Aripiprazole: Effectiveness and safety under naturalistic conditions.

Abstract

A retrospective study was conducted to examine aripiprazole's effectiveness and safety in a naturalistic treatment setting in both inpatients and outpatients affected by schizophrenia and other psychotic disorders. All patients with schizophrenia, schizoaffective and delusional disorders, and schizoid and schizotypal personality disorders treated with aripiprazole from March 1, 2005, to March 1, 2006, in the authors' community mental health service were divided into outpatient (n=26) and inpatient (n=17) groups; the average treatment periods were 204 days and 25 days, respectively. Effectiveness was evaluated by improvement of symptoms (a 25% reduction of Brief Psychiatric Rating Scale [BPRS] score from baseline) and functioning level (a 50% increase of Global Assessment of Functioning [GAF] scale score from baseline), as well as dropout rate. Adverse effects and their impact on treatment course were also evaluated. The final scores of the 2 scales showed a statistically significant difference from baseline (BPRS: p<.001 in the 2 groups; GAF: p<.005 in inpatients, p<.001 in outpatients). The average improvements in BPRS and GAF were 54% and 35%, respectively, in outpatients and 71% and 71% in inpatients. Side effects included anxiety, psychomotor agitation, insomnia, and psychotic symptom worsening. The dropout rate was 24% in inpatients and 23% in outpatients, largely because of the aforementioned side effects. The data, though limited by the small sample and naturalistic methodology, suggest that aripiprazole may be effective for both long- and short-term treatment, with a greater improvement among inpatients and a similar dropout rate between groups.

Diagnosis and treatment of schizotypal personality disorder: evidence from a systematic review

“…Most of the studies were prospective double-blind, placebo-controlled trials, 46 – 56 and all publications reported single-center results. We also identified one double-blind, treatment-controlled trial; 57 one single-blind, placebo-controlled trial; 58 four open-label trials; 59 – 62 one retrospective study; 63 and four case reports. 64 – 67 Please see Table 2A, B and Supplementary Table 3 and 4 for further study details and level of evidence (LoE) grading.…”

“…In total, 16 individual drug treatments were studied. The most frequently studied drug was risperidone, 50 , 53 , 54 , 62 and the most frequently studied class of drugs were the antipsychotics, 47 , 48 , 50 , 53 , 54 , 57 – 60 , 62 , 63 , 66 followed by the antidepressants. 46 , 61 , 64 , 65 Six studies tested other neuroactive drugs.…”

Chronic Treatment With Aripiprazole Prevents Development of Dopamine Supersensitivity and Potentially Supersensitivity Psychosis

“…The results of the present study suggest that chronic ARI administration may reduce the risk of supersensitivity psychosis, which might be related to a lower rate of rehospitalization. Although a transient worsening of psychosis can appear in certain supersensitized patients due to relatively excessive agonistic effects,32 ARI may be a helpful agent for patients with treatment-resistant schizophrenia by reducing excessive sensitivity to dopamine.…”

The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm

“…As an adverse event it is not reported in the dataset and on the contrary, aripiprazole is a recommended evidence based treatment against agitation associated with schizophrenia or bipolar mania (Sanford and Scott, 2008; Gonzalez et al, 2013; Citrome et al, 2016). However, it has been reported under naturalistic conditions (Di Lorenzo et al, 2007) and especially in vulnerable populations such as elderly patients (Coley et al, 2009). Agitation has also been described when initiating aripiprazole in patients after prolonged treatment with potent D2 blocking agents that may result in an upregulation of postsynaptic dopamine receptors (Lea et al, 2007).…”