Aripiprazole is a new generation antipsychotic drug with a partial agonist effect on dopamine D2 and D3 receptors. We report the case of a schizophrenic patient whose symptoms worsened after adding aripiprazole to another antipsychotic drug (amisulpiride). The physiopathology of this process seems to be mediated through the dopaminergic effect of aripiprazole in hypodopaminergic environments, caused by the administration of antipsychotic drugs such as amisulpiride. Besides this, the chronic administration of neuroleptic drugs may induce a hypersensitivity to dopamine agonists. In this context, we consider that the dopaminergic effect of aripiprazole may have induced a worsening of psychotic symptoms. We conclude that clinicians should be cautious when adding aripiprazole to patients under treatment with dopamine antagonists with a high affinity for D2 and D3 receptors.

BackgroundIn the last two decades, there has been a significant increase in the diagnosis of Bipolar Disorder (BD) in children. The notion of prepubertal onsets of BD is not without controversy, with researchers debating whether paediatric cases have a distinct symptom profile or follow a different illness trajectory from other forms of BD. The latter issue is difficult to address without long-term prospective follow-up studies. However, in the interim, it is useful to consider the phenomenology observed in groups of cases with different ages of onset and particularly to compare manic symptoms in children diagnosed with BD compared to cases presenting with BD in adolescence and adulthood. This review systematically explores the phenomenology of manic or hypomanic episodes in groups defined by age at onset of BD (children, adolescents and adults; or combined age groups e.g. children and adolescents versus adults).MethodsLiterature reviews of PubMed and Scopus were conducted to identify publications which directly compared the frequency or severity of manic symptoms in individuals with BD presenting with a first episode of mania in childhood, adolescence or adulthood.ResultsOf 304 studies identified, 55 texts warranted detailed review, but only nine studies met eligibility criteria for inclusion. Comparison of manic symptoms across age groups suggested that irritability is a key feature of BD with an onset in childhood, activity is the most prominent in adolescent-onset BD and pressure of speech is more characteristic of adult-onset BD. However, none of the eligible studies made a direct comparison of phenomenology in children versus adults. Assessment procedures varied in quality and undermined the reliability of cross-study comparisons. Other limitations were: the scarcity of comparative studies, the geographic bias (most studies originated in the USA), the failure to fully consider the impact of psychiatric comorbidities on recorded symptoms and methodological heterogeneity.ConclusionsDespite frequent discussion of similarities and differences in phenomenology of mania presenting in different age groups, systematic research is lacking and studies are still required to reliably establish whether the frequency and severity of manic symptoms varies. Such information has implications for clinical practice and the classification of mental disorders.

No abstract

In this article we argue that mental disorders have come to be defined according to a descriptive theory of meaning. In other words, mental disorders are defined according to superficial descriptive criteria that count as necessary and sufficient criteria for the inclusion of a particular instance under its corresponding class. These descriptive criteria are allegedly theory independent, leading to the assumption that psychiatric symptoms are directly identified in an object-like fashion. Against this view, we hold that a descriptive theory of meaning is unable to offer a proper account of the meaning of mental disorders both due to its own internal limitations and to the specific nature of psychiatric phenomena. Due to the hermeneutic structure of psychiatric practice, we argue that the identification and description of mental symptoms and disorders unavoidably depends on (frequently unacknowledged) theoretical assumptions. Since there is no global consensus regarding these theoretical commitments, and due to the fact that these significantly affect the final picture we hold with respect to each mental disorder, we believe that these commitments should be explicitly stated both in diagnostic argumentation and in theoretical discussions in order to maximise self- and mutual understanding.