Psychiatrie und Psychotherapie up2date 2012; 6(02): 73-84
DOI: 10.1055/s-0031-1277002
Schizophrenien und andere psychotische Störungen

Komorbide somatische Erkrankungen bei Schizophrenie

Kurt-Wolfram Sühs
,
Kai G. Kahl
Kernaussagen

Bei Patienten mit Schizophrenie finden sich häufig komorbide somatische Erkrankungen, die insbesondere die Morbidität und Mortalität bei Diabetes mellitus Typ 2 und Myokardinfarkt betreffen. Viele der zugrunde liegenden kardiovaskulären Risikofaktoren sind einer medikamentösen, verhaltenstherapeutischen oder psychoedukativen Intervention zugänglich.

Einige der kardiovaskulären Risikofaktoren werden durch die antipsychotische medikamentöse Therapie verstärkt. Im Kontext dieser Nebenwirkungen ist jedoch zu beachten, dass bei Patienten ohne eine Therapie das Risiko von Suiziden und Krankenhausaufnahmen sowie die Gesamtmortalität gegenüber behandelten Patienten erhöht ist. Der Verzicht auf eine antipsychotische Behandlung aus Angst vor einem negativen Gesamteffekt auf die Behandlung der Schizophrenie ist damit unberechtigt.

Verschiedene Faktoren, teils durch den Patienten selbst oder von außen bedingt, führen dazu, dass somatische Erkrankungen bei schizophrenen Patienten nicht frühzeitig erkannt oder aber nicht adäquat therapiert werden.

Um die verschiedenen relevanten Risikofaktoren überwachen zu können, sollten standardisierte, möglichst leicht in den klinischen Alltag integrierbare Routinen benutzt werden, Programme zum Ernährungsmanagement, Aufbau sportlicher Aktivitäten sowie Suchtmittelentwöhnung gefördert und die interdisziplinäre Zusammenarbeit ausgebaut werden.



Publication History

Publication Date:
07 February 2012 (online)

