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Atypische Antipsychotika bei therapieresistenter Schizophrenie

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Zusammenfassung

Die Ergebnisse vieler Studien belegen das Ausmaß der Therapieresistenz bei schizophrenen Patienten, von denen 20–30% nur unzureichend und etwa 7% gar nicht auf eine antipsychotische Therapie ansprechen. Clozapin hat sich trotz der Einschränkung durch die kontrollierte Anwendung bewährt, seine Überlegenheit gegenüber typischen Antipsychotika ist vielfach belegt. Zu neueren Atypika liegen nun 7 Doppelblindstudien vor. In 3 Untersuchungen wurde Risperidon mit Clozapin verglichen, in einer Clozapin mit Zotepin und 2 weiteren Clozapin mit Olanzapin. Eine vierarmige Vergleichsstudie untersuchte zudem die Wirksamkeit von Clozapin, Olanzapin, Risperidon und Haloperidol. Je strenger die Kriterien der Therapieresistenz gewählt wurden, desto deutlicher zeigte sich insgesamt ein Vorteil von Clozapin. Olanzapin zeigte in diesen Studien eine dem Clozapin vergleichbare Effektivität bei geringerer Nebenwirkungsrate. Aufgrund von Einschränkungen in Methode und Anzahl von Studien sind die Befunde zum Wirksamkeitsvergleich verschiedener Atypika noch zurückhaltend zu beurteilen. Systematische Untersuchungen zur vielversprechenden Kombination mehrerer Atypika bei Therapieresistenz fehlen bislang noch.

Summary

Many studies have shown that treatment resistance is a substantial problem in schizophrenic patients, with 20–30% of patients responding only partially and about 7% showing no response to antipsychotic treatment. Clozapine has been consistently shown to be effective in this subgroup of schizophrenic patients. It is still the drug of choice, despite the restricted indication and the need for a careful evaluation of side effects. Recently, several double-blind studies of newer atypical antipsychotics have been conducted in therapy-resistant patients. Three studies compared risperidone with clozapine, one study zotepine with clozapine and two others olanzapine with clozapine. One study compared the efficacy of clozapine, olanzapine, risperidone with one another and with haloperidol. In these studies, clozapine showed increasing superiority the more restrictive the criteria for therapy-resistance chosen. Olanzapine was found to be as effective as clozapine and was better tolerated . However, the results of studies comparing different atypical antipsychotics have to be interpreted carefully because of their limited number as well as methodological problems. Case studies also indicate the efficacy of combining different atypical antipsychotics, but no systematic research on this issue has been done so far.

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  1. Klinik für Psychiatrie und Psychotherapie der Universitätsklinik Hamburg-Eppendorf

    I. Schäfer, M. Lambert & D. Naber

  2. Klinik für Psychiatrie und Psychotherapie der Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246 , Hamburg

    I. Schäfer

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Schäfer, I., Lambert, M. & Naber, D. Atypische Antipsychotika bei therapieresistenter Schizophrenie. Nervenarzt 75, 79–91 (2004). https://doi.org/10.1007/s00115-003-1662-7

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