Kardiale Komplikationen bei Patienten mit schizophrenen Störungen

 

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Zusammenfassung

Es ist bekannt, dass Patienten mit schizophrenen Psychosen erhöhte kardiale Morbiditäts- und Mortalitätsraten aufweisen. Häufige kardiovaskuläre Erkrankungen lassen sich zum einen durch Lebensgewohnheiten wie Inaktivität, Ernährungsfehler, Nikotinabusus, aber auch durch eine verminderte Inanspruchnahme vorsorgender medizinischer Angebote erklären. Zum anderen ist belegt, dass insbesondere atypische Neuroleptika in unterschiedlicher Weise zu hohen Prävalenzraten für Adipositas, Hypertriglyzeridämie und Diabetes mellitus beitragen. Hier ist eine standardisierte Erfassung entsprechender Parameter angezeigt. Ggf. ist eine Umstellung der antipsychotischen Medikation vorzunehmen. Auch sollte eine diätetische Beratung des Patienten und seiner Angehörigen erfolgen. Neben medikamentösen Ansätzen zur Normalisierung von Dyslipidämien sind verhaltenstherapeutische Programme entwickelt worden, mit denen gezielt metabolische Parameter beeinflusst werden können. Bedrohliche kardiale Komplikationen im Langzeitverlauf lassen sich darüber hinaus auch auf direkte Nebenwirkungen unter Antipsychotika wie QT-Verlängerungen mit Induktion schwerer Arrhythmien zurückführen. Zur Prävention sind prädisponierende Risikofaktoren wie z. B. Elektrolytstörungen und kardiale Vorerkrankungen zu beachten, wie auch die Begleitmedikation in Hinblick auf QT-verlängernde Nebenwirkungen und Interaktionen über das Cytochrom P450 System.

Abstract

It is well known, that patients with schizophrenia exhibit increased rates of cardiac morbidity and mortality. Frequent cardiovascular diseases are only partially explained by lifestyle, inactivity, dietary habits and nicotine abuse, but also by reduced compliance in prevention programs. On the other hand, it has been shown that particularly atypical antipsychotic agents are differentially responsible for high rates of obesity, hypertriglyceridemia, and diabetes. Therefore, a standardized evaluation of corresponding parameters is indicated in every patient. If needed, modulation of the medication regimen has to be performed. Additionally, a dietary counselling of the patient and his family should be offered. Besides pharmacological approaches to normalize dyslipidemia, specific behavioural therapy programmes are an option that may alter metabolic parameters. Threatening cardiac complications in long-term treatment of schizophrenia may also be the result of direct side effects under treatment with antipsychotics, like QT-prolongation triggering major arrhythmias. For prevention, predisposing risk factors like electrolyt disturbances, pre-existing cardiac diseases, co-medication with QT prolonging drugs and medication with potential cytochrome P450 interaction have to be taken into consideration.

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Priv.-Doz. Dr. med. Ulrich Meincke

Klinik für Psychiatrie und Psychotherapie Klinikum Niederberg

Robert Koch-Str. 2

42549 Velbert

Email: Meincke@Klinikum-Niederberg.de