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Psychopharmakotherapie bei älteren Menschen mit schweren psychischen Erkrankungen

Psychiatric pharmacotherapy of older individuals with severe mental illness

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Zusammenfassung

Hintergrund

Chronische Schizophrenie, Depression, bipolare Störungen und andere chronische psychische Erkrankungen mit Beginn in Jugend oder jungem Erwachsenenalter werden oft als „severe mental illness“ (SMI) bezeichnet. Altwerden mit einer SMI ist vergesellschaftet mit verschiedenen psychosozialen, physiologischen und medizinischen Besonderheiten mit potenziellem Einfluss auf die Psychopharmakotherapie (PPT).

Fragestellung

Definition und Diskussion spezieller Probleme der PPT altgewordener Menschen mit SMI und Empfehlungen für die einzelnen Diagnosen.

Material und Methode

Internationale Literatur- und Leitliniensuche sowie Auswertung der Fachliteratur und Expertenempfehlungen.

Ergebnisse

Zu den allgemeinen Problemen mit Einfluss auf die PPT von altgewordenen Menschen mit SMI zählen Non-Adhärenz, Therapieresistenz, Polypharmazie, pharmakokinetische Veränderungen im Alter sowie körperliche Begleiterkrankungen. Psychopharmaka (PP) können kardiovaskuläre, metabolische, neuropsychiatrische und andere Risiken haben. Kontrollierte Studien zur Wirksamkeit von PP, Wirkstoffgruppen oder -kombinationen sind kaum existent.

Schlussfolgerungen

Die PPT von altgewordenen Menschen mit SMI sollte immer Teil eines Gesamtbehandlungsplans mit sozio- und psychotherapeutischen Komponenten sein, der die speziellen Probleme dieser Zielgruppe adressiert. Sie sollte deren vielfältigen Probleme und Risiken berücksichtigen und auf das spezielle Risikoprofil des individuellen Patienten zugeschnitten sein. Aufgrund des weitgehenden Fehlens evidenzbasierter Empfehlungen für die genannte Population müssen Behandlungsstrategien aus Standardleitlinien unter Berücksichtigung physiologischer und medizinischer Veränderungen im Alter angepasst werden.

Abstract

Background

Chronic schizophrenia, depression, and bipolar disorders, among other chronic psychiatric disorders with onset at youth or early adulthood are often referred to as severe mental illness (SMI). Aging with SMI is associated with various psychosocial, physiological, and medical problems with potential impact on psychiatric pharmacotherapy.

Objectives

Determination and discussion of problems and special features of the psychopharmacological treatment of older persons with SMI and presentation of treatment recommendations for the distinct diagnoses.

Materials and methods

International literature and guidelines were searched. In addition, the basic literature and expert opinions are discussed.

Results

General problems that influence the psychiatric pharmacotherapy of older persons with SMI include nonadherence, nonresponse, polypharmacy, and distinct pharmacokinetic changes with aging and somatic comorbidity. Psychotropic drugs may exhibit cardiovascular, metabolic, and neuropsychiatric risks, among others. The literature regarding effectiveness of psychotropic drugs, drug groups, or combination of drugs in older patients with SMI is scarce to nonexistent.

Conclusions

Drug treatment of older persons with SMI should be part of an overall treatment plan that also has to include social and psychotherapeutic components that address the specific problems of this population. Most importantly, psychiatric pharmacotherapy should consider these risks and the treatment should be tailored to a patient’s individual risk profile. Due to a general lack of evidence in this special population, treatment strategies of standard guidelines should be adjusted with special consideration to physiological changes of age.

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Literatur

  1. Ayuso-Gutierrez JL, Del Rio Vega JM (1997) Factors influencing relapse in the long-term course of schizophrenia. Schizophr Res 28:199–206

    Article  CAS  PubMed  Google Scholar 

  2. Brown S, Kim M, Mitchell C et al (2010) Twenty-five year mortality of a community cohort with schizophrenia. Br J Psychiatry 196:116–121

    Article  PubMed  PubMed Central  Google Scholar 

  3. Correll CU, Detraux J, De Lepeleire J et al (2015) Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry 14:119–136

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cummings SM, Kropf NP (2011) Aging with a severe mental illness: challenges and treatments. J Gerontol Soc Work 54:175–188

    Article  PubMed  Google Scholar 

  5. Currie CJ, Peyrot M, Morgan CL et al (2013) The impact of treatment non-compliance on mortality in people with type 1 diabetes. J Diabetes Complicat 27:219–223

    Article  Google Scholar 

  6. De Hert M, Cohen D, Bobes J et al (2011) Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 10:138–151

    Article  PubMed  Google Scholar 

  7. Dolder CR, Lacro JP, Jeste DV (2003) Adherence to antipsychotic and nonpsychiatric medications in middle-aged and older patients with psychotic disorders. Psychosom Med 65:156–162

    Article  PubMed  Google Scholar 

  8. Gladigau EL, Fazio TN, Hannam JP et al (2014) Increased cardiovascular risk in patients with severe mental illness. Int Med J 44:65–69

    Article  CAS  Google Scholar 

  9. Glassman AH, O’connor CM, Califf RM et al (2002) Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 288:701–709

    Article  CAS  PubMed  Google Scholar 

  10. Glassman AH, Roose SP, Bigger JT Jr. (1993) The safety of tricyclic antidepressants in cardiac patients. Risk-benefit reconsidered. JAMA 269:2673–2675

    Article  CAS  PubMed  Google Scholar 

  11. Grunze H, Vieta E, Goodwin GM et al (2013) The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders: update 2012 on the long-term treatment of bipolar disorder. World J Biol Psychiatry 14:154–219

