Prävention und Behandlung von Antipsychotika-induzierten tardiven Dyskinesien

Zusammenfassung

Tardive Dyskinesien (TD) sind immer noch häufige Langzeitfolgen einer Behandlung mit Antipsychotika. Sie sind meist irreversibel, mit einer geringeren Lebensqualität und kognitiven Defiziten assoziiert und ein Risikofaktor für erhöhte Sterblichkeit. Auch führen sie häufig zu einer weiteren Stigmatisierung der betroffenen Patienten. In der Behandlung von schweren psychiatrischen Krankheitsbildern sind Antipsychotika aber weiterhin nicht entbehrlich. Deshalb ist das Wissen insbesondere über die Prävention und die Risikofaktoren aber auch über die Behandlung von TD bei der Verordnung von Antipsychotika sehr wichtig. Die Behandlung von TD besteht in der Optimierung der antipsychotischen Pharmakotherapie. Des Weiteren können gezielte medikamentöse Behandlungen erfolgen. Hierbei kommt den sogenannten VMAT-2-Inhibitoren eine besondere Rolle zu. Die neuen VMAT-2-Inhibitoren sind in Deutschland noch nicht zugelassen. Weitere Medikamente zur Behandlung der TD sind unter anderem Clonazepam und Gingko biloba. Dieser Übersichtsartikel fasst die gegenwärtige Evidenz für die Behandlung von TD zusammen und versucht klinische Empfehlungen zur Prävention und Behandlung von TD zu formulieren.

ABSTRACT

Tardive dyskinesias (TDs) are still common long-term sequelae of antipsychotic treatment. They are generally irreversible and associated with cognitive deficits, a decrease in quality of life and increased mortality. Furthermore, they potentially contribute to further stigmatization of the affected patients. However due to limited treatment options, antipsychotic drugs are still one of the cornerstones in treatment of most severe mental illnesses. Therefore, knowledge about risk factors and prevention of TDs is crucial. If TDs occur, the immediate optimization of the antipsychotic drug regimen is required. Targeted medical treatments such as VMAT - 2 inhibitors can be considered. The novel VMAT-2 inhibitors are not yet approved in Germany. Other drugs that are currently used to treat TDs include clonazepam and gingko biloba. This review summarizes the current evidence of treatment options of TDs and seeks to formulate clinical recommendations for the prevention and management of TDs.

Schlüsselwörter

tardive Dyskinesie - Antipsychotika - Prävention - Behandlung - VMAT-2-Inhibitor

Key words

tardive dyskinesia - antipsychotics - prevention - treatment - VMAT-2-inhibitor

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