Gewichtszunahme während der Behandlung mit Antipsychotika: Klinische Relevanz, Pathophysiologie und therapeutische Möglichkeiten

 

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Zusammenfassung

Patienten, die unter antipsychotischer Therapie an Körpergewicht zunehmen, haben ein erhöhtes Risiko für die Entwicklung der Adipositas und der mit ihr assoziierten Krankheiten. Pathophysiologisch tragen zu diesen Gewichtsveränderungen die psychiatrische Grunderkrankung selbst, Veränderungen in den Neurotransmittersystemen und in den Zytokin- und Hormonsystemen bei. Die Therapie der antipsychotikainduzierten Gewichtszunahme umfasst diätetische, verhaltenstherapeutische und pharmakologische Maßnahmen. Mögliche, aber noch nicht in größeren Studien geprüfte pharmakotherapeutische Add-on-Strategien könnten Behandlungsversuche mit Ephedrin, Sibutramin, Orlistat, Topiramat, Nizatidin, Naltrexon, Metformin, Amantadin oder Reboxetin darstellen.

Abstract

The clinical relevance of drug-induced weight changes is due to the development of obesity, increased rates of morbidity and reduced treatment compliance, even if the psychopharmacological treatment is effective. Possible underlying causes of weight gain in patients treated with antipsychotic drugs are the psychiatric disorder itself, and changes in the neurotransmitter, cytokine and hormone systems. Clinical management of psychopharmacologically induced weight gain includes diet, behavioral and pharmacological therapy. Possible add-on strategies - based on case reports and small studies - are ephedrine, sibutramine, orlistat, topiramate, nizatidine, naltrexone, metformin, amantadine, and reboxetine.

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Prof. Dr. med. Thomas Pollmächer

Zentrum für psychische Gesundheit · Klinikum Ingolstadt

Krumenauerstraße 25

85049 Ingolstadt

Email: thomas.pollmaecher@klinikum-ingolstadt.de