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Atypische Neuroleptika und metabolisches Syndrom

Atypical Antipsychotics and Metabolic Syndrome

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Summary

The introduction of atypical antipsychotics in psychopharmacology represented a major advance in the treatment of psychotic disorders. However, there have been numerous studies that certain atypical antipsychotics may be associated with a greater risk of metabolic abnormalities than others, including weight gain, hyperlipidemia and new-onset typ 2 diabetes mellitus. A G-Protein beta3 subunit Gen (C825T) polymorphism, an increased carbohydrate metabolism and dyshormonism are discussed as pathogenetic mechanisms. High risk patients (adiposity, hyperlipidaemia, hyperglycaemia, preexisting diabetes) should maintain an antipsychotic agent with a favourable side effect profile. In these cases a periodical diabetes screening and blood lipid controls are required. Clinicans must balance the significant benefits of atypical antipsychotics against the risk of metabolic disturbances. In this article recent findings are reviewed.

Zusammenfassung

Die Einführung atypischer Neuroleptika führte bekanntlich zu einer entscheidenden Therapieverbesserung in der Behandlung psychotischer Erkrankungen. In zahlreichen Studien wird jedoch für einige Präparate dieser Gruppe belegt, dass sie ausgeprägte metabolische Veränderungen (u. a. starke Gewichtszunahmen, Hyperlipidämien, Diabetes mellitus Typ 2) auslösen. Als beteiligte Pathomechanismen werden zurzeit ein G-Protein beta3 subunit Gen (C825T) Polymorphismus, ein gesteigerter Kohlenhydratmetabolismus und hormonelle Veränderungen diskutiert. Bei Hochrisikopatienten (Übergewicht, Hyperlipidämie, Hyperglykämie und Diabetes vor Behandlungsbeginn, hereditäre Belastungen, Nikotinkonsum etc.) sollten Neuroleptika mit einem in diesem Bereich günstigen Nebenwirkungsprofil gewählt werden und ein regelmäßiges Diabetesscreening und eine Kontrolle der Blutfettwerte erfolgen. Ein entsprechendes Monitoring erscheint notwendig, um Folgeerkrankungen zu verhindern.

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  1. Universitätsklinik für Psychiatrie Graz, Medizinische Universität Graz, Graz, Austria

    Andreas Baranyi, Renè Yazdani, Alexandra Haas-Krammer, Alexandra Stepan, Hans-Peter Kapfhammer & Hans-Bernd Rothenhäusler

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  1. Andreas Baranyi
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Baranyi, A., Yazdani, R., Haas-Krammer, A. et al. Atypische Neuroleptika und metabolisches Syndrom. Wien Med Wochenschr 157, 255–270 (2007). https://doi.org/10.1007/s10354-007-0379-9

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