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Psychopharmakotherapie bei Herz-Kreislauf-Erkrankungen

Psychopharmacotherapy in patients with cardiovascular diseases

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Zusammenfassung

Bei schweren psychischen Erkrankungen besteht eine erhöhte kardiometabolische Morbidität und eine gegenüber der Allgemeinbevölkerung erhöhte Mortalität. Daher ist die kardiometabolische Verträglichkeit einer psychopharmakologischen Behandlung bei psychisch Kranken bedeutsam, insbesondere wenn eine kardiometabolische Grunderkrankung vorliegt. Relativ häufige Nebenwirkungen einer psychopharmakologischen Therapie sind Veränderungen des Fett- und Glukosestoffwechsels, des Körpergewichts und des QTc-Intervalls. Je nach Präparat und individueller Vulnerabilität des Patienten treten diese Nebenwirkungen in unterschiedlicher Häufigkeit auf. Daher ist ein regelmäßiges Monitoring unter Einschluss von EKG-Kontrollen empfehlenswert. Darüber hinaus sind bei psychisch und kardiometabolisch Erkrankten Arzneimittelwechselwirkungen zu beachten, die zu einer Erhöhung oder Erniedrigung der Medikamentenspiegel führen können. Vor Beginn einer psychiatrischen Pharmakotherapie ist eine stabile kardiologisch-medikamentöse Einstellung empfehlenswert, ebenso wie die interdisziplinäre Zusammenarbeit beim Management komorbider Patienten.

Abstract

Increased cardiometabolic morbidity and increased overall mortality has been observed in patients with severe mental disorders. Therefore, cardiometabolic safety is an important issue in the treatment of patients with psychiatric disorders, in particular in patients with comorbid cardiometabolic diseases. Frequent adverse side effects include disturbances of lipid and glucose metabolism, body weight changes and alterations of the QTc interval. Dependent on the particular substance used and on factors concerning individual vulnerability, these side effects vary in relative frequency. Therefore, regular monitoring is recommended including ECG. Furthermore, interactions between different medicaments may occur, either leading to enhanced or decreased drug concentrations. Prior to psychopharmacological treatment, proper cardiological treatment is recommended. The management of cardiovascular risks under psychopharmacology requires interdisciplinary cooperation between the cardiologist, general practitioner and psychiatrist.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: J. Cordes: Vortragstätigkeit, Projektunterstützung, Kongressteilnahme: AstraZeneca, Pfizer Pharma, Lilly Deutschland, Servier, Janssen-Cilag und Magventure. C. Hiemke hat ohne persönliche Honorierung Vorträge auf Veranstaltungen gehalten, die von den Firmen AstraZeneca, Bio-Rad, Bristol-Meyers Squibb, Pfizer, Lilly oder Servier unterstützt wurden, und die Firma Servier beraten. Er ist Geschäftsführer der psiac GmbH, die ein internetbasiertes Programm für Arzneimittelwechselwirkungen entwickelt hat, das über den Springer-Verlag vertrieben wird. C. Lange-Asschenfeldt (letzte 24 Monate): Projektförderung durch Bristol-Myers Squibb, Pfizer Pharma; Vortragstätigkeit für Servier. J. Cordes seit 2011: BMBF-Projektförderung. K.G. Kahl: Vortragshonorare von Eli Lilly, BMS, GSK, Lundbeck, Servier, Janssen-Cilag, Otsuka und Pfizer.

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Authors and Affiliations

  1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Deutschland

    J. Cordes M.D. & C. Lange-Asschenfeldt

  2. Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin, Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland

    C. Hiemke

  3. Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Deutschland

    K.G. Kahl

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  1. J. Cordes M.D.
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  2. C. Lange-Asschenfeldt
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  3. C. Hiemke
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  4. K.G. Kahl
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Correspondence to J. Cordes M.D..

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Cordes, J., Lange-Asschenfeldt, C., Hiemke, C. et al. Psychopharmakotherapie bei Herz-Kreislauf-Erkrankungen. Internist 53, 1304–1314 (2012). https://doi.org/10.1007/s00108-012-3070-1

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  • DOI: https://doi.org/10.1007/s00108-012-3070-1

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