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Behandlung kognitiver Defizite bei Schizophrenie

Teil II: Pharmakologische Strategien

Treatment of cognitive deficits in schizophrenia

Part 2: Pharmacological strategies

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Zusammenfassung

Kognitive Defizite bilden eine klinisch relevante und für den Verlauf entscheidende Symptomgruppe der Schizophrenie. Die pharmakologische Behandlung der kognitiven Defizite stellt eine Herausforderung dar. Ziel dieses Artikels ist es, eine theoretisch fundierte und klinisch bedeutungsvolle Übersicht über die pharmakologischen Strategien der Behandlung kognitiver Defizite bei schizophrenen Psychosen zu geben. Die für die Behandlung schizophrener Psychosen zugelassenen Antipsychotika der 1. Generation sind hinsichtlich ihrer Wirkung auf die Kognition noch kontrovers. Die Antipsychotika der 2. Generation zeigen einen allenfalls geringen positiven Einfluss und sind denen der 1. Generation nicht nachweisbar überlegen. Vielversprechend erscheint der gezielte Einsatz von Präparaten, die kognitive Prozesse spezifisch beeinflussen können, so genannte kognitionsverbessernde Substanzen („cognition-enhancing drugs“).

Summary

Cognitive deficits in schizophrenia are a clinically relevant symptom dimension and one of the best predictors for functional outcome. Pharmacological treatment of cognitive deficits in schizophrenia is still a challenge. The objective of this article is to present a detailed review of the literature on strategies for the pharmacological treatment of cognitive deficits. It is not clear whether first-generation antipsychotics have a genuine positive influence on cognition. There is only sparse evidence for the positive effect of second-generation antipsychotics on cognitive processes. Furthermore it is not evident that second-generation antipsychotics are more beneficial than first-generation antipsychotics in the treatment of cognitive deficits. The add-on use of substances which directly influence cognitive processes, so-called cognition-enhancing drugs is more promising.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Daniela Roesch-Ely erhielt Forschungsmittel, Vortragshonorare und Reisekosten von Eli Lilly. Ute Pfueller erhielt Vortragshonorare und Reisekosten von Eli Lilly. Matthias Weisbrod erhielt Finanzierung von Studien von ESPARMA GmbH, Lilly Deutschland GmbH, Pfizer Pharma GmbH; Sponsoring von Veranstaltungen und Vorträgen: Bristol-Myers Squibb GmbH & Co, Lilly Deutschland GmbH, Pfizer Pharma GmbH, Novartis, ESPARMA GmbH, Janssen-Cilag, Merz Pharmaceuticals GmbH, GlaxoSmithKline GmbH & Co, AstraZeneca GmbH. Ulrich Müller erhielt Forschungsmittel, Berater- und/oder Vertragshonorare und Reisekosten von Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Pharmacia-Upjohn und UCB Pharma. Christoph Mundt: von Servier und AstraZeneca zur Mitorganisation von Symposien eingeladen.

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  1. Klinik für allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Voss-Straße 4, 69115, Heidelberg, Deutschland

    D. Roesch-Ely, U. Pfueller, C. Mundt & M. Weisbrod

  2. Klinik für Psychiatrie und Psychotherapie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Deutschland

    U. Pfueller & M. Weisbrod

  3. Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK

    U. Müller

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  1. D. Roesch-Ely
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  4. U. Müller
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Roesch-Ely, D., Pfueller, U., Mundt, C. et al. Behandlung kognitiver Defizite bei Schizophrenie. Nervenarzt 81, 564–576 (2010). https://doi.org/10.1007/s00115-009-2919-6

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