© Georg Thieme Verlag KG Stuttgart · New York

 
  • Literatur

  • Wild S, Roglic G, Green A. et al Global prevalence of diabetes: estimates for the year 2000 and projections 2030.. Diabetes Care 2004; 27: 1047-1053
  • Casey DE, Hansen TE. Excessive morbidity and mortality in schizophrenia.. In: Meyer JM, Nasrallah HA. eds Medical illness and schizophrenia.. Washington (DC): American Psychiatric Publishing; 2003: 13-34
  • Newsome CA, Shiell AW, Fall CH. et al Is birth weight related to later glucose and insulin metabolism? A systematic review.. Diabet Med 2003; 20: 339-348
  • Littrell K, Perry R, Hilligoss N. et al Insulin resistance and syndrome X among schizophrenic patients.. Presented at the 156th annual meeting of the American Psychiatric Association. San Francisco, California: 17.05.2003
  • Heiskanen T, Niskanen L, Lyytikäinen R. et al Metabolic syndrome in patients with schizophrenia.. J Clin Psychiatry 2003; 64: 575-579
  • Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey.. J Am Med Assoc 2002; 287: 356-359
  • McCready RG. Scottish Schizophrenia Lifestyle Group. Diet, smoking, and cardiovascular risk in people with schizophrenia: descriptive study.. Br J Psychiatry 2003; 183: 534-539
  • Thakore JH, Mann JN, Vlahos I. et al Increased visceral fat distribution in drug-naïve individuals with and without schizophrenia.. Int J Obes Relat Metab Disord 2002; 26: 137-141
  • Dandona P, Aljada A, Chaudhuri A. et al The potential influence of inflammation and insulin resistance on the pathogenesis and treatment of atherosclerosis-related complications in type 2 diabetes.. J Clin Endocrinol Metab 2003; 88: 2422-2429
  • Wajchenberg LB. Subcutaneus and visceral adipose tissue. Their relation to the metabolic syndrome.. Endocr Rev 2000; 21: 697-738
  • Dixon L, Postrado L, Delahanty J. et al The association of medical comorbidity in schizophrenia with poor physical and mental health.. J Nerv Ment Dis 1999; 187: 496-502
  • Nasrallah HA, Meyer JM. et al Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline.. Schizophr Res 2006; 86: 15-22
  • Sernak MJ, Leslie DL, Alarcon RD. et al Assoziation of diabetes mellitus with use of atypical neuroleptics in the treatment of schizophrenia.. Am J Psychiatry 2002; 159: 561-566
  • Ryan MC, Collins P, Thakore JH. Impaired fasting glucose tolerance in first episode, drug naïve patients with schizophrenia.. Am J Psychatry 2003; 160: 284-289
  • Mukerjee S, Schur DB, Reddy R. Family history of type 2 diabetes in schizophrenic patients.. Lancet 1989; 333: 495
  • Wolford JK, Gruber JD, Ossowski VM. et al A C-reactive protein promoter polymorphism is associated with type 2 diabetes mellitus in Pima Indians.. Mol Genet Metab 2003; 78: 136-144
  • Juvonen H, Reunanen A, Haukka J. et al Incidence of schizophrenia in a nationwide cohort of patients with type 1 diabetes mellitus.. Arch Gen Psychiatry 2007; 64: 894-899
  • Eaton WW, Byrne M, Ewald H. et al Association of schizophrenia and autoimmune diseases: linkage of Danish national registers.. Am J Psychiatry 2006; 163: 521-528
  • Druss BG, Bradford DW, Rosenheck RA. et al Mental disorders and use of cardiovascular procedures after myocardial infarction.. J Am Med Assoc 2000; 283: 506-511
  • Osborn DP, Levy G, Nazareth I. et al Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdoms General Practice Reasearch Database.. Arch Gen Psychiatry 2007; 64: 242-249
  • Cohen M, Dembling B, Schorling J. The association between schizophrenia and cancer: a population-based mortality study.. Schizophr Res 2002; 57: 139-146
  • Oksbjerg Dalton S, Munk Laursen T, Mellemkjaer L. et al Schizophrenia and the risk for breast cancer.. Schizophr Res 2003; 62: 89-92
  • Park JK, Lee HJ, Kim JW. et al Differences in p53 gene polymorphisms between Korean schizophrenia and lung cancer patients.. Schizophr Res 2004; 67: 71-74
  • Dinwiddie SH, Shicker L, Newman T. Prevalence of hepatitis C among psychiatric patients in the public sector.. Am J Psychiatry 2003; 160: 172-174
  • Oken RJ, Schulzer M. At issue: schizophrenia an rheumatoid arthritis: a negative association revisted.. Schizophr Bull 1999; 25: 625-638
  • Eaton W, Mortensen PB, Agerbo E. et al Coeliac disease and schizophrenia: population based case control study with linkage of Danish national registers.. Br Med J 2004; 328: 438-439
