Polypharmazie in der Behandlung der Schizophrenie

Zusammenfassung

Die derzeit gültigen Therapiestandards in der psychopharmakologischen Behandlung der Schizophrenie favorisieren eine antipsychotische Monotherapie. Obgleich die in den letzten Jahren entwickelten atypischen Antipsychotika in den geforderten Zulassungsstudien den Nachweis erbrachten, mindestens gleich wirksam zu sein wie Haloperidol, belegen pharmakoepidemiologische Daten eine Zunahme vielfältiger Kombinationstherapien. Die Bedeutung dieser Untersuchungen wird dadurch evident, dass rund 40 - 50 % der stationär behandlungsbedürftigen schizophrenen Patienten und bis zu 90 % der ambulanten Patienten eine antipsychotische Kombinationstherapie erhalten. Therapieresistenz, Reduzierung von dosisabhängigen Nebenwirkungen einer antipsychotischen Monotherapie oder die Einflussnahme auf schizophrene Begleitsymptome, z. B. Depression, können Motive für eine Kombinationsbehandlung oder Augmentierungsstrategien sein. Abgesehen von den Kosten nehmen mit der Anzahl der Verordnungen die medikamentöse Compliance ab und die Risiken für unerwünschte pharmakologische Effekte zu. Da Kombinationsbehandlungen sehr häufig sind, erhält die psychopharmakologische Fort- und Weiterbildung eine besondere Gewichtung. Angesichts der geringen Zahl kontrollierter Studien werden in dieser Übersicht vorrangig Einzelfallberichte zu den häufigeren, aber auch zu den selten angewandten Kombinationstherapien referiert und abschließend therapeutische Empfehlungen diskutiert.

Abstract

Current standards for the pharmacological treatment of schizophrenia favour antipsychotic monotherapy. Most atypical antipsychotics developed in recent years meet the statutory requirement of being at least as effective as Haloperidol. Nevertheless, pharmacoepidemiological data show an increase in polypharmacy. The importance of the studies is underlined by the fact that 40 - 50 % of schizophrenic inpatients and up to 90 % schizophrenic outpatients receive antipsychotic combination therapies. Treatment resistance, reduction of dose-related side effects caused by antipsychotic monotherapy or the effect on concomitant symptoms of schizophrenia, such as comorbid depression, might justify combination therapy or augmentation strategies. Apart from the high costs, polypharmacy is associated with reduced patient compliance and an increased risk of undesired pharmacological effects. Since polypharmacy is increasingly common further educational measures in psychopharmacology should be getting more attention. Due to the very small number of controlled studies that exist at present this report will focus on case reports of the most frequent as well as some of the lesser prescribed combination therapies. Finally, conclusions will be discussed in relation to therapy recommendations.

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