Skip to main content
SpringerLink
Log in

Behandlung von Menschen mit geistiger Behinderung

  • Chapter
  • First Online:
Polypharmazie in der Behandlung psychischer Erkrankungen

Zusammenfassung

Menschen mit einer Intelligenzminderung sind nicht nur vulnerabler für das Auftreten koinzidenter somatischer Störungen und Erkrankungen, sondern auch für psychische Störungen sowie impulsive und aggressive Verhaltensauffälligkeiten. Für die Psychopharmakotherapie koinzidenter psychischer Störungen bzw. auch impulsiv aggressiven Verhaltens gelten die gleichen Behandlungskriterien wie für nicht intelligenzgeminderte Personen. Dennoch sollte stets mit einer geringeren Dosis begonnen und in langsameren Schritten die Dosis gesteigert werden (start low, go slow).

Da Menschen mit einer geistigen Behinderung besonders vulnerabel, d.h. generell anfälliger für Nebenwirkungen sind, sollte deren Auftreten systematisch und regelmäßig mit entsprechend validierten Skalen erfasst werden.

Die Vor- und Nachteile einer Polypharmazie müssen sorgfältig gegeneinander abgewogen werden. Zunächst sind die Möglichkeiten einer Monotherapie primär auszuschöpfen, ehe eine Kombinationstherapie in Erwägung gezogen wird. Ein Therapeutisches Drug Monitoring (TDM) sollte bei einer Polypharmazie gewährleistet sein. Auch die epileptogene Potenz eines jeden Psychopharmakons muss berücksichtigt werden.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 89.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Literatur

  • AACAP (1999) Practice Parameters for the Assessment and Treatment for Children, Adolescents, and Adults With Mental Retardation and Comorbid Mental Disorders. J Am Acad Child Adolesc Psychiatry 38 (suppl. 12): 5–31

    Article  Google Scholar 

  • Advokat CD, Mayville EA, Matson JL (2000) Side effect profiles of atypical antipsychotics, typical antipsychotics, or no psychotropic medications in persons with mental retardation. Res Dev Disabil 21: 75–84

    Article  CAS  PubMed  Google Scholar 

  • Airaksinen EM, Matilainen R, Mononen T, Mustonen K, Partanen J, Jokela V (2000) A population-based study on epilepsy in mentally retarded children. Epilepsia 41: 1214–1220

    Article  CAS  PubMed  Google Scholar 

  • Alper K, Schwartz KA, Kolts RL, Khan A (2007) Seizure incidence in psychopharmacological clinical trials: an analysis of FDA summary basis of approval reports. Biol Psychiatry 62: 345–354

    Article  PubMed  Google Scholar 

  • Aman MG (1983) Psychoactive drugs in mental retardation. In: Matson JL, Andrasik F (Hrsg.) Treatment issues and innovations in mental retardation. Plenum Press, New York, S 455–513

    Google Scholar 

  • Aman MG, Singh NN (1988) Patterns of drug use: Methodological considerations, measurement techniques, and future trends. In: Aman MG, Singh NN (Hrsg.) Psychopharmacology of the developmental disabilities. Springer, New York, S 1–28

    Chapter  Google Scholar 

  • Aman MG, Buican B, Arnold LE (2003) Methylphenidate treatment in children with borderline IQ and mental retardation: analysis of three aggregated studies. Journal of Child and Adolescent Psychopharmacology 13: 29–40

    Article  PubMed  Google Scholar 

  • Antshel KM, Phillips MH, Gordon M, Barkley R, Faraone SV (2006) Is ADHD a valid disorder in children with intellectual delays? Clin Psychol Rev 26: 555–572

    Article  PubMed  Google Scholar 

  • Ballinger BR, Ballinger CB, Reid AH, McQueen E (1991) The psychiatric symptoms, diagnoses and care need of 100 mentally handicapped patients. Br J Psychiatry 158: 251–254

    Article  CAS  PubMed  Google Scholar 

  • Bramble D (2007) Psychotropic drug prescribing in child and adolescent learning disability psychiatry. Journal of Psychopharmacology 21: 486–491

    Article  PubMed  Google Scholar 

  • Baumeister AA, Todd ME, Sevin JA (1993) Efficacy and Specifity of Pharmacological Therapies for Behavioral Disorders in Persons with Mental Retardation. Clin Neuropharmacology 16: 271–294

    Article  CAS  Google Scholar 

  • Cooper SA, Smiley E, Morrison J, Williamson A, Allan L (2007) Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. Br J Psychiatry 190: 27–35

