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Fortschr Neurol Psychiatr 2013; 81(S 01): S9-S16
DOI: 10.1055/s-0033-1335241
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Deeskalationstechniken und atypische Neuroleptika in der Behandlung der akuten Manie

De-Escalation and Atypical Antipsychotics in the Treatment of Acute Mania
B. L. Amann
1   FIDMAG Research Foundation Germanes Hospitalàries Barcelona, Spain
2   CIBERSAM, Spain
,
R. Wesuls
3   ProDeMa®, Professionelles Deeskalationsmanagement, Dielheim, Deutschland
,
R. Landin Romero
1   FIDMAG Research Foundation Germanes Hospitalàries Barcelona, Spain
,
H. Grunze
4   Academic Psychiatry, Institute of Neuroscience, Newcastle upon Tyne, UK
› Author Affiliations
Further Information

Publication History

Publication Date:
16 May 2013 (online)

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Zusammenfassung

Erregungszustände bei psychiatrischen Patienten stellen eine therapeutische Herausforderung dar und treten häufig bei bipolaren Patienten in der Manie oder in gemischten Phasen auf. Lange Zeit waren Behandlungsmöglichkeiten bei der akuten Manie auf Lithium und typische Neuroleptika beschränkt. Neben stimmungsstabilisierenden Antikonvulsiva wurden im vergangenen Jahrzehnt in zunehmendem Maße atypische Neuroleptika in dieser Indikation erfolgreich untersucht. Um intramuskuläre Verabreichung und zu sedierende Neuroleptika zu vermeiden, muss allerdings ein therapeutischer Zugang zum angespannten Patienten geschaffen werden. Deeskalationstechniken erscheinen diesbezüglich hilfreich und sollen auch aggressive Eskalationen mit mechanischer Beschränkung auf Station reduzieren, Compliance verbessern, Rückfälle vermindern und insgesamt zu einer günstigeren Prognose des Krankheitsverlaufs beitragen. Nach einer kurzen Einführung und kritischen Würdigung der Literatur zum Thema Deeskalation, werden atypische Neuroleptika wie Olanzapin, Zotepin, Risperidon, Quetiapin, Ziprasidon, Aripiprazol, Paliperidon und Asenapin und deren Verträglichkeit in der Behandlung der Manie diskutiert.

Abstract

Agitation is a severe clinical state which represents a therapeutic challenge and often forms part of manic or mixed episodes. Therapeutic options for acute mania have been limited for many years to lithium and typical antipsychotics. Besides anticonvulsants, atypical antipsychotics have been increasingly introduced in the last decade after proving their efficacy in this indication. To avoid intramuscular administration and excessive sedation, a therapeutic contact to the often agitated patient is required. De-escalation techniques can be helpful in this respect but also reduce aggressive behaviour on the ward, improve compliance, reduce relapse rates and lead to a better outcome in the long-term course of the illness. Therefore, a basic knowledge about de-escalation techniques in acute manic patients is an important clinical tool which will be critically reviewed. Furthermore, the efficacy and tolerability of atypical antipsychotics in acute mania, such as olanzapine, zotepine, risperidone, quetiapine, ziprasidone, aripiprazole, paliperidone and asenapine are discussed.

Schlüsselwörter

bipolare Störung - Manie - typische Neuroleptika - atypische Neuroleptika - Deeskalation

Key words

bipolar disorder - mania - typical antipsychotics - atypical antipsychotics - de-escalation
 

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