Möglichkeiten des Gewichtsmanagements in der Behandlung schizophrener Psychosen mit atypischen Antipsychotika

Zusammenfassung

In einer umfassenden selektiven Literaturrecherche, vornehmlich in den Datenbanken Medline und Cochrane, wurden über 2500 Publikationen aus den letzten Jahren bis Dezember 2007 inhaltlich geprüft. Relevante Suchbegriffe ergaben sich aus der Verknüpfung der Begriffe „antipsychotic or schizophrenia or individual drug names (amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone)” verknüpft mit den Suchbegriffen „BMI, weight gain, metabolic syndrome, diabetes, lipid(s)”, cholesterol, triglycerides”. Ungeachtet der den atypischen Antipsychotika (AAP) [37] zugeschriebenen Vorteilen und der besonderen Wirksamkeit von Clozapin bei therapieresistenten und suizidalen Patienten ist das Risiko für eine Gewichtszunahme bei einigen dieser Substanzen deutlich erhöht. Patienten mit Schizophrenie haben eine deutlich reduzierte Lebenserwartung, die auch im Zusammenhang mit einem erhöhten Auftreten kardiovaskulärer Risikofaktoren steht. Es fehlt an in die klinische psychiatrische Versorgung integrierten Praxisleitlinien für das Management kardiovaskulärer Risikofaktoren. Das vor diesem Hintergrund im Consensus Papier der APA/ADA empfohlene Monitoring von mit AAP behandelten Patienten ist in der klinischen Praxis bisher unzureichend etabliert. Das regelmäßige Monitoring kann dem Patienten Selbstkontrolle und Motivation vermitteln. Der Arzt erhebt durch das Monitoring eine Analyse metabolischer Parameter, die der Verlaufskontrolle von Interventionen und der Identifizierung von Risikopatienten dienen. Insbesondere bei Patienten mit hohem kardiovaskulären Risikoprofil ist die Teilnahme an einem Gewichtsmanagement-Programm bereits aus präventiver Sicht sinnvoll. Ein derartiges spezielles Programm sollte die Elemente einer Ernährungstherapie, Verhaltenstherapie und Bewegungstherapie beinhalten. Erste kontrollierte Studien ergeben Hinweise auf eine effektive Prävention von Gewichtszunahme und metabolischen Veränderungen bei Anwendung eines derart strukturierten Programms.

Abstract

Extensive, selective literature review of 2500 articles from the last years (up to December 2007) predominantly from Medline and Cochrane, using as search terms “antipsychotic or schizophrenia or individual drug names (amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, ziprasidone)” and the terms “BMI, weight gain, metabolic syndrome, diabetes, lipid(s), cholesterol, triglycerides” was conducted. Regardless of the advantages ascribed to atypical antipsychotics and the special effectiveness of clozapine in patients resistant to therapy and at risk for suicide, the probability of weight gain is considerably increased for some of these substances. Patients with schizophrenia have a considerably reduced life expectancy associated with an increased prevalence of cardiovascular risk factors. There is a lack of practical guidelines integrated into clinical psychiatric care for the management of cardiovascular risk factors. The monitoring of patients treated with atypics, which has been recommended in the APA/ADA Consensus Paper in light of these facts, is insufficiently established in clinical practice. A regular monitoring can convey self control and motivation to the patient. In the case of corresponding risk constellations further decisions regarding indication and therapy have to be considered. Especially patients with a high cardiovascular risk profile are highly recommended to participate in a weight-management program for prevention purposes. Such a special program should include elements of dietetic treatment and behaviour and exercise therapy. First controlled studies suggest an effective prevention of weight gain and metabolic changes when applying such a structured program. The practice oriented step by step concept presented here is meant to provide points of reference for the implementation of required medical and psychoeducative measures facilitating the management of weight and further cardiovascular risk factors in the context of psychiatric care in patients with schizophrenia.

Schlüsselwörter

Schizophrenie - Antipsychotika - Gewichtsmanagement - Review

Key words

Schizophrenia - Antipsychotics - Weight Management - Review

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