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Management von Therapieresistenzen – therapieresistente Schizophrenie

Management of treatment resistance—Treatment-resistant schizophrenia

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Zusammenfassung

Trotz enorm hoher Prävalenz und substanzieller Beeinträchtigungen der Betroffenen ist die therapieresistente Schizophrenie (TRS) in der klinischen Forschung im Bereich psychiatrischer Störungsbilder zu wenig erforscht und die Pathophysiologie bisher kaum verstanden. Ein besseres klinisches und pathophysiologisches Verständnis dieser heterogenen und schwer betroffenen Population von Menschen mit persistierenden Symptomen in unterschiedlichen Domänen ist notwendig, um nicht nur frühzeitig intervenieren zu können, sondern auch, um neuartige Therapiestrategien zu entwickeln bzw. individualisierte Therapieangebote machen zu können. In dieser Übersicht werden State-of-the-Art-Kriterien der pharmakologischen TRS, neurobiologische Krankheitsmodelle und prädiktive Faktoren der TRS sowie das Phänomen der Pseudotherapieresistenz und das klinische Management der TRS vorgestellt. Zukünftig ist nicht nur die Verwendung von operationalisierten Kriterien und Definitionen von TRS in longitudinalen Studien und randomisiert-kontrollierten Studien (RCTs) elementar, sondern auch die Verlaufsbeobachtung von Trajektorien mit Integration einer multimodalen longitudinalen Phänotypisierung, aber auch die longitudinale Erhebung von Routinedaten in der akademischen Forschung, wie es im neu geschaffenen Deutschen Zentrum für Psychische Gesundheit (DZPG) möglich sein wird.

Abstract

Despite a very high prevalence and substantial impairments among affected individuals, treatment-resistant schizophrenia (TRS) has not been sufficiently researched in clinical research in the field of psychiatric disorders and the pathophysiology is still poorly understood. A better clinical and pathophysiological understanding of this heterogeneous and severely affected population of people with persistent symptoms in different domains is necessary in order not only to be able to intervene early but also to develop novel therapeutic strategies or individualized treatment approaches. This review article presents the state of the art criteria of the pharmacological TRS, neurobiological disease models and predictive factors for TRS as well as the phenomenon of pseudo-treatment resistance and the clinical management of TRS. In the future, not only the use of operationalized criteria and definitions of TRS in longitudinal studies and randomized-controlled trials (RCTs) are paramount, but also the observation of trajectories with the integration of multimodal longitudinal phenotyping and the longitudinal collection of clinical routine data in academic research, which will be possible in the newly created German Center for Mental Health (DZPG).

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Förderung

Diese Arbeit wurde unterstützt durch eine Förderung der DFG (HA 6091/4–1, Projekt: 316096538, http://gepris.dfg.de/gepris/projekt/316096538) und des Deutschen Zentrums für psychische Gesundheit (Standort München-Augsburg, (FKZ: 01EE2303C).

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Authors and Affiliations

  1. Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät, Universität Augsburg, Augsburg, Deutschland

    Elias Wagner &  Alkomiet Hasan

  2. Evidenzbasierte Psychiatrie und Psychotherapie, Medizinische Fakultät, Universität Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland

    Elias Wagner

  3. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Lübeck, Deutschland

    Stefan Borgwardt

  4. Deutsches Zentrum für psychische Gesundheit, Augsburg, Deutschland

    Alkomiet Hasan

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  1. Elias Wagner
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Correspondence to Elias Wagner.

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Interessenkonflikt

E. Wagner war Mitglied in Advisory Boards von Recordati und Boehringer Ingelheim. S. Borgwardt war Mitglied im Advisory Board von Janssen und erhielt Vortragshonorare von Recordati und Lundbeck. A. Hasan erhielt Vortragshonorare von AbbVie, Advanz, Janssen, Otsuka, Rovi, Recordati und Lundbeck. Er war Mitglied in Advisory Boards für Boehringer Ingelheim, Janssen, Otsuka, Rovi, Recordati und Lundbeck. Einladungen zu Kongressen oder anderen Aktivitäten wurden nicht angenommen. Er ist Herausgeber der AWMF S3-Leitlinie Schizophrenie, Angestellter des Freistaats Bayern und der Bezirkskliniken Schwaben.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Wagner, E., Borgwardt, S. & Hasan, A. Management von Therapieresistenzen – therapieresistente Schizophrenie. Nervenarzt 95, 423–431 (2024). https://doi.org/10.1007/s00115-024-01608-6

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