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Zur Bedeutung der therapeutischen Serumspiegelüberwachung von Neuroleptika bei Nonresponse

  • Conference paper
Therapieresistenz unter Neuroleptikabehandlung

Zusammenfassung

Die Einbeziehung der therapeutischen Serumspiegelüberwachung als Teil der rationalen Behandlung mit Neuroleptika wird seit den sechziger Jahren gefordert (Brodie 1967); sie hat jedoch noch keinen Eingang in den Klinikalltag gefunden. Dies gilt auch für die therapeutische Neuroleptika-Serumspiegelüberwachung bei Nonresponse. Die Gründe hierfür sind vielschichtig:

  1. 1.

    Da die Serumspiegel von einigen Neuroleptika sehr niedrig sind, erfordert ihre Quantifizierung komplizierte Verfahren. Geräte und Personal stehen hierfür nur in seltenen Fällen zur Verfügung.

  2. 2.

    Neuroleptika weisen ein hohes Verteilungsvolumen auf, und daher sind die zu postulierenden therapeutischen Fenster breit.

  3. 3.

    Neuroleptika werden zu aktiven und inaktiven Metaboliten verstoffwechselt, d.h. einige der Neuroleptika-Metaboliten sind ebenso aktiv wie oder aktiver als die Mutterverbindung, andere weisen keine Dopamin-D2-Rezeptor-blockierende Wirkung auf; es ergibt sich außerdem das Problem, daß sie unterschiedlich gehirngängig sind, wie beispielsweise die Metaboliten des Thioridazins.

  4. 4.

    Zur Behandlung einer akuten psychotischen Exazerbation sind höhere Serumspiegel notwendig als zur Erhaltungstherapie.

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  1. Psychiatrische Klinik und Poliklinik, Universität Bonn, Sigmund-Freud-Straße 25, D-53115, Bonn, Bundesrepublik Deutschland

    Prof. Dr. M. L. Rao

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    Hans-Jürgen Möller (Direktor) (Direktor)

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Rao, M.L. (1993). Zur Bedeutung der therapeutischen Serumspiegelüberwachung von Neuroleptika bei Nonresponse. In: Möller, HJ. (eds) Therapieresistenz unter Neuroleptikabehandlung. Springer, Vienna. https://doi.org/10.1007/978-3-7091-9292-4_8

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  • DOI: https://doi.org/10.1007/978-3-7091-9292-4_8

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