Fortschr Neurol Psychiatr 2004; 72(12): 705-726
DOI: 10.1055/s-2004-818454
Fort- und Weiterbildung
© Georg Thieme Verlag Stuttgart · New York

Akuttherapie der Schizophrenie

Acute Treatment of SchizophreniaT.  Wobrock1 , P.  Falkai1 , F.-G.  Pajonk1
  • 1Universitäts-Nervenklinik - Psychiatrie und Psychotherapie - Universitätskliniken des Saarlandes, Homburg/Saar (Direktor: Prof. Dr. med. P. Falkai)
Further Information

Publication History

Publication Date:
06 December 2004 (online)

Lernziel

Für die Therapie schizophrener Störungen stehen mehrere, mittlerweile zum überwiegenden Teil auch evidenzbasierte, Behandlungsverfahren zur Verfügung. Hierbei sollten die individuellen Bedürfnisse des an einer Schizophrenie erkrankten Patienten und die aus der Symptomatik im Einzelfall resultierenden Erforderlichkeiten in ein phasenspezifisches, mehrdimensionales Behandlungskonzept eingebettet werden. Der vorliegende Beitrag stellt die wichtigsten Elemente in der Akuttherapie unter Berücksichtigung allgemeiner, pharmakotherapeutischer und psychotherapeutischer Aspekte dar. Darüber hinaus soll eine Orientierungshilfe für spezielle Behandlungssituationen gegeben werden.

