Zusammenfassung
Patienten mit Morbus Parkinson haben ein hohes Risiko für die Entwicklung psychischer
Störungen, wie insbesondere depressive oder psychotische Syndrome, Demenz oder Schlafstörungen.
Obwohl diese psychischen Erkrankungen häufig dem Beginn der motorischen Symptomatik
vorausgehen, bleiben sie nicht selten unerkannt und somit unbehandelt. Die vorliegende
Arbeit gibt einen umfassenden Überblick über therapeutische Optionen psychopathologischer
Syndrome bei Morbus Parkinson. Bei depressiven Syndromen ist die dopaminerge Medikation
zu optimieren, insbesondere durch Gabe von Dopamin-Agonisten. In aktuellen Studien
zeigten trizyklische Antidepressiva stärkere antidepressive Effekte als SSRI. Psychotische
Symptome treten meist unter Gabe von dopaminergen Substanzen auf oder im Rahmen eines
demenziellen Abbaus. Bei der Einstellung sollte L-Dopa in möglichst niedriger Dosis
eingesetzt werden, gegebenenfalls in Kombination mit COMT-Inhibitoren. Falls eine
antipsychotische Therapie angezeigt ist, ist Clozapin Mittel der ersten Wahl. Aber
auch die Gabe von Quetiapin kann hilfreich sein. Psychotische Symptome bei dementen
Patienten sprechen häufig auf Cholinesterasehemmer an, die gleichzeitig den kognitiven
Abbau verzögern können. Patienten mit Morbus Parkinson benötigen eine individuell
ausgerichtete Therapie nicht nur für die motorische Symptomatik, sondern auch für
die häufig auftretenden psychischen Syndrome. Diese beeinflussen maßgeblich die Lebensqualität
des Patienten und seiner Angehörigen, sind prädiktiv für Hospitalisation und haben
daher eine große ökonomische Bedeutung für Gesundheitssysteme.
Abstract
Patients with Parkinson’s disease (PD) have a high risk of psychiatric complications,
like depressive or psychotic syndromes, dementia and sleep disorders. Although these
disorders may even precede the onset of motor symptoms, they are often not recognized
and therefore not adequately treated. This article provides a comprehensive overview
of the therapeutic options of the most commonly observed psychopathological syndromes
in PD. In the case of depressive syndromes medication could be optimized by making
use of dopamine agonists that have been proven to have antidepressant properties.
In recent studies tricyclic antidepressants showed stronger effects than SSRI. Psychotic
symptoms are most often evoked by dopaminergic therapy or are seen in the course of
cognitive decline. The therapeutic regimen should be built mainly on L-Dopa medication
in the lowest tolerated dose, if required in combinations with COMT-Inhibitors. When
antipsychotic medication is indicated, clozapine is the first choice. Quetiapine might
also be useful in many patients. Psychotic symptoms in demented patients may respond
to Cholinesterase-Inhibitors, that also delay cognitive decline. Patients with PD
require an individually optimized therapeutic regimen not only for motor symptoms,
but also for frequently occurring psychiatric syndromes since these strongly influence
the patients’ and their caregivers’ quality of life, are predictors for hospitalization
and therefore have great economic importance for health care systems.
Schlüsselwörter
Demenz - Depression - Morbus Parkinson - Psychose
Keywords
dementia - depression - Parkinson’s disease - psychosis
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Dr. Ulrich Meincke
Psychiatrie und Psychotherapie Klinikum Niederberg
Robert-Koch-Str. 2
42549 Velbert
Email: Meincke@Klinikum-Niederberg.de
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