therapiestudien, die ausschließlich multizentrisch bewältigt werden können, kann diesem Mangel abhelfen.



Publication History

Publication Date:
16 April 2007 (online)

© Georg Thieme Verlag KG Stuttgart · New York

 

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