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Ist manisches Verhalten ein autoregulatorischer Versuch zur Vigilanzstabilisierung?

Manic behavior as an autoregulatory attempt to stabilize vigilance

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Zusammenfassung

Manische Patienten weisen in reizarmen Situationen häufig massive, mit der Elektroenzephalographie nachweisbare Vigilanzabfällen bis hin zu „micro sleeps“ innerhalb der ersten Minute auf (Labilität der Vigilanzregulation). Postuliert wird, dass die manische Symptomatik durch Schaffung einer reizintensiven Umwelt der Vigilanzstabilisierung dient. Es werden theoretische Argumente und empirische Belege präsentiert, nach denen nicht nur die Symptomatik bei Manie, sondern auch bei Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) als ein derartiges Vigilanzautostabilisierungssyndrom zu interpretieren ist. Der therapeutische Effekt von Psychostimulanzien, der bei ADHS gut belegt und wiederholt kasuistisch als „paradoxer“ Effekt auch bei manischen Patienten beschrieben ist, erklärt sich über deren vigilanzstabilisierende Wirkung. Das vorgestellte Konzept eröffnet neue Ansätze für die Manietherapie.

Summary

In situations with low external stimulation, manic patients often present rapid declines in vigilance, with microsleeps occurring even in the 1st min of EEG recordings (lability of vigilance regulation). We postulate that manic symptoms creating a high level of external stimulation serve to stabilize vigilance. Theoretical arguments and empirical results are presented, showing that both mania and ADHD should be interpreted as vigilance autostabilization syndromes. The therapeutic effects of psychostimulants can be explained by their vigilance-stabilizing properties. They are well proven for ADHD and have repeatedly been shown to have a paradoxical effect in manic patients. The proposed concept opens new approaches for the treatment of acute mania.

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Der korrespondierende Autor weist auf folgende Beziehungen hin: Sponsoring durch die Firmen Cephalon GmbH, Novartis Pharma GmbH sowie durch Wyeth Pharma GmbH, Sanofi-Aventis Deutschland GmbH, Lilly Deutschland GmbH, Astra-Zeneca GmbH und Lundbeck GmbH.

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  1. Klinik und Poliklinik für Psychiatrie, Universitätsklinikum Leipzig, AöR, Semmelweißstraße 10, 04107, Leipzig, Deutschland

    U. Hegerl, S. Olbrich, P. Schönknecht & C. Sander

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  1. U. Hegerl
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  3. P. Schönknecht
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Hegerl, U., Olbrich, S., Schönknecht, P. et al. Ist manisches Verhalten ein autoregulatorischer Versuch zur Vigilanzstabilisierung?. Nervenarzt 79, 1283–1290 (2008). https://doi.org/10.1007/s00115-008-2553-8

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