Zusammenfassung
Spätestens seit der klassifikatorischen Erweiterung durch DSM IV und ICD 10 in Richtung
eines bipolaren Spektrums kann man annehmen, dass bipolare Störungen nicht nur klinisch
heterogen sind, sondern auch unterschiedliche Mechanismen der Erkrankung zugrunde
liegen können. Dennoch gibt es einige übergreifende Prinzipien, die bei der Regulierung
der neuronalen Erregbarkeit, aber auch bei der Überlebensfähigkeit der Neurone eine
tragende Rolle spielen. Hier sind zugleich Angriffspunkte der im klinischen Alltag
am häufigsten eingesetzten Stimmungsstabilisierer, wie Lithium, Carbamazepin, Valproat
oder Lamotrigin. Der Wirkmechanismus dieser Substanzen lässt zumindest indirekte Schlüsse
zu, welche Störungen auf zellulärer Ebene den bipolaren Störungen zugrunde liegen
könnten.
Abstract
Not ever since the broadening of diagnosis towards bipolar spectrum disorder with
DSM IV and ICD-10 at the latest, we should assume that bipolar disorders are not only
clinically heterogeneous, but may have a diversity of underlying pathophysiological
disturbances. However, there are some general principles which are of importance both
for the regulation of neuronal excitability and neuronal survival. They may also constitute
the main targets of clinically used mood stabilisers as lithium, carbamazepine, valproate
and lamotrigine. The mechanisms of action of these substances may give us at least
indirect hints for the underlying cellular disturbances in bipolar disorders.
Schlüsselwörter
Bipolare Störungen - Lithium - Valproat - Lamotrigin - Spannungsabhängige Ionenkanäle
- Zytoprotektive Proteine
Key words
Bipolar disorders - Lithium - Valproate - Lamotrigine - Voltage-gated ion channels
- Cytoprotective proteins
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Dr. med. H. Grunze
Psychiatrische Klinik der LMU
Nußbaumstr. 7
80336 München
Email: grunze@psy.med.uni-muenchen.de
