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Zeitschrift für Gerontologie und Geriatrie

, Volume 51, Issue 7, pp 768–776 | Cite as

Psychopharmakotherapie bei älteren Menschen mit schweren psychischen Erkrankungen

  • Christian Lange-Asschenfeldt
Themenschwerpunkt
  • 138 Downloads

Zusammenfassung

Hintergrund

Chronische Schizophrenie, Depression, bipolare Störungen und andere chronische psychische Erkrankungen mit Beginn in Jugend oder jungem Erwachsenenalter werden oft als „severe mental illness“ (SMI) bezeichnet. Altwerden mit einer SMI ist vergesellschaftet mit verschiedenen psychosozialen, physiologischen und medizinischen Besonderheiten mit potenziellem Einfluss auf die Psychopharmakotherapie (PPT).

Fragestellung

Definition und Diskussion spezieller Probleme der PPT altgewordener Menschen mit SMI und Empfehlungen für die einzelnen Diagnosen.

Material und Methode

Internationale Literatur- und Leitliniensuche sowie Auswertung der Fachliteratur und Expertenempfehlungen.

Ergebnisse

Zu den allgemeinen Problemen mit Einfluss auf die PPT von altgewordenen Menschen mit SMI zählen Non-Adhärenz, Therapieresistenz, Polypharmazie, pharmakokinetische Veränderungen im Alter sowie körperliche Begleiterkrankungen. Psychopharmaka (PP) können kardiovaskuläre, metabolische, neuropsychiatrische und andere Risiken haben. Kontrollierte Studien zur Wirksamkeit von PP, Wirkstoffgruppen oder -kombinationen sind kaum existent.

Schlussfolgerungen

Die PPT von altgewordenen Menschen mit SMI sollte immer Teil eines Gesamtbehandlungsplans mit sozio- und psychotherapeutischen Komponenten sein, der die speziellen Probleme dieser Zielgruppe adressiert. Sie sollte deren vielfältigen Probleme und Risiken berücksichtigen und auf das spezielle Risikoprofil des individuellen Patienten zugeschnitten sein. Aufgrund des weitgehenden Fehlens evidenzbasierter Empfehlungen für die genannte Population müssen Behandlungsstrategien aus Standardleitlinien unter Berücksichtigung physiologischer und medizinischer Veränderungen im Alter angepasst werden.

Schlüsselwörter

Schwere psychische Erkrankung Pharmakotherapie Schizophrenie Chronische Depression Bipolare Störung 

Psychiatric pharmacotherapy of older individuals with severe mental illness

Abstract

Background

Chronic schizophrenia, depression, and bipolar disorders, among other chronic psychiatric disorders with onset at youth or early adulthood are often referred to as severe mental illness (SMI). Aging with SMI is associated with various psychosocial, physiological, and medical problems with potential impact on psychiatric pharmacotherapy.

Objectives

Determination and discussion of problems and special features of the psychopharmacological treatment of older persons with SMI and presentation of treatment recommendations for the distinct diagnoses.

Materials and methods

International literature and guidelines were searched. In addition, the basic literature and expert opinions are discussed.

Results

General problems that influence the psychiatric pharmacotherapy of older persons with SMI include nonadherence, nonresponse, polypharmacy, and distinct pharmacokinetic changes with aging and somatic comorbidity. Psychotropic drugs may exhibit cardiovascular, metabolic, and neuropsychiatric risks, among others. The literature regarding effectiveness of psychotropic drugs, drug groups, or combination of drugs in older patients with SMI is scarce to nonexistent.

Conclusions

Drug treatment of older persons with SMI should be part of an overall treatment plan that also has to include social and psychotherapeutic components that address the specific problems of this population. Most importantly, psychiatric pharmacotherapy should consider these risks and the treatment should be tailored to a patient’s individual risk profile. Due to a general lack of evidence in this special population, treatment strategies of standard guidelines should be adjusted with special consideration to physiological changes of age.

Keywords

Severe mental illness Pharmacotherapy Schizophrenia Chronic depression Bipolar disorder 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Lange-Asschenfeldt gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Copyright information

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

Authors and Affiliations

  1. 1.Abteilung Gerontopsychiatrie, Klinik und Poliklinik für Psychiatrie und Psychotherapie, LVR-Klinikum, Medizinische FakultätHeinrich-Heine-Universität DüsseldorfDüsseldorfDeutschland

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