    Article  PubMed  Google Scholar 

  12. Hackam DG, Mrkobrada M (2012) Selective serotonin reuptake inhibitors and brain hemorrhage: a meta-analysis. Neurology 79:1862–1865

    Article  CAS  PubMed  Google Scholar 

  13. Haussmann R, Lewitzka U, Severus E et al (2017) Correct treatment of mood disorders with lithium. Nervenarzt 88:1323–1334

    Article  CAS  PubMed  Google Scholar 

  14. Heald A, Livingston M, Yung A et al (2017) Prescribing in schizophrenia and psychosis: Increasing polypharmacy over time. Hum Psychopharmacol. https://doi.org/10.1002/hup.2579

    Article  PubMed  Google Scholar 

  15. Hiemke C, Bergemann N, Clement HW et al (2018) Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: update 2017. Pharmacopsychiatry 51:9–62

    Article  CAS  PubMed  Google Scholar 

  16. Holt RI, Abdelrahman T, Hirsch M et al (2010) The prevalence of undiagnosed metabolic abnormalities in people with serious mental illness. J Psychopharmacol 24:867–873

    Article  CAS  PubMed  Google Scholar 

  17. Howes OD, Mccutcheon R, Agid O et al (2017) Treatment-resistant schizophrenia: treatment response and resistance in psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology. Am J Psychiatry 174:216–229

    Article  PubMed  Google Scholar 

  18. Iwagami M, Mansfield KE, Hayes JF et al (2018) Severe mental illness and chronic kidney disease: a cross-sectional study in the United Kingdom. Clin Epidemiol 10:421–429

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lange-Asschenfeldt C, Kojda G, Cordes J et al (2013) Epidemiology, symptoms, and treatment characteristics of hyponatremic psychiatric inpatients. J Clin Psychopharmacol 33:799–805

    Article  PubMed  Google Scholar 

  20. Mukku SSR, Sivakumar PT, Varghese M (2018) Clozapine use in geriatric patients—Challenges. Asian J Psychiatr 33:63–67

    Article  PubMed  Google Scholar 

  21. Pan Y, Nicolazzo JA (2018) Impact of aging, Alzheimer’s disease and Parkinson’s disease on the blood-brain barrier transport of therapeutics. Adv Drug Deliv Rev. https://doi.org/10.1016/j.addr.2018.04.009

    Article  PubMed  Google Scholar 

  22. Preskorn SH (2009) Treatment options for the patient who does not respond well to initial antidepressant therapy. J Psychiatr Pract 15:202–210

    Article  PubMed  Google Scholar 

  23. Roshanaei-Moghaddam B, Katon W (2009) Premature mortality from general medical illnesses among persons with bipolar disorder: a review. Psychiatr Serv 60:147–156

    Article  PubMed  Google Scholar 

  24. Sendt KV, Tracy DK, Bhattacharyya S (2015) A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry Res 225:14–30

    Article  PubMed  Google Scholar 

  25. Si T, Zhuo J, Turkoz I et al (2017) Once-monthly injection of paliperidone palmitate in patients with recently diagnosed and chronic schizophrenia: a post-hoc comparison of efficacy and safety. Expert Opin Pharmacother 18:1799–1809

    Article  CAS  PubMed  Google Scholar 

  26. Spellmann I, Reinhard MA, Veverka D et al (2018) QTc prolongation in short-term treatment of schizophrenia patients: effects of different antipsychotics and genetic factors. Eur Arch Psychiatry Clin Neurosci 268:383–390

    Article  PubMed  Google Scholar 

  27. Thompson JV, Clark JM, Legge SE et al (2016) Antipsychotic polypharmacy and augmentation strategies prior to clozapine initiation: a historical cohort study of 310 adults with treatment-resistant schizophrenic disorders. J Psychopharmacol 30:436–443

    Article  CAS  PubMed  Google Scholar 

  28. Uchida H, Mamo DC, Mulsant BH et al (2009) Increased antipsychotic sensitivity in elderly patients: evidence and mechanisms. J Clin Psychiatry 70:397–405

    Article  CAS  PubMed  Google Scholar 

  29. Uher R, Mors O, Rietschel M et al (2011) Early and delayed onset of response to antidepressants in individual trajectories of change during treatment of major depression: a secondary analysis of data from the Genome-Based Therapeutic Drugs for Depression (GENDEP) study. J Clin Psychiatry 72:1478–1484

    Article  PubMed  Google Scholar 

  30. Valenstein M, Copeland LA, Blow FC et al (2002) Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission. Med Care 40:630–639

    Article  PubMed  Google Scholar 

  31. Vancampfort D, Correll CU, Galling B et al (2016) Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta-analysis. World Psychiatry 15:166–174

    Article  PubMed  PubMed Central  Google Scholar 

  32. Zhou X, Ravindran AV, Qin B et al (2015) Comparative efficacy, acceptability, and tolerability of augmentation agents in treatment-resistant depression: systematic review and network meta-analysis. J Clin Psychiatry 76:e487–498

    Article  PubMed  Google Scholar 

  33. Lange-Asschenfeldt C, Benkert O (2017) Psychopharmaka im Alter und bei internistischen Erkrankungen. In: Benkert O, Hippius H (Hrsg) Kompendium der Psychiatrischen Pharmakotherapie, 12. Aufl. Springer, Berlin-Heidelberg-New York

    Google Scholar 

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Authors and Affiliations

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

    Christian Lange-Asschenfeldt

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Correspondence to Christian Lange-Asschenfeldt.

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C. Lange-Asschenfeldt gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Lange-Asschenfeldt, C. Psychopharmakotherapie bei älteren Menschen mit schweren psychischen Erkrankungen. Z Gerontol Geriat 51, 770–778 (2018). https://doi.org/10.1007/s00391-018-1455-z

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  • DOI: https://doi.org/10.1007/s00391-018-1455-z

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