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Erschienen in: Der Nervenarzt 5/2019

19.10.2018 | Schizophrenie | Übersichten

Antipsychotikaassoziierte motorische Symptome bei schizophrenen Psychosen – Teil 3

Spätdyskinesien

verfasst von: PD Dr. D. Hirjak, K. M. Kubera, S. Bienentreu, P. A. Thomann, R. C. Wolf

Erschienen in: Der Nervenarzt | Ausgabe 5/2019

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Zusammenfassung

Die Behandlung schizophrener Psychosen mit Antipsychotika (AP) geht häufig mit einem erhöhten Risiko für später auftretende antipsychotikaassoziierte Bewegungsstörungen (AIB) einher. Diese Symptome zeigen sehr häufig einen chronischen Verlauf. Das Risiko für das Auftreten von Spätdyskinesien (TD) ist assoziiert mit dem pharmakologischen Wirkprofil eines AP, mit der Behandlungsdauer und mit dem Alter. Diese systematische Übersichtsarbeit fasst die aktuelle Studienlage zu Prävalenz, Risikofaktoren, Präventions- und Therapiemöglichkeiten sowie zur Voraussage von TD bei schizophrenen Psychosen zusammen. Die aktuelle Datenlage zur Behandlung von TD ist sehr heterogen. Für die Therapie von TD gibt es vorläufige Evidenz für eine Reduktion oder ein Absetzen der AP, Umstellung auf Clozapin, Gabe von Benzodiazepinen (Clonazepam) und Behandlung mit vesikulären Monoamintransporter(VMAT2)-Inhibitoren, Ginkgo biloba, Amantadin oder Vitamin E. TD können zwar präzise diagnostiziert, jedoch nicht immer effektiv behandelt werden. Früherkennung und Frühbehandlung von TD können die Prognose und das klinische Outcome günstig beeinflussen.
Anhänge
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Fußnoten
1
Zur ausführlichen Darstellung der GMA bei schizophrenen Psychosen sei auf weitere Arbeit [1] in Der Nervenarzt verwiesen.
 
2
Die aktuelle Evidenz zur Therapie von akuten AIB sowie antipsychotikaassoziierten katatonen Phänomenen und des malignen neuroleptischen Syndroms soll im Rahmen von zwei eigenständigen systematischen Übersichtsarbeiten in Der Nervenarzt dargestellt werden (s. auch [11, 12]).
 
3
Diese Wirkstoffe sind in Deutschland derzeit nicht zur Behandlung der TD zugelassen.
 
4
Die hier vorgestellten fünf Schritte für den Umgang mit TD bei schizophrenen Psychosen stellen keinesfalls wissenschaftlich validierte Leitlinien zur Behandlung von TD dar. Sie spiegeln vielmehr die aktuelle Datenlage und die klinische Erfahrung der Autoren wider.
 
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Metadaten
Titel
Antipsychotikaassoziierte motorische Symptome bei schizophrenen Psychosen – Teil 3
Spätdyskinesien
verfasst von
PD Dr. D. Hirjak
K. M. Kubera
S. Bienentreu
P. A. Thomann
R. C. Wolf
Publikationsdatum
19.10.2018
Verlag
Springer Medizin
Erschienen in
Der Nervenarzt / Ausgabe 5/2019
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI
https://doi.org/10.1007/s00115-018-0629-7

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