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Behandlung bipolarer Störungen

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Polypharmazie in der Behandlung psychischer Erkrankungen

Zusammenfassung

Die meisten Therapieempfehlungen und Guidelines, vor allem wenn sie den Anspruch der Evidenzbasierung haben, schlagen bei bipolaren Störungen, ähnlich wie bei unipolaren Depressionen oder Schizophrenien, die Monotherapie als Therapie der Wahl vor. Dies gilt vor allem für die Manie- und die Langzeitbehandlung und ist in erster Linie darin begründet, dass bis vor kurzem fast ausschließlich Monotherapiestudien zur arzneimittelrechtlichen Zulassung in kontrollierter und aussagekräftiger Form durchgeführt wurden. Erst durch die Änderung der einschlägigen Vorschriften der Zulassungsbehörden verfügen wir nun auch über eine wachsende Anzahl von Kombinationstherapiestudien. Dabei hinkt die wissenschaftliche Evidenz aber deutlich dem klinischen Alltag hinterher; weniger als 10% akut manischer Patienten werden in Monotherapie behandelt und auch in der Langzeitbehandlung steigt beständig die Anzahl der Patienten mit Polypharmazie. Dieses Kapitel soll klinische Praxis und wissenschaftliche Evidenz hinsichtlich der Wirksamkeit von Kombinationstherapien in Akut- und Langzeitbehandlung bipolarer Störungen zusammenführen und, nicht zuletzt auch unter Berücksichtigung des Nebenwirkungsspektrums von Kombinationstherapien, praxisrelevante Empfehlungen aussprechen.

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Authors and Affiliations

  1. Christian Doppler Klinik, Unversitätsklinik für Psychiatrie und Psychotherapie der PMU, Ignaz Harrer Strasse 79, 5020, Salzburg, Österreich

    Prof. Dr. Heinz Grunze

  2. CMHT East, NTW NHS Foundation Trust, Molineux Street, NE6 1SG, Newcastle upon Tyne, United Kingdom

    Dr. med. Anna Grunze

  3. Psychiatrische Universitätsklinik, Ludwig-Maximilians-Universität, Nussbaumstrasse 7, 80336, München, Deutschland

    Dr. med. Christoph Born

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  1. Prof. Dr. Heinz Grunze
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  2. Dr. med. Anna Grunze
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  3. Dr. med. Christoph Born
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Correspondence to Heinz Grunze .

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  1. Danuvius Klinik Pfaffenhofen, Pfaffenhofen, Germany

    Thomas Messer

  2. und Psychosomatik, Bezirkskrankenhaus Augsburg Klinik für Psychiatrie, Psychotherapie,, Augsburg, Germany

    Max Schmauß

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Grunze, H., Grunze, A., Born, C. (2016). Behandlung bipolarer Störungen. In: Messer, T., Schmauß, M. (eds) Polypharmazie in der Behandlung psychischer Erkrankungen. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1849-8_3

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