Metabolische Risiken in der Behandlung der Schizophrenie

Zusammenfassung

Bei schizophrenen Patienten besteht bereits unabhängig von der Medikation eine erhöhte Prävalenz des metabolischen Syndroms. Darüber hinaus komplizieren metabolische Nebenwirkungen die Pharmakotherapie der Schizophrenie. Aufgrund zunehmender Polypharmazie summieren sich metabolische Begleiteffekte der verschiedenen Psychopharmaka. Daher sind folgende Aspekte in der Therapie von Patienten mit schizophrenen Erkrankungen zu beachten: 1. initiales Monitoring zur Identifikation von Patienten mit hohem Risiko für die Entwicklung von Diabetes Typ 2 und kardiovaskulären Erkrankungen; 2. Einleitung einer leitliniengerechten psychopharmakologischen Therapie unter Berücksichtigung individueller Risikofaktoren; 3. kontinuierliches und langfristiges metabolisches Monitoring; 4. präventiver Einsatz von Interventionen zum Gewichtsmanagement und zur Reduktion kardiovaskulärer Risikofaktoren sowie 5. eine gegebenenfalls interdisziplinäre Versorgung schizophrener Patienten.

Summary

The prevalence of the metabolic syndrome is increased in drug-naïve patients with schizophrenia, leading to an increased risk for cardiovascular disorders and diabetes mellitus type 2. Furthermore, treatment of schizophrenia is complicated by the metabolic side effects of common antipsychotic medicaments. Polypharmacy in these patients may also heighten the risk for somatic morbidity. Therefore, the following recommendations should be considered in patients with schizophrenia when treatment is initiated: 1) metabolic monitoring to identify patients at risk for the development of diabetes mellitus type 2 and cardiovascular disorders; 2) start of pharmacological treatment according to treatment guidelines and with regard to the individual metabolic risk factors; 3) continuous monitoring of long duration; 4) implementation of preventive weight management strategies in individual treatment plans to reduce the risk for cardiovascular disorders; 5) if necessary, multidisciplinary treatment of patients with schizophrenia.

Schlüsselwörter

Schizophrenie - Psychopharmaka - metabolisches Syndrom - Diabetes mellitus

Keywords

Schizophrenia - psychotropic drugs - metabolic syndrome - diabetes mellitus

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