    Article  PubMed  Google Scholar 

  • Cosgrove PVF (1996) Risperidone added to methylphenidate in attention deficit hyperactivity disorder. Eur Neuropsychopharmacol 6 (suppl. 3): 11–12

    Article  Google Scholar 

  • Davanzo PA, Belin TR, Widawski MH, King BH (1998) Paroxetine Treatment of Aggression and Self-Injury in Persons With Mental Retardation. Am J Ment Retard 102: 427–437

    Article  CAS  PubMed  Google Scholar 

  • Deb S, Thomas M, Bright C (2001) Mental disorder in adults with intellectual disability. 2: The rate of behaviour disorders among a community-based population aged between 16 and 64 years. J Intellect Disabil Res 45: 506–514

    Article  CAS  PubMed  Google Scholar 

  • Deb S, Unwin GL (2007) Psychotropic medication for behaviour problems in people with intellectual disability: a review of the current literature. Curr Opin Psychiat 20: 461–466

    Article  Google Scholar 

  • Deb S, Kwok H, Bertelli M, Salvador-Carulla L, Bradley E, Torr J, Barnhill J, fort he Guideline Development Group of the WPA Section on Psychiatry of intellectual disability (2009) International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities. World Psychiatry 8: 181–186

    Article  PubMed  PubMed Central  Google Scholar 

  • DSM-5 (2013) dsm 5-intellectual disability-fact-sheet.pdf

    Google Scholar 

  • Emerson E, Einfeld S, Stancliffe RJ (2010) The mental health of young children with intellectual disabilities or borderline intellectual functioning. Soc Psychiat Epidemiol 45: 579–587

    Article  Google Scholar 

  • Engel C, Szrama E, Häßler F (2010) Die psychopharmakologische Therapie von Menschen mit geistiger Behinderung – Ein Vergleich der Jahre 1991 und 2005. Psychiat Prax 37: 391–396

    Article  Google Scholar 

  • Espie CA, Watkins J, Curtice L, Espie A, Duncan R, Ryan JA (2003) Psychopathology in people with epilepsy and intellectual disability; an investigation of potential explanatory variables. J Neurol neurosurg Psychiatry 74: 1485–1492

    CAS  Google Scholar 

  • Gadow KD (1986) Children on Medication. College Hill Press, San Diego

    Google Scholar 

  • Gerhardt N, Häßler F (2011) Psychopharmakaprävalenz bei Menschen mit geistiger Behinderung. Südwestdeutscher Verlag für Hochschulschriften, Saarbrücken

    Google Scholar 

  • Handen BL, Gilchrist R (2006) Practitioner review: psychopharmacology in children and adolescent with mental retardation. Journal of Child Psychology and Psychiatry 47: 871–882

    Article  PubMed  Google Scholar 

  • Härtter S (2004) Moderne Antidepressiva: Pharmakokinetik, Interaktionspoenzial und TDM. Pharm Unserer Zeit 33: 296–303

    Article  PubMed  Google Scholar 

  • Häßler F, Schläfke D (2004) Impulskontrollstörungen und ihre medikamentöse Behandlung bei Sexualstraftätern. Recht & Psychiatrie 22: 213–218

    Google Scholar 

  • Häßler F (2005) Rivastigmin in der Demenz-Therapie bei Menschen mit geistiger Behinderung. Psychopharmakotherapie 13: 205–209

    Google Scholar 

  • Häßler F, Reis O (2010) Pharmacotherapy of disruptive behavior in mentally retarded subjects: A review of the current literature. Develop Disabil Res Rev 16: 265–272

    Article  Google Scholar 

  • Häßler F, Thome J (2012) Intelligenzminderung und ADHS. Z Kinder-Jugendpsychiatr Psychother 40: 83–94

    Article  PubMed  Google Scholar 

  • Hertzman M (2003) Galantamin in the treatment of adult autism: a report of three clinical cases. Intl J Psychiatry in Medicine 33: 395–398

    Google Scholar 

  • Huber B (2004) Epilepsien bei geistiger Behinderung. In: Häßler F, Fegert JM (Hrsg) Geistige Behinderung und seelische Gesundheit. Schattauer, Stuttgart, S 193–251

    Google Scholar 

  • ICD-10 (2000) Internationale Klassifikation psychischer Störungen. Hans Huber, Göttingen

    Google Scholar 

  • ICF (2001) ▶ www.dimdi.de

  • Ipser J, Stein DJ (2007) Systematic review of psychopharmacotherapy of disruptive behavior disorders in children and adolescents. Psychopharmacology 191: 127–140

