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Schizophrenie pp 125-137 | Cite as

Dopamin-(D1-/D2-)Antagonisten und serotonerge Einflüsse bei extrapyramidalen Syndromen: Studien an nichthumanen Primaten

  • D. E. Casey

Zusammenfassung

Mit Einführung der Neuroleptika (Antipsychotika) Anfang der 50er Jahre erfuhr die Behandlung akuter und chronischer Psychosen revolutionäre Veränderungen. Die Bezeichnung „neuroleptisch“, die wörtlich „das Neuron (unter Kontrolle) nehmen“ bedeutet, wurde geprägt, um zum Ausdruck zu bringen, daß gleiche oder sehr ähnliche Dosierungen dieser neu entdeckten Substanzen sowohl antipsychotisch wirken als auch extrapyramidalmotorische Symptome (EPS) hervorrufen (Deniker 1984). Diese hypothetische Verbindung zwischen motorischen und psychischen Effekten führte zum Konzept der neuroleptischen Schwelle, wonach das Auftreten von EPS mit der korrekten antipsychotischen Dosierung korreliert. Heute liegt umfassendes Datenmaterial vor, aus dem hervorgeht, daß dieses Konzept der neuroleptischen Schwelle nur teilweise richtig war, denn es gibt Medikamente, die nur eine der beiden Wirkungen ohne die jeweils andere hervorrufen. Es besteht jedoch kein Zweifel daran, daß es gemeinsame Mechanismen gibt, die sowohl motorische Funktionen als auch Denkstörungen steuern. Andererseits ist es ebenfalls sehr wahrscheinlich, daß wenigstens einige klar voneinander getrennte Prozesse existieren, die diese Funktionen kontrollieren. Das Ziel der Entwicklung spezifischer Medikamente besteht darin, diese verschiedenen Mechanismen auszunutzen, um Verbindungen zu erhalten, die mehr erwünschte und weniger unerwünschte Wirkungen zeigen. Solche Entwicklungen sind dringend nötig, denn die zur Zeit verfügbaren Neuroleptika besitzen eine schmale therapeutische Breite, die Nutzen und Risiko voneinander trennt.

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© Springer-Verlag Berlin Heidelberg 1995

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  • D. E. Casey

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