Optimierung der antipsychotischen Therapie mit Olanzapin durch Augmentationsstrategien

 

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Zusammenfassung

Anliegen: Wegen Therapieresistenz werden Antipsychotika oft in Kombination eingesetzt. Ein Überblick über Olanzapinaugmentationen wird unternommen. Methode: Recherche in medizinischen Datenbanken (Medline und BIOSIS). Ergebnisse: Unter 9 verschiedenen Antipsychotikaaugmentationen (16 Publ., 85 Pat.) wurde nur Sulpirid randomisiert getestet, andere psychotrope Substanzen wurden zumeist in prospektiven, oft plazebo-kontrollierten Studien untersucht (9 Strategien, 10 Publ., 837 Pat.). Schlussfolgerungen: Die empirische Basis für Kombinationen mit Antipsychotika ist ungenügend, der positive Effekt bei Valproataugmentation auf feindseliges Verhalten erscheint bemerkenswert.

Abstract

Objective: Up to 40 % of patients with schizophrenic psychosis suffer from symptoms that are resistant to monotherapy with antipsychotic drugs. As a consequence, combined approaches are often used, especially based on clozapine and olanzapine. This review aims to provide a critical overview on olanzapine-augmentations. Methods: A systematic database search including generic and trade names of antipsychotic substances as well as general items such as „augmentation” and „combination” was performed in Medline and BIOSIS (OVID) until May 2005. Results: Amongst a number of 16 reports dealing with 9 different antipsychotic augmentation strategies (85 patients) only sulpiride was tested in a randomized manner. A significant part of the treatments achieved favourable results. In contrast, augmentations of olanzapine with antidepressants or mood stabilizers were evaluated in well-designed clinical trials (9 strategies, 10 publications, 837 patients). Improvements of positive and/or negative symptoms as well as depressed mood were reported. Conclusions: The empirical basis to combine olanzapine with antipsychotic substances has to be improved in order to evaluate benefits and risks. Augmentations with mood stabilizers were successful, for example on hostility, showing that randomized and placebo-controlled trials are feasible.

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Dr. med. Mathias Zink

Zentralinstitut für Seelische Gesundheit · Klinik für Psychiatrie und Psychotherapie

Postfach 12 21 20

68072 Mannheim

Email: mathias.zink@zi-mannheim.de