    Article  CAS  PubMed  Google Scholar 

  • Kalachnik JE, Hanzel TE, Sevenich R, Harder SR (2002) Benzodiazepine behavioural side effects: Review and implications for individuals with mental retardation. Am J Ment Retard 5: 376–410

    Article  Google Scholar 

  • Kerr M, Gil-Nagel A, Glynn M, Mula M, Thompson R, Zuberi SM (2013) treatment of behavioural problems in intellectually disabled adult patients with epilepsy. Epilepsia 54 (suppl. 1): 34–40

    Article  PubMed  Google Scholar 

  • King BH (2002) Psychopharmacology in mental retardation. Curr Opin Psychiatry 15: 497–502

    Article  Google Scholar 

  • De Kuijper G, Hoekstra P, Visser F, Scholte FA, Penning C, Evenhuis H (2010) Use of antipsychotic drugs in individuals with intellectual disability (ID) in the Netherlands: prevalence and reasons for prescription. J Intell Dis Res 54: 659–667

    Article  Google Scholar 

  • Lott IT, McGregor M, Engelman L, Touchette P, Tournay A, Sandman C, Fernandez G, Plon L, Walsh D (2004) Longitudinal prescribing patterns for psychoactive medications in community-based individuals with developmental disabilities: utilization of pharmacy records. J Intellect Disabil Res 48: 563–571

    Article  CAS  PubMed  Google Scholar 

  • Matson JL, Fodstad JC, Rivet TT (2008) The convergent and divergent validity of the Matson Evaluation of Drug Side-effects (MEDS) and the Dyskinesia Identification System: Condensed User Scale (DISCUS). J Intellect Dev Disabil 33: 337–344

    Article  PubMed  Google Scholar 

  • Matson JL, Neal D (2009) Psychotropic medication use for challenging behaviors in persons with intellectual disabilities: An overview. Res Dev Disabil 30: 572–586

    Article  PubMed  Google Scholar 

  • Matson JL, Mahan S (2010) Antipsychotic drug side effects for persons with intellectual disability. Res Dev Disabil 31: 1570–1576

    Article  PubMed  Google Scholar 

  • McKeith IG, Grace JB, Walker Z, Byrne EJ, Wilkinson D, Stevens T, Perry EK (2000) Rivastigmine in the treatment of dementia with Lewy bodies: preliminary findings from an open trail. Int J Geriat Psychiatry 15: 387–392

    Article  CAS  Google Scholar 

  • Müller U, Wolf H, Kiefer M, Gertz HJ (2003) Nationale und internationale Demenz-Leitlinien im Vergleich. Fortschr Neurol Psychiat 71: 285–295

    Article  PubMed  Google Scholar 

  • Paton C, Flynn A, Shingleton-Smith A, McIntyre S, Bhaumik S, Rasmussen J, Hardy S, Barnes T (2011) Nature and quality of antipsychotic prescribing practice in UK psychiatry of intellectual disability services. J Intell Disabil Res 55: 665–674

    Article  CAS  Google Scholar 

  • Pearson DA, Lane DM, Santos CW, Casat CD, Jerger SW, Loveland KA, Faria LP; Mansour R, Henderson JA, Payne CD, Roache JD, Lachar D, Cleveland LA (2004) Effects of Methylphenidate Treatment in Children With Mental Retardation and ADHD: Individual Variation in Medication Response. J Am Acad Child Adolesc Psychiatry 43: 686–698

    Article  PubMed  Google Scholar 

  • Research units on pediatric psychopharmacology autism network (2005) Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Archives of General Psychiatry 62: 1266–1274

    Article  Google Scholar 

  • Roeleveld N, Zielhuis GA, Gabreels F (1997) The prevalence of mental retardation: a critical review of recent literature. Developmental Medicine and Child Neurology 39: 125–139

    Article  CAS  PubMed  Google Scholar 

  • Rosato NS, Correll CU, Pappadopulos E, Chait A, Crystal S, Jensen PS (2012) Treatment of maladaptive aggression in youth: CERT guidelines II. treatment and ongoing management. Pediatrics 129: 1577–1586

    Article  Google Scholar 

  • Rösler M, Retz-Junginger P, Retz W (1998) Alzheimer Demenz und Exelon®. Thieme, Stuttgart

