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Der Nervenarzt

, Volume 90, Issue 1, pp 1–11 | Cite as

Antipsychotikaassoziierte motorische Symptome bei schizophrenen Psychosen – Teil 1

Dystonien, Akathisie und Parkinsonismus
  • D. HirjakEmail author
  • K. M. Kubera
  • S. Bienentreu
  • P. A. Thomann
  • R. C. Wolf
Übersichten

Zusammenfassung

Akute antipsychotikainduzierte Bewegungsstörungen (AIB) sind klinisch relevant, subjektiv häufig ausgesprochen beeinträchtigend und für die Therapieadhärenz in der Langzeitbehandlung schizophrener Psychosen potenziell nachteilig. Diese Übersichtsarbeit fasst die aktuellen Studien zu Prävalenz, Risikofaktoren, Präventions- und Therapiemöglichkeiten sowie zur Voraussage akuter AIB bei schizophrenen Psychosen zusammen. Die aktuelle Evidenz und therapeutischen Empfehlungen gliedern sich in Abschnitte über akute Dystonien, Akathisie und Parkinsonismus. Für die Behandlung akuter Dystonien haben sich Trihexyphenidyl und Biperiden als hilfreich erwiesen. Zur Behandlung von Akathisie konnte die Wirksamkeit von lipophilen β‑Rezeptor-Blockern (Propranolol und Pindolol), Clonidin, Benzodiazepinen, Mianserin, Mirtazapin und Trazadon nachgewiesen werden. Die Therapie des antipsychotikainduzierten Parkinsonismus besteht in der Reduktion oder Umstellung des Antipsychotikums auf ein Präparat mit geringerer Affinität zum Dopamin-D2-Rezeptor oder in der regelmäßigen Gabe von Amantadin oder Anticholinergika. Zusammenfassend können akute AIB zwar präzise diagnostiziert, jedoch nicht immer effektiv und nachhaltig behandelt werden. Die Früherkennung und Frühbehandlung akuter AIB könnte gegebenenfalls auch die Krankheitsprognose und das klinische Outcome günstig beeinflussen.

Schlüsselwörter

Dystonien Akathisie Parkinsonismus Antipsychotika Therapie 

Antipsychotic-induced motor symptoms in schizophrenic psychoses—Part 1

Dystonia, akathisia und parkinsonism

Abstract

Acute antipsychotic-induced movement disorders (AIMD) are clinically relevant since they are frequently associated with high subjective distress, and since over the long-term they can negatively impact treatment adherence of patients with schizophrenic psychoses. This review article summarizes the relevant studies on the prevalence, risk factors, prevention and treatment options and instruments for early prediction of acute AIMD in schizophrenic psychoses. The current evidence and treatment recommendations are divided into three main areas: acute dystonia, akathisia, and parkinsonism. For the treatment of acute dystonia trihexyphenidyl and biperiden have shown their efficacy. Considering pharmacological treatment of akathisia, there is some preliminary evidence for medication with lipophilic beta-receptor blockers (propranolol and pindolol), clonidine, benzodiazepines, mianserin, mirtazapine und trazodone. The treatment options for drug-induced parkinsonism include reduction or switching from one antipsychotic to another with a lower affinity for dopamine D2 receptors, amantadine or in the regular administration of anticholinergic drugs. In conclusion, acute AIMD is easily to recognize but is not always effectively and durably treated. Early recognition and treatment of acute AIMD could be associated with improved treatment outcomes.

Keywords

Dystonia Akathisia Parkinsonism Antipsychotics Therapy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

D. Hirjak, K.M. Kubera, S. Bienentreu, P.A. Thomann 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_582_MOESM1_ESM.pdf (933 kb)
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Copyright information

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

Authors and Affiliations

  • D. Hirjak
    • 1
    Email author
  • K. M. Kubera
    • 2
  • S. Bienentreu
    • 3
  • P. A. Thomann
    • 2
    • 4
  • R. C. Wolf
    • 2
  1. 1.Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät MannheimUniversität HeidelbergMannheimDeutschland
  2. 2.Zentrum für Psychosoziale Medizin, Klinik für Allgemeine PsychiatrieUniversität HeidelbergHeidelbergDeutschland
  3. 3.Fachklinik für Psychiatrie und PsychotherapieMARIENBORN GmbHZülpichDeutschland
  4. 4.Zentrum für Seelische GesundheitGesundheitszentrum OdenwaldkreisErbachDeutschland

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