Literatur

  • 1 Addonizio G, Susman V, Roth S. Symptoms of neuroleptic malignant syndrome in 82 consecutive inpatients.  Am J Psychiatry. 1986;  143 1587-1590
  • 2 Allison D B, Mentore J L, Heo M. et al . Antipsychotic-induced weight gain: a comprehensive research synthesis.  Am J Psychiatry. 1999;  156 1686-1696
  • 3 American Psychiatric Association . Practice guideline for the treatment of patients with schizophrenia. Second edition.  Am J Psychiatry. 2004;  Supplement 1-114
  • 4 Azorin J M, Spiegel R, Remington G, Vanelle J M, Péré J J, Giguere M, Bourdeix I. A double-blind comparative study of clozapine and risperidone in the management of severe chronic schizophrenia.  Am J Psychiatry. 2001;  158 1305-1313
  • 5 Barak Y, Shamir E, Zemishlani H, Mirecki I, Toren P, Weizman R. Olanzapine vs. haloperidol in the treatment of elderly chronic schizophrenia patients.  Prog Neuropsychopharmacol Biol Psychiatry. 2002;  26 1199-1202
  • 6 Barnas C, Quiner S, Tauscher J, Hilger E, Willeit M, Kufferle B, Asenbaum S, Brucke T, Rao M L, Kasper S. In vivo (123)I IBZM SPECT imaging of striatal dopamine 2 receptor occupancy in schizophrenic patients.  Psychopharmacology (Berl). 2001;  157 236-242
  • 7 Battaglia J, Moss S, Rush J, Kang J, Mendoza R, Leedom L. et al . Haloperidol, lorazepam, or both for psychotic agitation? A multicenter, prospective, double-blind, emergency department study.  Am J Emerg Med. 1997;  15 335-340
  • 8 Bench C J, Lammertsma A A, Grasby P M, Dolan R J, Warrington S J, Boyce M, Gunn K P, Brannick L Y, Frackowiak R S. The time course of binding to striatal dopamine D2 receptors by the neuroleptic ziprasidone (CP-88,059-01) determined by positron emission tomography.  Psychopharmacology. 1996;  124 141-147
  • 9 Benkert O, Hippius H . Kompendium der Psychiatrischen Pharmakotherapie, 4. Auflage. Berlin, Heidelberg, New York: Springer-Verlag 2003
  • 10 Bieniek S A, Ownby R L, Penalver A, Dominguez R A. A double-blind study of lorazepam versus the combination of haloperidol and lorazepam in managing agitation.  Pharmacotherapy. 1998;  18 57-62
  • 11 Casey D E, Daniel D G, Wassef A A, Tracy L A, Wozniak P, Sommerville K W. Replyeffect of divalproex combined with olanzapine or risperidone in patients with an acute exacerbation of schizophrenia.  Neuropsychopharmacology. 2003;  28 2052-2053
  • 12 Copolov D L, Link C G, Kowalcyk B. A multicentre, double-blind, randomized comparison of quetiapine (ICI 204,636, ‘Seroquel’) and haloperidol in schizophrenia.  Psychol Med. 2000;  30 95-105
  • 13 Currier G W, Simpson G M. Risperidone liquid concentrate and oral lorazepam versus intramuscular haloperidol and intramuscular lorazepam for treatment of psychotic agitation.  J Clin Psychiatry. 2001;  62 153-157
  • 14 Daniel D G, Potkin S G, Reeves K R, Swift R H, Harrigan E P. Intramuscular (IM) ziprasidone 20 mg is effective in reducing acute agitation associated with psychosis: a double-blind, randomized trial.  Psychopharmacology (Berl). 2001;  155 128-134
  • 15 Davis J M, Chen N, Glick I D. A meta-analysis of the efficacy of second-generation antipsychotics.  Arch Gen Psychiatry. 2003;  60 553-564
  • 16 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (Hrsg) .Praxisleitlinien in Psychiatrie und Psychotherapie (Band 1). Behandlungsleitlinie Schizophrenie. Darmstadt: Steinkopff 1998
  • 17 Devinsky O, Honigfeld G, Patin J. Clozapine-related seizures.  Neurology. 1991;  41 369-371
  • 18 Drury V, Birchwood M, Cochrane R. Cognitive therapy and recovery from acute psychosis: a controlled trial.  Br J Psychiatry. 2000;  177 8-14
  • 19 Falloon I RH. Family interventions for mental disorders: efficacy and effectiveness.  World Psychiatry. 2003;  2 20-28
  • 20 Fenton M K, Coutinho E SF, Campbell C. Zuclopenthixol acetate in the treatment of acute schizophrenia and similar serious mental illnesses.  (Cochrane-Review). In: The Cochrane Library, Issue 2, 2003. Oxford, Update Software
  • 21 Foster S, Kessel J, Berman M E, Simpson G M. Efficacy of lorazepam and haloperidol for rapid tranquilization in a psychiatric emergency room setting.  Int Clin Psychopharmacol. 1997;  12 175-179
  • 22 Freudenreich O, Goff D C. Antipsychotic combination therapy in schizophrenia. A review of efficacy and risks of current combinations.  Acta Psychiatr Scand. 2002;  106 323-330
  • 23 Gaebel W, Janner M, Frommann N, Pietzcker A, Kopcke W, Linden M, Müller P, Müller-Spahn F, Tegeler J. First vs multiple episode schizophrenia: two-year outcome of intermittent and maintenance medication strategies.  Schizophr Res. 2002;  53 145-159
  • 24 Geddes J, Freemantle N, Harrison P, Bebbington P. Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis.  BMJ. 2000;  321 1371-1376
  • 25 Gefvert O, Bergstrom M, Laangstrom B, Lundberg T, Lindstrom I, Yates R A. Time course of central nervous dopamine-D2 and 5-HT2 receptor blockade and plasma drug concentrations after discontinuitation of quetiapine in patients with schizophrenia.  Psychopharmacology. 1998;  135 119-126
  • 26 Glick I D, Lemmens P, Vester-Blokland E. Treatment of the symptoms of schizophrenia: a combined analysis of double-blind studies comparing risperidone with haloperidol and other antipsychotic agents.  Int Clin Psychopharmacol. 2001;  16 265-274
  • 27 Gunasekara N S, Spencer C M, Keating G M. Ziprasidone: a review of its use in schizophrenia and schizoaffective disorder.  Drugs. 2002;  62 1217-1251
  • 28 Henderson D, Nasrallah R, Goff D. Switching from clozapine to olanzapine in treatment-refractory schizophrenia: safety, clinical efficacy, and predictors of response.  J Clin Psychiatry. 1998;  59 585-588
  • 29 Hogarty G E, Anderson C M, Reiss D J, Kornblinth S J, Greenwald P, Javan C D, Manonia M J,. EPICS research group . Family psychoeducation, social skills training and maintenance chemotherapy in the aftercare treatment of schizophrenia.  Arch Gen Psychiatry. 1986;  43 633-642
  • 30 Hori M, Suzuki T, Sasaki M, Shiraishi H, Koizumi J. Convulsive seizures in schizophrenic patients induced by zotepine administration.  Jpn J Psychiatry Neurol. 1992;  46 161-167
  • 31 Johns C, Thompson J. Adjunctive treatments in schizophrenia: pharmacotherapies and electroconvulsive therapy.  Schizophr Bull. 1995;  21 607-619
  • 32 Kane J, Honigfeld G, Singer J, Meltzer H. Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine.  Arch Gen Psychiatry. 1988;  45 789-796
  • 33 Kane J M, Woerner M, Lieberman J. Tardive dyskinesia: prevalence, incidence and risk factors.  J Clin Psychopharmacol. 1988;  8 52-56
  • 34 Kapur S, Remington G, Jones C, Wilson A, DaSilva J, Houle S, Zipursky R. High levels of dopamine D2 receptor occupancy with low-dose haloperidol treatment: a PET study.  Am J Psychiatry. 1996;  153 948-950
  • 35 Kapur S, Zipursky R B, Remington G. Clinical and theoretical implication of 5-HT2 and D2 receptor occupancy of clozapine, risperidone, and olanzapine in schizophrenia.  Am J Psychiatry. 1999;  156 286-293
  • 36 Kapur S, Zipursky R B, Jones C, Remington G, Houle S. Relationship between dopamine D2 occupancy, clinical response, and side effects: a double-blind PET study of first-episode schizophrenia.  Am J Psychiatry. 2000;  157 514-520
  • 37 Kemp R, Kirov G, Everitt B, Hayward P, David A. Randomised controlled trial of compliance therapy. 18-month follow-up.  Br J Psychiatry. 1998;  172 413-419
  • 38 Kopala L C, Good K P, Honer W G. Extrapyramidal signs and clinical symptoms in first-episode schizophrenia: response to low dose risperidone.  J Clin Psychopharmacol. 1997;  17 308-313
  • 39 Koro C E, Fedder D O, L'Italien G J, Weiss S, Magder L S, Kreyenbuhl J, Revicki D, Buchanan R W. An assessment of the independent effects of olanzapine and risperidone exposure on the risk of hyperlipidemia in schizophrenic patients.  Arch Gen Psychiatry. 2002;  59 1021-1026
  • 40 Krausz M, Moritz S, Lambert M, Naber D. Dosage of conventional neuroleptic medication and subjective cognitive functioning in schizophrenia.  Int J Psychopharmacol. 2000;  2 77-81
  • 41 Lehmann A F, Steinwachs D M,. PORT Co-investigators . Translating research into practice: the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations.  Schizophr Bull. 1998;  24 1-10
  • 42 Lerner V, Chudakova B, Kravets S, Polyakova I. Combined use of risperidone and olanzapine in the treatment of patients with resistant schizophrenia: a preliminary case series report.  Clin Neuropharmacol. 2000;  23 284-286
  • 43 Lewis S, Tarrier N, Haddock G, Bentall R, Kinderman P, Kingdon D, Siddle R, Drake R, Everitt J, Leadley K, Benn A, Grazebrook K, Haley C, Akhtar S, Davies L, Palmer S, Faragher B, Dunn G. Randomised controlled trial of cognitive-behavioral therapy in early schizophrenia: acute-phase outcomes.  Br J Psychiatry (Suppl.). 2002;  43 S91-S97
  • 44 Lieberman J A. Atypical antipsychotic drugs as a first-line treatment of schizophrenia: a rationale and hypothesis.  J Clin Psychiatry. 1996;  57 (Suppl. 11) 68-71
  • 45 Lieberman J A, Koreen A, Chakos M, Sheitman B, Woerner M, Alvir J M, Bilder R. Factors influencing treatment response and outcome of first-episode schizophrenia: implications for understanding the pathophysiology of schizophrenia.  J Clin Psychiatry. 1996;  57 (Suppl. 9) 5-9
  • 46 Lieberman J A, Tollefson G, Tohen M, Green A I, Gur R E, Kahn R, McEvoy J, Perkins D, Sharma T, Zipursky R, Wei H, Hamer R M. HGDH Study Group . Comparative efficacy and safety of atypical and conventional antipsychotic drugs in first-episode psychosis: a randomized, double-blind trial of olanzapine versus haloperidol.  Am J Psychiatry . 2003;  160 1396-1404
  • 47 Lindenmayer J P, Volavka J, Lieberman J, Sheitman B, Citrome L, Chakos M, Czobor P, Parker B, Iskander A. Olanzapine for schizophrenia refractory to typical and atypical antipsychotics: an open-label, prospective trial.  J Clin Psychopharmacol.. 2001;  21 448-453
  • 48 Loebel A D, Lieberman J A, Alvir J M, Mayerhoff D I, Geisler S H, Szymanski S R. Duration of psychosis and outcome in first episode schizophrenia.  Am J Psychiatry. 1992;  149 1183-1188
  • 49 Martinot J L, Paillere-Martinot M L, Poirier M F, Dao-Castellana M H, Loch C, Maziere B. In vivo characteristics of dopamine D2 receptor occupancy by amisulpride in schizophrenia.  Psychopharmacology (Berl). 1996;  124 154-158
  • 50 McGorry P D, Edwards J, Mihalopoulos C. EPPIC: an evolving system of early detection and optimal management.  Schizophr Bull. 1996;  22 305-322
  • 51 Möller H J, Boyer P, Fleurot O, Rein W. Improvement of acute exacerbation of schizophrenia with amisulpride: a comparison with haloperidol.  Psychopharmacology. 1997;  132 396-401
  • 52 Mullen J, Jibson M D, Sweitzer D. for the QUEST Study Group . A comparison of the relative safety, efficacy, and tolerability of quetiapine and risperidone in outpatients with schizophrenia and other psychotic disorders: the quetiapine experience with safety and tolerability (QUEST) study.  Clin Ther. 2001;  23 1839-1854
  • 53 National Institute for Clinical Excellence .Guidance on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia. NICE Technology Appraisal Guidance - No. 43. 2002
  • 54 Nordstrom A L, Farde L, Nyberg S, Karlsson P, Halldin C, Sedval G. D1, D2, and 5-HT2 receptor occupancy in relation to clozapine serum concentration: a PET study of schizophrenic patients.  Am J Psychiatry. 1995;  152 1444-1449
  • 55 Nyberg S, Eriksson B, Oxenstierna G, Halldin C, Farde L. Suggested minimal effective dose of risperidone based on PET-measured D2 and 5-HT2A receptor occupancy in schizophrenic patients.  Am J Psychiatry. 1999;  156 869-875
  • 56 Nyberg S, Olsson H, Nilsson U, Maehlum E, Halldin C, Farde L. Low striatal and extra-striatal D2 receptor occupancy during treatment with the atypical antipsychotic sertindole.  Psychopharmacology (Berl). 2002;  162 37-41
  • 57 Pajonk F G, Raedler T J, Schreiner A, Wiedemann K. Effectiveness of risperidone in higly agitated schizophrenic patients.  European Neuropsychopharmacol. 2002;  12 (Suppl 3) S276
  • 58 Robinson D G, Woerner M G, Alvir J M, Geisler S, Koreen A, Sheitman B, Chakos M, Mayerhoff D, Bilder R, Goldman R, Lieberman J A. Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder.  Am J Psychiatry. 1999;  156 544-549
  • 59 Rummel C, Hamann J, Kissling W, Leucht S. New generation antipsychotics for first episode schizophrenia.  (Cochrane-Review). In: The Cochrane Library, Issue 4, 2003. Chichester, UK: John Wiley & Sons, Ltd.
  • 60 Sanger T M, Lieberman J A, Tohen M, Grundy S, Beasley C, Tollefson G D. Olanzapine versus haloperidol treatment in first-episode psychosis.  Am J Psychiatry. 1999;  156 79-87
  • 61 Scholer N R. Maintenance medication for schizophrenia: strategies for dose reduction.  Schizophr Bull. 1991;  17 311-324
  • 62 Tandon R, Jibson M D. Efficacy of newer generation antipsychotics in the treatment of schizophrenia.  Psychoneuroendocrinology. 2003;  28 9-26
  • 63 Thayran P, Adams C E. Electroconvulsive therapy for schizophrenia.  (Cochrane-Review). In: The Cochrane Library, Issue 4, 2002. Chichester, UK: John Wiley & Sons, Ltd.
  • 64 Tollefson G D, Birkett M A, Kiesler G M, Wood A J,. Lilly Resistant Schizophrenia Study Group . Double-blind comparison of olanzapine versus clozapine in schizophrenic patients clinically eligible for treatment with clozapine.  Biol Psychiatry. 2001;  49 52-63
  • 65 Bruggen J van, Tijssen J, Dingemans P, Gersons B, Linszen D. Symptom response and side-effects of olanzapine and risperidone in young adults with recent onset schizophrenia.  Int Clin Psychopharmacol. 2003;  18 341-346
  • 66 Putten T van, Marder S R, Mintz J. A controlled dose comparison of haloperidol of newly admitted schizophrenic patients.  Arch Gen Psychiatry. 1990;  47 754-758
  • 67 Volz H P, Pajonk F G. Akuttherapie schizophrener Psychosen. Stuttgart: Thieme-Verlag 2003: S.33-36
  • 68 Wahlbeck K, Cheine M, Tuisku K, Ahokas A, Joffe G, Rimon R. Risperidone versus clozapine in treatment-resistant schizophrenia: a randomised pilot study.  Prog Neuropsychopharmacol Biol Psychiatry. 2000;  24 911-922
  • 69 Wetzel H, Bardeleben U von, Holsboer F, Benkert O. Zotepin versus Perazin bei Patienten mit paranoider Schizophrenie: eine doppelblind-kontrollierte Wirksamkeitsprüfung.  Fortschr Neurol Psychiat. 1991;  59 (Suppl. 1) 23-29
  • 70 Wiedemann G, Klingberg S. Psychotherapie produktiver Symptomatik bei Patienten mit schizophrener Psychose.  Nervenarzt. 2003;  74 76-84
  • 71 Wright P, Birkett M, David S R, Meehan K, Ferchland I, Alaka K J. et al . Double-blind, placebo-controlled comparison of intramuscular olanzapine and intramuscular haloperidol in the treatment of acute agitation in schizophrenia.  Am J Psychiatry. 2001;  158 1149-1151

Dr. med. Thomas Wobrock

Universitäts-Nervenklinik - Psychiatrie und Psychotherapie Universitätskliniken des Saarlandes

66421 Homburg/Saar

Email: thomas.wobrock@uniklinik-saarland.de

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