Gibt es eine Pharmakotherapie von “herausforderndes Verhalten”?

Zusammenfassung

Nicht kognitive Demenz-Symptome wie Agitation und Aggression, eventuell begleitet von produktiven Symptomen wie Halluzinationen und Wahnvorstellungen sind als “herausforderndes Verhalten” konzeptualisiert worden, um die Verantwortungszuweisung an den Erkrankten zu verhindern. Auch Depression und Apathie werden darunter subsumiert, wenn dies zu Konflikten mit den versorgenden Personen führt. Die Gabe von Neuroleptika bei älteren Menschen birgt die Gefahr von einer erhöhten Mortalität sowie von einem erhöhten Risiko zerebrovaskulärer Ereignisse. Nichtsdestotrotz gibt es Situationen im klinischen Alltag bei der Behandlung dementer Patienten, die eine neuroleptische Therapie erfordern. Insgesamt gesehen sind die psychopharmakologischen Behandlungsmöglichkeiten von herausforderndem Verhalten ernüchternd. Bei Patienten, die eine Demenz und ein Parkinson-Syndrom haben, ist die Pharmakotherapie zusätzlich erschwert. Einzige Neuroleptika, die bei Parkinson-Syndromen in Frage kommen, sind Clozapin (on-label für Psychose, nicht “herausforderndes Verhalten”) und Quetiapin (off-Label). Cholinesterasehemmer sind auch bei Patienten mit Parkinson-Syndrom zu erwän. Studiendaten legen einen Einsatz von Citalopram bei Agitation nahe.

Summary

“Challenging behaviour” is the term used for non-cognitive symptoms of dementia such as agitation and aggression. It can include productive symptoms such as hallucinations and delusions. For more than ten years it is known that antipsychotic drugs will increase mortality in elderly people and the risk of cerebrovascular events. Nevertheless, there are situations with challenging behavior which require drug therapy. However, psychopharmacological treatment options are scarce. In patients with parkinsonism in addition to dementia pharmacotherapy is even more difficult. In this instance, clozapine (on-label for psychosis, but not for non-cognitive dementia symptoms) and quetiapine (off-label) could be used as neuroleptic. New data suggest citalopram for the treatment of agitation in dementia.

Schlüsselwörter

Herausforderndes Verhalten - Demenz - Neuroleptika

Keywords

Challenging behaviour - dementia - antipsychotic drugs

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