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Der Nervenarzt

, Volume 87, Issue 7, pp 719–723 | Cite as

Chancen und Kontroversen von Depotantipsychotika in der Behandlung von Patienten mit Schizophrenie

  • S. Breit
  • G. HaslerEmail author
Übersichten

Zusammenfassung

Hintergrund

Dieses Review soll einen Überblick über Vor- und Nachteile der Anwendung von Depotantipsychotika in der Therapie der Schizophrenie geben. Es erfolgt ein Vergleich zur oralen Anwendungsform, wobei der Fokus auf Wirksamkeit, Verträglichkeit, Rückfallverhütung und Patientenzufriedenheit liegt.

Material und Methoden

Wir führten eine Literaturrecherche in medizinischen Datenbanken durch. Dabei wurden Ergebnisse von Metaanalysen, randomisierten kontrollierten Studien und systematischen Reviews aus den Jahren 1999 bis 2014 miteinbezogen.

Ergebnisse und Diskussion

Depotantipsychotika ermöglichen die Aufrechterhaltung eines stabilen Medikamentenplasmaspiegels und tragen zur Sicherung der therapeutischen Wirkung bei. Sie führen zu einer Verbesserung der Compliance und senken dadurch die Rückfall- und Hospitalisierungsrate. Auf diese Weise wirken sich Depotantipsychotika nicht nur positiv auf den persönlichen Verlauf aus, sondern tragen auch dazu bei, die Gesundheitskosten zu senken.

Schlüsselwörter

Schizophrenie Verträglichkeit Compliance Rückfallverhütung Gesundheitskosten 

Advantages and controversies of depot antipsychotics in the treatment of patients with schizophrenia

Abstract

Background

The objective of this article is to give an overview of the advantages and disadvantages of the use of depot antipsychotics in the treatment of schizophrenia. The focus is on efficacy, tolerability, relapse prevention, patient compliance and satisfaction compared to oral administration forms.

Material and methods

A literature search was conducted in medical databases. The results of meta-analyses, randomized controlled trials and systematic reviews from the years 1999–2014 were included.

Results and discussion

Depot antipsychotics ensure maintenance of constant blood levels and a continuous medication delivery. The efficacy and tolerability of depot antipsychotics are comparable to oral administration forms. Due to an improved medication compliance a reduction of relapse and hospitalization rates can be achieved. This is a key focus for improving outcomes and reducing costs in the treatment of schizophrenia.

