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Der Nervenarzt

, Volume 90, Issue 1, pp 12–24 | Cite as

Antipsychotikaassoziierte motorische Symptome bei schizophrenen Psychosen – Teil 2

Katatone Symptome und malignes neuroleptisches Syndrom
  • D. HirjakEmail author
  • A. Sartorius
  • K. M. Kubera
  • R. C. Wolf
Übersichten

Zusammenfassung

Pharmakotherapie bei schizophrenen Psychosen kann in seltenen Fällen mit folgenschweren antipsychotikaassoziierten Bewegungsstörungen einhergehen. Die zwei schwerwiegendsten Komplikationen der antipsychotischen Behandlung sind „antipsychotikaassoziierte katatone Symptome“ (AKS) und das „maligne neuroleptische Syndrom“ (MNS). Beide Konstellationen erfordern ein schnelles ärztliches Handeln, allerdings kann die differenzialdiagnostische Abgrenzung eine Herausforderung sein. Therapeutisch sollte bei AKS (hier konzipiert als eine spezifische Unterform katatoner Symptome) ein Versuch mit Benzodiazepinen erfolgen; auch Memantine könnte hilfreich sein. In schweren pharmakorefraktären Fällen kann eine Elektrokonvulsionstherapie (EKT) indiziert sein. Das MNS stellt eine lebensbedrohliche Konstellation dar, die häufig intensivmedizinisch behandelt werden muss. Die medikamentöse Behandlung mit Benzodiazepinen, Bromocriptin, Amantadin, Dantrolen und/oder EKT hat sich als effektiv erwiesen. Nicht zuletzt fasst diese Übersichtsarbeit auch die vorliegende Literatur zur Therapie genuiner katatoner Symptome zusammen. Zusammenfassend kann festgehalten werden, dass diese klinischen Syndrome schnellstmöglich erkannt und behandelt werden müssen. Ihre Früherkennung und Frühbehandlung kann unter Umständen lebensrettend sein und das spätere klinische Outcome günstig beeinflussen.

Schlüsselwörter

Antipsychotikaassoziierte Katatonie Katatonie Malignes neuroleptisches Syndrom Differenzialdiagnosen Therapie 

Antipsychotic-induced motor symptoms in schizophrenic psychoses—Part 2

Catatonic symptoms and neuroleptic malignant syndrome

Abstract

In rare cases, pharmacotherapy in schizophrenic psychoses can be associated with life-threatening antipsychotic-induced movement disorders. The two most severe complications are antipsychotic-associated catatonic symptoms (ACS) and neuroleptic malignant syndrome (NMS). Although both constellations necessitate rapid medical care, the diagnosis is still a clinical challenge. Although there is no established treatment of ACS (here designated as a specific subtype of catatonic symptoms), an attempt should be made with benzodiazepines and memantine can also be helpful. In severe drug-refractory cases electroconvulsive therapy (ECT) can be indicated. The NMS represents a life-threatening constellation that frequently requires intensive care unit treatment. The medicinal treatment with benzodiazepines, bromocriptine, amantadine, dantrolene and/or ECT is also advocated. Finally, this review article also summarizes the currently available literature for treatment of genuine catatonic symptoms. In conclusion, the abovementioned clinical syndromes must be rapidly recognized and treated. Early recognition and treatment of these movement disorders can under certain circumstances be lifesaving and favorably influence the later clinical outcome.

Keywords

Antipsychotic-associated catatonia Catatonia Neuroleptic malignant syndrome Differentialdiagnosis Therapy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

D. Hirjak, A. Sartorius, K. M. Kubera und R.C. Wolf geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Supplementary material

115_2018_581_MOESM1_ESM.pdf (2.1 mb)
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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • D. Hirjak
    • 1
    Email author
  • A. Sartorius
    • 1
  • K. M. Kubera
    • 2
  • R. C. Wolf
    • 2
  1. 1.Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und PsychotherapieMedizinische Fakultät Mannheim, Universität HeidelbergMannheimDeutschland
  2. 2.Zentrum für Psychosoziale Medizin, Klinik für Allgemeine PsychiatrieUniversität HeidelbergHeidelbergDeutschland

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