Antipsychotika-Depotbehandlung im Wandel der Zeit

Zusammenfassung

Rund zwei Drittel der schizophrenen Erkrankungen nehmen einen chronisch-rezidivierenden Krankheitsverlauf. Eine kontinuierliche antipsychotische Rezidivprophylaxe trägt nach überwiegenden Studienergebnissen dazu bei, Krankheitsepisoden zu vermeiden, den psychosozialen Funktionsstatus und die Lebensqualität der Betroffenen zu verbessern sowie die Angehörigen zu entlasten. Dabei haben sich die Therapiemöglichkeiten in den letzten Jahren verbessert. Besonders durch die Verfügbarkeit von modernen Depot-Antipsychotika hat bei deren Einsatz ein Paradigmenwechsel stattgefunden. In der Vergangenheit war die Depotbehandlung mit Erstgenerations-Antipsychotika durch erhebliche motorische Nebenwirkungen gekennzeichnet und wurde als Ultima Ratio bei einer Negativselektion von Patienten mit schlechter Therapietreue eingesetzt. Heute steht eine Palette wirksamer und gut verträglicher Zweitgenerations-Antipsychotika in Depot-Formulierung zur Verfügung. Die wachsende Evidenz aus klinischen und naturalistischen Studien macht sie zu einer wichtigen Therapieoption und Alternative zu oralen Antipsychotika und dies bereits in früheren Krankheitsstadien. Die vorliegende Übersichtsarbeit beleuchtet den Wandel der Depotbehandlung und wichtige Aspekte, welche die Therapieentscheidung für eine Langzeittherapie mit Depot-Formulierungen in der Praxis beeinflussen.

Summary

Almost two third of all schizophrenic diseases show a chronic-relapsing course. According to predominant study outcomes, a continuous antipsychotic relapse prevention contributes to prevent psychotic episodes, to improve psychosocial functioning and life quality of affected patients, and to disburden relatives. Thereby, therapeutic options improved in recent years. Especially the availability of modern depot antipsychotics has led to a paradigm shift with their use. In the past, using first generation depots was characterized by substantial motoric side effects and was restricted as an ultima ratio to patients with poor adherence. At present, a wide range of efficient and well-tolerated second-generation antipsychotics has become available as depots. Growing evidence from clinical and naturalistic studies makes their administration to an important therapeutic option and to an alternative to oral antipsychotics already at early stages of the disease. This review highlights the change within depot antipsychotics therapy as well as critical issues that influence the therapeutic decision for a maintenance therapy with depots in clinical practice.

Schlüsselwörter

Schizophrene Spektrumserkrankungen - Depot - atypische Antipsychotika - Therapieziele

Keywords

Schizophrenia - depot - atypical antipsychotics - treatment goals

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