    Google Scholar 

  • Rösler M, Anand R, Cicin-Sain A, Gauthier S, Agid Y, Dal-Bianco P, Szählin HB, Hartman R, Gharabawi M (1999) Efficacy and safety of rivastigmine in patients with Alzheimer’s disease: international randomised controlled trial. BMJ 318: 633–640

    Article  PubMed  PubMed Central  Google Scholar 

  • Santosh PJ, Baird G (1999) Psychopharmacotherapy in children and adults with intellectual disability. Lancet 354: 233–242

    Article  CAS  PubMed  Google Scholar 

  • Scheifes A, Stolker JJ, Egberts ACG, Nijman HLI, Heerdink ER (2011) Representation of people with intellectual disabilities in randomised controlled trials on antipsychotic treatment for behavioural problems. J Intell Disabil Res 55: 650–664

    Article  CAS  Google Scholar 

  • Simonoff E, Pickles A, Wood N, Gringras P, Chadwick O (2007) ADHD symptoms in children with mild intellectual disability. J Am Acad Child Adolesc Psychiatry 46: 591–600

    Article  PubMed  Google Scholar 

  • Singh NN, Ellis CR, Wechsler HBA (1997) Psychopharmacoepidemiology of mental retardation: 1966 to 1995. J Child Adolesc Psychopharmacol 4: 255–266

    Article  Google Scholar 

  • Spreat S, Conroy JW, Fullerton A (2004) Statewide Longitudinal Survey of Psychotropic Medication Use for Persons With Mental Retardation: 1994 to 2000. Am J Ment Retard 109: 322–331

    Article  PubMed  Google Scholar 

  • Steinhausen HC, Häßler F, Sarimski K (2013) Psychische Störungen und Verhaltensprobleme. In: Neuhäuser G, Steinhausen HC, Häßler F, Sarimski K (Hrsg.) Geistige Behinderung, Kohlhammer, Stuttgart S 141–171

    Google Scholar 

  • Stigler KA, Desmond LA, Posey DJ, Wiegand RE, McDougle CJ (2004) A naturalistic retrospective analysis of psychostimulants in pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology 14: 49–56

    Article  PubMed  Google Scholar 

  • Stolker JJ, Koedoot PJ, Heerdink ER, Leufkens HGM, Nolen WA (2002) Psychotropic drug use in intellectually disabled group-home residents with behavioural problems. Pharmacopsychiatry 35: 19–23

    Article  CAS  PubMed  Google Scholar 

  • Tiedtke K, Haury S, Eichhorn C, Nordbeck R, Fegert JM, Häßler F (2002) Einsatz einer kombinierten Psychopharmakotherapie mit Risperidon und Methylphenidat bei Kindern, die eine expansive Verhaltensstörung und eine leichte Intelligenzminderung aufweisen. In: Lehmkuhl U (Hrsg.) Seelische Krankheit im Kindes- und Jugendalter – Wege zur Heilung. Vandenhoeck & Ruprecht, Göttingen, S 130–131

    Google Scholar 

  • Verhoeven WMA, Veendrik-Meekens, Jacobs GAJ, van den Berg YWMM, Tuinier S (2001) Citalopram in mentally retarded patients with depression: a long-term clinical investigation. Eur Psychiatry 16: 104–108

    Google Scholar 

  • Wachtel LE, Hagopian LP (2006) Psychopharmacology and applied behavioural analysis: tandem treatment of severe problem behaviors in intellectual disability and a case series. Isr J Psychiatry Relat Sci 43: 265–274

    PubMed  Google Scholar 

  • Wriedt E, Wiberg A, Sakar V, Noterdaeme M (2010) Psychiatrische Störungen und neurologische Komorbiditäten bei Kindern und Jugendlichen mit Intelligenzminderung. Z Kinder- und Jugendpsychiatr Psychother 38: 201–209

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie Kindes- und Jugendalter Universitätsmedizin Rostock, Gelsheimerstraße 20, 18147, Rostock, Deutschland

    Frank Häßler

Authors
  1. Frank Häßler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frank Häßler .

Editor information

Editors and Affiliations

  1. Danuvius Klinik Pfaffenhofen, Pfaffenhofen, Germany

    Thomas Messer

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

    Max Schmauß

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer-Verlag Wien

About this chapter

Cite this chapter

Häßler, F. (2016). Behandlung von Menschen mit geistiger Behinderung. In: Messer, T., Schmauß, M. (eds) Polypharmazie in der Behandlung psychischer Erkrankungen. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1849-8_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-1849-8_4

  • Published:

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-1848-1

  • Online ISBN: 978-3-7091-1849-8

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation