Pharmakotherapie der therapieresistenten Schizophrenie

Kernaussagen

Bis zu 30 % aller schizophrenen Patienten sprechen auf eine initiale Medikation mit einem Antipsychotikum nicht ausreichend an. Nach Ausschluss einer sog. Pseudo-Resistenz wird als nächste Maßnahme häufig die Dosis des bestehenden Antipsychotikums erhöht oder ein Wechsel auf ein anderes, zweites Antipsychotikum vollzogen. Basierend auf der gegenwärtigen Datenlage scheint eine Umstellung auf ein neues Antipsychotikum (vorzugsweise mit einem anderen Rezeptorbindungsprofil) einer Hochdosisbehandlung leicht überlegen zu sein.

Nach mindestens 2 gescheiterten Behandlungsversuchen mit 2 Antipsychotika verschiedener Substanzklassen in ausreichender Dosierung und Dauer gilt eine Monotherapie mit Clozapin als Therapieoption der ersten Wahl.

Sowohl pharmakologische Kombinations- als auch Augmentationsstrategien können aufgrund der inkonsistenten Datenlage nicht generell als evidenzbasierte Behandlungsmethoden bei Therapieresistenz empfohlen werden. Wenn man diese einsetzt, empfiehlt es sich, bei einer Kombination zweier Antipsychotika 2 Medikamente mit unterschiedlichem Rezeptorbindungsprofil zu verwenden. Die Auswahl einer Substanz zur Augmentation von Antipsychotika sollte sich in erster Linie an der spezifischen Zielsymptomatik orientieren.

Bei Versagen aller psychopharmakologischen Maßnahmen kann die Durchführung einer Elektrokrampftherapie (EKT) erwogen werden.

Publication History

Publication Date:
25 September 2014 (online)

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