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Fortschr Neurol Psychiatr 2010; 78(5): 279-287
DOI: 10.1055/s-0029-1245307
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© Georg Thieme Verlag KG Stuttgart · New York

Therapie psychischer Störungen bei Morbus Parkinson

Treatment of Mental Disorders in Patients with Parkinson’s DiseaseU. Meincke1, 2 , C. M. Kosinski3
  • 1Klinik für Psychiatrie und Psychotherapie Klinikum Niederberg, Lehrkrankenhaus der Universität Duisburg-Essen
  • 2Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum der RWTH Aachen
  • 3Klinik für Neurologie, Medizinisches Zentrum Kreis Aachen gGmbH, Lehrkrankenhaus der RWTH Aachen
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Publication Date:
26 April 2010 (online)

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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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