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Nationale und internationale Leitlinien zur Schizophrenie

Update 2013 zum Stand der Empfehlungen zur antipsychotischen Medikation

National and international schizophrenia guidelines

Update 2013 regarding recommendations about antipsychotic pharmacotherapy

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Zusammenfassung

Behandlungsleitlinien stellen evidenzbasierte Empfehlungen für Diagnostik und Therapie zur Verfügung, um Behandler, Angehörige und Betroffene bei der Entscheidungsfindung für die optimale Behandlungsoption in spezifischen Behandlungssituationen zu unterstützen. In Deutschland ist seit 2006 eine Leitlinie der Deutschen Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) zur Behandlung der Schizophrenie auf dem S3-Niveau der AWMF verfügbar. Diese Leitlinie unterliegt derzeit einem umfassenden Revisionsprozess, der voraussichtlich 2014 abgeschlossen sein wird. Seit 2006 wurde jedoch eine Vielzahl an klinischen Studien und Metaanalysen publiziert, die eine neue Bewertung der antipsychotischen medikamentösen Behandlung erforderlich erscheinen lassen. Aktuelle nationale und internationale nicht-deutschsprachige Leitlinien wie die WFSBP-, die PORT- und die NICE-Leitlinie haben die generelle Priorisierung atypischer Antipsychotika aufgehoben und betonen zunehmend eine nebenwirkungsorientierte Hierarchisierung der verfügbaren Substanzen. Der folgende Beitrag diskutiert aktuelle Entwicklungen in der Leitlinienentwicklung zur Behandlung der Schizophrenien im Vergleich zu der vorhandenen nationalen S3-Leitlinie der DGPPN und anderen kürzlich publizierten Leitlinien. Besondere Problemfelder und Veränderungen werden detailliert beschrieben und Leitlinien miteinander verglichen, um einen Ausblick auf mögliche Anpassungen der therapeutischen Empfehlungen zu geben.

Summary

Treatment guidelines provide evidence-based recommendations for diagnosis and treatment to assist clinicians, care givers and patients in finding an optimized treatment option in given clinical situations. Specific treatment guidelines for schizophrenia issued by the German Association of Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and published under the auspices of the Working Group for Scientific Medical Specialist Societies (AWMF) (i.e. fulfilling the highest quality standards at the S3 level) have been available in Germany since 2006. Currently, a comprehensive revision process is ongoing to update these guidelines with the aim to publish the revision before 2014. However, since publication of the German treatment guidelines many clinical trials and meta-analyses have been published which appear to make a new evaluation of antipsychotic drug treatment necessary. Currently available national and international guidelines, such as the WFSBP, PORT and NICE guidelines, place less emphasis on the general superiority of atypical antipsychotic medication but support the idea to evaluate antipsychotic drugs based on the side effect profiles. The present overview discusses the recent guidelines development processes regarding schizophrenia and compares the available German treatment guidelines with recently published international guidelines. Current developments and issues for discussion are described in detail to provide possible implications for changes in treatment recommendations.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Hasan: Einladungen zu wissenschaftlichen Kongressen von Janssen Cilag, Pfizer und Lundbeck; Vortragshonorar von Desitin. T. Wobrock: Honorare für Referententätigkeit von AstraZeneca, Alpine Biomed, Bristol Myers Squibb, Janssen Cilag, Eli Lilly, Essex, Fa. I3G, Novartis, Organon, Pfizer, Sanofi-Synthelabo/Aventis sowie Unterstützung bei Reisekosten und Kongressen durch AstraZeneca, Bristol Myers Squibb, Eli Lilly, Essex, Janssen Cilag, Lundbeck, Sanofi-Synthelabo/Aventis; finanzielle Unterstützung von Forschungsaktivitäten durch die DFG, das BMBF, AstraZeneca (Investigator initiierte Studie, IIT), Fa. Cerbomed, Fa. I3G und dem AOK-Bundesverband/Landesverband Niedersachsen. W. Gaebel: Unterstützung für wissenschaftliche Symposien durch die Janssen-Cilag GmbH, Neuss, Lilly Deutschland GmbH, Bad Homburg, und Servier, München; Mitglied der Fakultät der Lundbeck International Neuroscience Foundation (LINF), Dänemark. B. Janssen: keine. J. Zielasek: keine. P. Falkai: bis 01.01.2011 Vortrags- und Schulungstätigkeiten für Lundbeck, Pfizer, Lilly, Janssen-Cilag, Novartis, Servier, AstraZeneca, Forschungsunterstützung von AstraZeneca (Abschluss 2011). Alle Autoren sind Mitglieder der Deutschen Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN).

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Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, Nußbaumstr. 7, 80336, München, Deutschland

    A. Hasan & P. Falkai

  2. Zentrum für Seelische Gesundheit, Kreiskliniken Darmstadt-Dieburg, Dieburg, Deutschland

    T. Wobrock

  3. Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland

    W. Gaebel, B. Janssen & J. Zielasek

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  1. A. Hasan
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  2. T. Wobrock
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  3. W. Gaebel
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  4. B. Janssen
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  5. J. Zielasek
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  6. P. Falkai
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Correspondence to A. Hasan.

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Hasan, A., Wobrock, T., Gaebel, W. et al. Nationale und internationale Leitlinien zur Schizophrenie. Nervenarzt 84, 1359–1368 (2013). https://doi.org/10.1007/s00115-013-3913-6

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  • DOI: https://doi.org/10.1007/s00115-013-3913-6

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