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Übersichtsarbeit

Atypische Neuroleptika in der kinder- und jugendpsychiatrischen Behandlung - Indikationen außerhalb der Schizophrenie mit Anwendungshinweisen

Published Online:September 01, 2006https://doi.org/10.1024/1422-4917.33.3.159

Abstract

Zusammenfassung:Fragestellung: Wegen ihres besonderen Rezeptorbindungsprofils beeinflussen atypische Neuroleptika neben Produktiv- auch Minussymptome günstig. Insbesondere die Affinität zum serotonergen System legt eine Wirksamkeit auch bei zwanghaften, ängstlichen oder depressiven Symptomen nahe. Im Weiteren soll der aktuelle Stand der klinischen Erfahrungen sowie die derzeitige Studienlage zu atypischen Neuroleptika und deren Einsatz bei verschiedenen Indikationen außerhalb der Schizophrenie in der Kinder- und Jugendpsychiatrie referiert werden. Methodik: Die bisherige Studienlage wurde für die Jahre 1988 bis 2004 mittels PubMed und CurrentContents ermittelt. Ergebnisse: Anwendungsbereiche für atypische Neuroleptika sind neben Erkrankungen aus dem schizophrenen Formenkreis Ticstörungen, manische und bipolare Störungen, Impulskontrollstörungen, (Auto-)Aggressivität sowie Anorexia nervosa. Problematisch sind die lückenhafte Studienlage für das Kindes- und Jugendalter mit Fehlen von Placebo-kontrollierten Doppelblindstudien bzw. offenen Studien an größeren Populationen sowie die Off-label-Anwendung. Schlussfolgerungen: Atypische Neuroleptika sind aufgrund ihrer relativ guten Verträglichkeit Teil des Therapiestandards in der Kinder- und Jugendpsychiatrie geworden. Sie erweisen sich als wirksam bei Schizophrenien, Tics, Manien und bipolaren affektiven Störungen, Impulsivität, (Auto-)Aggressivität sowie therapieresistenten Essstörungen.


Atypical antipsychotics in child and adolescent psychiatry - indications apart from schizophrenia

Summary:Objectives: Given their special receptor profile, atypical antipsychotics are effective in the treatment of both positive and negative symptoms. Especially the serotonergic affinity suggests their potential utility for the treatment of depressive, anxious, and obsessive-compulsive symptoms as well. Reviewed here are the clinical experience with, studies of, and published reports on the use of atypical antipsychotics in the treatment of different psychiatric disorders other than schizophrenia in children and adolescents. Methods: The literature from 1998-2004 was reviewed by means of PubMed and CurrentContents. Results: In addition to schizophrenic symptoms, the therapeutic indications for atypical antipsychotics include tic disorders, bipolar affective disorders and mania, impulsiveness and disruptive behaviour, (auto-)aggression, and severe anorexia nervosa. Empirical data such as those from placebo-controlled double-blind or open-label studies in larger child and adolescent populations are rare. Substances are used mostly off-label. Conclusions: Atypical antipsychotics today comprise part of the standard psychopharmacotherapy in child and adolescent psychiatry. They have proved to be effective in the treatment of schizophrenia, tic disorders, impulsiveness, (auto-)aggression, and eating disorders.

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