  • Cannon M, Jones PB, Murray RM. Obstetric complications and schizophrenia: historical and meta-analytic review.. Am J Psychiatry 2002; 159: 1080-1092
  • Nilsson E, Lichtenstein P, Cnattingius S. et al Women with schizophrenia. Pregnancy outcome and infant death among their offspring.. Schizophr Res 2002; 58: 221-229
  • Diwan A, Castine M, Pomerleau CS. et al Differential prevalence of cigarette smoking in patients with schizophrenic vs mood disorders.. Schizophr Res 1998; 33: 113-118
  • George TP, Vessicchio JC, Termine A. et al A placebo controlled trial of bupropion for smoking cessation in schizophrenia.. Biol Psychiatry 2002; 52: 53-61
  • Regier DA, Farmer ME, Rae DS. et al Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) Study.. J Am Med Assoc 1990; 264: 2511-2518
  • Veen ND, Selten JP, van der Tweel I. et al Cannabis use and age at onset of schizophrenia.. Am J Psychiatry 2004; 161: 501-506
  • Ryan MCM, Shafiri N, Condren R. et al Evidence of basal pituitary-adrenal overactivity in first episode, drug naïve patients with schizophrenia.. Psychoneuroendocrinol 2004; 29: 1065-1070
  • Drexhage RC, Knijff EM, Padmos RC. et al The mononuclear phagozyte system and its cytokine networks in schizophrenia and bipolar disorder.. Expert Review of Neurotherapeutics 2010; 10: 59-76
  • Potvin S, Stip E, Sepehry AA. et al Inflammatory cytokine alterations in schizophrenia: a systematic quantitative review.. Biological Psychiatry 2008; 63: 801-808
  • Gianfrancesco FD, Grogg AL, Mahmoud RA. et al Differential effects of risperidone, olanzapine and conventional antipsychotics on type 2 diabetes: findings from a large health plane database.. J Clin Psychiatry 2002; 63: 920-930
  • Leslie DL, Rosenheck RA. Incidence of newly diagnosed diabetes attributable to atypical antipsychotic medication.. Am J Psychiatry 2004; 161: 1709-1711
  • Lieberman JA, Stroup TS, McEvoy JP. et al Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.. N Engl J Med 2005; 353: 1209-1223
  • Leucht S, Corves C, Arbter D. et al Second generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis.. Lancet 2009; 373: 31-41
  • Leslie DL, Rosenheck RA. Incidence of newly diagnosed diabetes attributable to antipsychotic medication.. Am J Psychiatry 2004; 161: 1709-1711
  • Seol IW, Kuo NY, Kim KM. Effects of dopaminergic drugs on mast cell degranulation and nitric oxide generation in RAW 264.7 cells.. Arch Pharm Res 2004; 27: 94-98
  • Tandon R. Safety and tolerability: how do newer generation „atypical“ antipsychotics compare?. Psychiatr Q 2002; 73: 297-311
  • De Hert M, Schreurs V, Sweers K. et al Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: a retrospective chart review.. Schizophr Res 2008; 101: 295-303
  • Ryan MCM, Flanagan S, Kinsella U. et al The effects of antipsychotics on visceral fat distribution in first episode, drug naïve patients with schizophrenia.. Life Sci 2004; 74: 1999-2008
  • Tiihonen J, Wahlbeck K, Lönnqvist J. et al Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study.. Br Med J 2006; 333: 224
  • Xia J, Merinder LB, Belgamwar MR. Psychoeducation for schizophrenia.. Cochrane Database Syst Rev 2011; 15: 1-155
  • Fleischhacker WW, Cetkovich-Bakmas M, De Hert M. et al Comorbid somatic illnesses in patients with severe mental disorders: clinical, policy and research challenges.. J Clin Psychiatry 2008; 69: 514-519
  • Cordes J, Thünker J, Regenbrecht G. et al Can an early weight management program (WMP) prevent olanzapine (OLZ)-induced disturbances in body weight, blood glucose and lipid metabolism? Twenty-four and 48-week results from a 6 month randomized trial.. World J Biol Psychiatry 2011; Epub ahead of print. 0
  • Osterheider M, Franken-Hiep K, Horn R. Gesamtkrankenkosten der Schizophrenie und monetäre Bewertung einer Rezidivprophylaxe am Beispiel eines Standard-Depot-Neuroleptikums (Flupenthixol decanoate).. Psychiat Prax 1998; 25: 38-43
  • Miettunen J, Lauronen E, Veijola J. et al Socio-demographic and clinical predictors of occupational status in schizophrenic psychoses-follow-up within Northern Finland 1966 Birth Cohort.. Psychiatry Res 2007; 150: 217-225
  • De Hert M, Dekker JM, Wood D. et al Eine Konsensuserklärung der European Psychiatric Association zu kardiovaskulären Erkrankungen und Diabetes bei Patienten mit einer schweren psychischen Erkrankung.. Psychopharmakother 2010; 17: 3-13