Keywords

Schizophrenia Tolerability Compliance Relapse Health costs 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Breit und G. Hasler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Agid O et al (2010) Long acting injectable antipsychotics in the treatment of schizophrenia: their role in relapse prevention. Expert Opin Pharmacother 11(14):2301–2317CrossRefPubMedGoogle Scholar
  2. 2.
    Ascher-Savanum H et al (2010) The cost of relapse and the predictors of relapse in the treatment of schizophrenia. BMC Psychiatry 10:2CrossRefGoogle Scholar
  3. 3.
    Ascher-Svanum H et al (2006) Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. J Clin Psychiatry 67(3):453–460CrossRefPubMedGoogle Scholar
  4. 4.
    Citrome L (2010) Paliperidone palmitate – review of the efficacy, safety and cost of a new second-generation depot antipsychotic medication. Int J Clin Pract 64(2):216–239CrossRefPubMedGoogle Scholar
  5. 5.
    Coutinho E, Fenton M, Quraishi S (2000) Zuclopenthixol decanoate for schizophrenia and other serious mental illnesses. Cochrane Database Syst Rev 2:CD001164PubMedGoogle Scholar
  6. 6.
    Das AK et al (2014) A qualitative study of the attitudes of patients in an early intervention service towards antipsychotic long-acting injections. Ther Adv Psychopharmacol 4(5):179–185CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Detke HC et al (2010) Post-injection delirium/sedation syndrome in patients with schizophrenia treated with olanzapine long-acting injection, I: analysis of cases. BMC Psychiatry 10(10):43CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Deutsche Gesellschaft für Psychiatrie (2006) Psychotherapie und Nervenheilkunde (DGPPN), S3 Behandlungsleitlinie Schizophrenie. Deutsche Gesellschaft für Psychiatrie, BerlinGoogle Scholar
  9. 9.
    Emsley R et al (2008) Remission in patients with first-episode schizophrenia receiving assured antipsychotic medication: a study with risperidone long-acting injection. Int Clin Psychopharmacol 23(6):325–331CrossRefPubMedGoogle Scholar
  10. 10.
    Emsley R et al (2012) Treatment response after relapse in a placebo-controlled maintenance trial in schizophrenia. Schizophr Res 138(1):29–34CrossRefPubMedGoogle Scholar
  11. 11.
    Fleischhacker WW et al (2013) Long-term safety and tolerability of aripiprazole once-monthly in maintenance treatment of patients with schizophrenia. Int Clin Psychopharmacol 28(4):171–176PubMedGoogle Scholar
  12. 12.
    Fusar-Poli P, Kempton MJ, Rosenheck RA (2013) Efficacy and safety of second-generation long-acting injections in schizophrenia: a meta-analysis of randomized-controlled trials. Int Clin Psychopharmacol 28(2):57–66CrossRefPubMedGoogle Scholar
  13. 13.
    Gustavsson A et al (2011) Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 21(10):718–779CrossRefPubMedGoogle Scholar
  14. 14.
    Hamann J et al (2014) Checking the plausibility of psychiatrists’ arguments for not prescribing depot medication. Eur Neuropsychopharmacol 24(9):1506–1510CrossRefPubMedGoogle Scholar
  15. 15.
    Hawton K et al (2005) Schizophrenia and suicide: systematic review of risk factors. Br J Psychiatry 187(1):9–20CrossRefPubMedGoogle Scholar
  16. 16.
    Heres S et al (2006) Attitudes of psychiatrists toward antipsychotic depot medication. J Clin Psychiatry 67(12):1948–1953CrossRefPubMedGoogle Scholar
  17. 17.
    Iyer S et al (2013) A qualitative study of experiences with and perceptions regarding long-acting injectable antipsychotics: part I-patient perspectives. Can J Psychiatry 58(5 Suppl 1):14S–22SPubMedGoogle Scholar
  18. 18.
    Iyer S et al (2013) A qualitative study of experiences with and perceptions regarding long-acting injectable antipsychotics: part II-physician perspectives. Can J Psychiatry 58(5 Suppl 1):23S–29SPubMedGoogle Scholar
  19. 19.
    Kane JM et al (2012) Aripiprazole intramuscular depot as maintenance treatment in patients with schizophrenia: a 52-week, multicenter, randomized, double-blind, placebo-controlled study. J Clin Psychiatry 73(5):617–624CrossRefPubMedGoogle Scholar
  20. 20.
    Kane JM et al (2013) Hospitalisation rates in patients switched from oral anti-psychotics to aripiprazole once-monthly for the management of schizophrenia. J Med Econ 16(7):917–925CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kohler S, Heinz A, Sterzer P (2013) Long-acting injectable antipsychotics : overview and advice for daily routine care. Nervenarzt 85(9):1067–1074CrossRefGoogle Scholar
  22. 22.
    Lieberman JA et al (2001) The early stages of schizophrenia: speculations on pathogenesis, pathophysiology and therapeutic approaches. Biol Psychiatry 50(11):884–897CrossRefPubMedGoogle Scholar
  23. 23.
    McEvoy JP et al (2014) Effectiveness of paliperidone palmitate vs. haloperidol decanoate for maintenance treatment of schizophrenia: a randomized clinical trial. JAMA 311(19):1978–1987CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    National Institute for Health and Care Excellence (2014) Psychosis and Schizophrenia in Adults: Treatment and Management. Clinical guideline CG178. National Institute for Health and Care Excellence, LondonGoogle Scholar
  25. 25.
    Oehl M, Hummer M, Fleischhacker WW (2000) Compliance with antipsychotic treatment. Acta Psychiatr Scand Suppl 407:83–86CrossRefPubMedGoogle Scholar
  26. 26.
    Owens DC et al (2010) Duration of untreated illness and outcome in schizophrenia: test of predictions in relation to relapse risk. Br J Psychiatry 196(4):296–301CrossRefPubMedGoogle Scholar
  27. 27.
    Pandina G et al (2011) A double-blind study of paliperidone palmitate and risperidone long-acting injectable in adults with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 35(1):218–226CrossRefPubMedGoogle Scholar
  28. 28.
    Peng X et al (2011) Decline in hospitalization risk and health care cost after initiation of depot antipsychotics in the treatment of schizophrenia. Clinicoecon Outcomes Res 3:9–14PubMedPubMedCentralGoogle Scholar
  29. 29.
    Primavera D et al (2012) Does duration of untreated psychosis predict very long term outcome of schizophrenic disorders? Results of a retrospective study. Ann Gen Psychiatry 11(1):21CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Robinson D et al (1999) Predictors of treatment response from a first episode of schizophrenia or schizoaffactive disorder. Arch Gen Psychiatry 56(3):241–247CrossRefPubMedGoogle Scholar
  31. 31.
    Shajahan P, Taylor M (2010) The uses and outcomes of quetiapine in depressive and bipolar mood disorders in clinical practice. J Psychopharmacol 24(4):565–572CrossRefPubMedGoogle Scholar
  32. 32.
    Shi L et al (2007) Characteristics and use patterns of patients taking first generation depot antipsychotics or oral antipsychotics for schizophrenia. Psychiatr Serv 58(4):482–488CrossRefPubMedGoogle Scholar
  33. 33.
    Tiihonen J et al (2011) A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia. Am J Psychiatry 168(6):603–609CrossRefPubMedGoogle Scholar
  34. 34.
    Weiden PJ et al (2014) A trial evaluating gradual- or immediate-switch strategies from risperidone, olanzapine, or aripiprazole to iloperidone in patients with schizophrenia. Schizophr Res 153(1-3):160–168CrossRefPubMedGoogle Scholar
  35. 35.
    Weiden PJ et al (2009) A randomized controlled trial of long-acting injectable risperidone vs continuation on oral atypical antipsychotics for first-episode schizophrenia patients: initial adherence outcome. J Clin Psychiatry 70(10):1397–1406CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Universitätsklinik für Psychiatrie und Psychotherapie Universität BernBernSchweiz

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