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Der Nervenarzt

, Volume 75, Issue 1, pp 36–43 | Cite as

Die initial dysphorische Reaktion (IDR) auf die Ersteinnahme von Neuroleptika

  • B. Graf Schimmelmann
  • M. Schacht
  • C. Perro
  • M. Lambert
Article

Zusammenfassung

Die initial dysphorische Reaktion (IDR) bezeichnet negative affektive Reaktionen von Patienten innerhalb von 48 h auf die Testdosis eines Neuroleptikums. Zur Messung werden 3 unterschiedliche Instrumente verwendet (Neuroleptic Dysphoria Scale, Dysphoric Response Index, Drug Attitude Inventory).

Die Definition, Operationalisierung und Vorstellungen zur Ätiologie der IDR sind uneinheitlich. Dennoch muss die IDR mit einer wiederholt replizierten Prävalenz von etwa 30% als klinisch relevantes Phänomen angesehen werden. Der Zusammenhang zwischen einer IDR und einem ungünstigen Behandlungsverlauf lässt sich bei methodisch uneinheitlicher Datenlage noch nicht abschließend belegen. Bislang konnte kein Zusammenhang zwischen der IDR und psychosozialen Daten (Alter, Geschlecht), der Psychopathologie (etwa Depression oder Feindseligkeit) oder anderen Vorbehandlungsvariablen nachgewiesen werden.

Ätiologisch werden Befindlichkeitsveränderungen durch extrapyramidal-motorische Störungen oder direkte affektive Nebenwirkungen der Neuroleptika diskutiert. Allerdings existieren auch Hinweise, dass es sich bei der IDR nicht um ein neuroleptika-spezifisches Phänomen handeln könnte.

Nach ersten eigenen Ergebnisse ist die IDR unter atypischen Neuroleptika seltener und schwächer ausgeprägt als bei Patienten unter konventionellen Neuroleptika.

Zusätzlich sind die Untersuchung der IDR unter placebokontrollierten Bedingungen und die Erfassung spezifischer Vorbehandlungsvariablen sowie Grundlagenforschung zur Ätiologie der IDR notwendig.

Schlüsselwörter

Initial dysphorische Reaktion Neuroleptika Subjektive Befindlichkeit Schizophrenie 

Summary

Initial dysphoric response (IDR) is characterized by a negative affective reaction within 48 h after a neuroleptic test dose. Currently, there are three scales for measuring the IDR (Neuroleptic Dysphoria Scale, Dysphoric Response Index, Drug Attitude Inventory). The debate continues about the definition, measurement, and underlying aetiology of IDR. Nevertheless, with a prevalence of 30%, the response is a clinically relevant phenomenon. Empirical data give some evidence of an association between IDR and short-term outcome. No correlation of IDR with pretreatment variables has been found yet (e.g. age, gender, and psychopathology at baseline, especially depression and hostility). With respect to aetiology, a negative subjective reaction to concurrent extrapyramidal side effects and direct dysaffective effects of some neuroleptics have been discussed. Other studies found that IDR might not be a specifically antipsychotic effect. Our first results give some evidence that patients treated with atypical antipsychotics experience IDR less often and less severely than those treated with conventional antipsychotics described in the literature. Further research should include placebo-controlled studies and the evaluation of specific pretreatment variables. To assess the aetiology of IDR, further basic research is needed.

Keywords

Initial dysphoric reaction Antipsychotics Subjective well-being Schizophrenia 

Notes

Danksagung

Wir danken Prof. Dr. D. Naber und Prof. Dr. M. Schulte-Markwort herzlich für die kritische Durchsicht des Manuskripts.

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • B. Graf Schimmelmann
    • 1
    • 3
  • M. Schacht
    • 1
  • C. Perro
    • 2
  • M. Lambert
    • 2
  1. 1.Klinik für Kinder- und Jugendpsychiatrie und -psychotherapieUniversitätsklinikum Hamburg-EppendorfHamburg
  2. 2.Klinik für Psychiatrie und PsychotherapieUniversitätsklinikum Hamburg-EppendorfHamburg
  3. 3.Klinik für Kinder- und Jugendpsychiatrie und -psychotherapieUniversitätsklinikum Hamburg-EppendorfHamburg

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