Comparative study of treatment continuation using second-generation antipsychotics in patients with schizophrenia or schizoaffective disorder

Azekawa, Takaharu; Ohashi, Shizuko; Itami, Akira

doi:10.2147/ndt.s26672

Cited by 10 publications

(12 citation statements)

References 16 publications

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“…However, the evidence that aripiprazole is more efficacious than other antipsychotics is lacking [ 79 ]. In a comparative study looking at treatment continuation of various atypical antipsychotics, aripiprazole seemed to have lower rates of relapse; however, the study design was a large observational study, which carries a lower level of evidence and provides less convincing support [ 80 ]. In a meta-analysis of comparative trials, the overall effectiveness of aripiprazole in treating psychotic symptoms was no different than olanzapine, with similar discontinuation rates compared to all groups, although the quality of data analyzed was viewed as generally poor as many studies lacked detailed methods of randomization and blinding [ 81 ].…”

Section: Role Of Antipsychotics In Prevention Of Dspmentioning

confidence: 99%

Antipsychotic Induced Dopamine Supersensitivity Psychosis: A Comprehensive Review

Yin¹,

Barr²,

Ramos-Miguel³

et al. 2017

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Chronic prescription of antipsychotics seems to lose its therapeutic benefits in the prevention of recurring psychotic symptoms. In many instances, the occurrence of relapse from initial remission is followed by an increase in dose of the prescribed antipsychotic. The current understanding of why this occurs is still in its infancy, but a controversial idea that has regained attention recently is the notion of iatrogenic dopamine supersensitivity. Studies on cell cultures and animal models have shown that long-term antipsychotic use is linked to both an upregulation of dopamine D2-receptors in the striatum and the emergence of enhanced receptor affinity to endogenous dopamine. These findings have been hypothesized to contribute to the phenomenon known as dopamine supersensitivity psychosis (DSP), which has been clinically typified as the foundation of rebound psychosis, drug tolerance, and tardive dyskinesia. The focus of this review is the update of evidence behind the classification of antipsychotic induced DSP and an investigation of its relationship to treatment resistance. Since antipsychotics are the foundation of illness management, a greater understanding of DSP and its prevention may greatly affect patient outcomes.

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Section: Role Of Antipsychotics In Prevention Of Dspmentioning

confidence: 99%

Antipsychotic Induced Dopamine Supersensitivity Psychosis: A Comprehensive Review

Yin¹,

Barr²,

Ramos-Miguel³

et al. 2017

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“…It was reported that patients with schizophrenia treated with aripiprazole (ARI), a DRD2 partial agonist (DPA), have lower rates of relapse of psychosis and treatment discontinuation compared to those treated with other antipsychotics, including several new atypical antipsychotics ( Azekawa et al., 2011 ; Gorwood, 2006 ). We demonstrated in an animal model that a chronic administration of ARI did not induce a DRD2 up-regulation or behavioral supersensitivity, whereas equivalent doses of haloperidol, a full DRD2 antagonist, induced a prominent DRD2 up-regulation and behavioral supersensitivity ( Tadokoro et al., 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Dopamine supersensitivity psychosis and dopamine partial agonist: A retrospective survey of failure of switching to aripiprazole in schizophrenia

et al. 2015

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The administration of aripiprazole (ARI), a dopamine partial agonist, could provoke abrupt psychotic worsening in patients with schizophrenia. We explored the relationship between this psychotic worsening and dopamine supersensitivity psychosis (DSP), which is a clinically vulnerable state. We conducted a retrospective investigation for 264 patients whose treatment medication was switched to ARI from other antipsychotics. We divided the patients into the DSP(+) group with a history of DSP episode(s) (N = 70) and the DSP(–) group without such a history (N = 194), and then compared the clinical factors relevant to the success or failure of the switch to ARI between them. The results revealed that patients in the DSP(+) group experienced psychotic worsening following the switch to ARI with a significant higher rate compared to the DSP(–) group (23% vs. 8%, P < 0.01). Moreover, the dosages of the drugs before the ARI introduction in the patients experiencing the psychotic worsening in the DSP (-) group were higher than those in other patients of the group. Our findings suggest that patients who receive high dosages of antipsychotic drugs form overt or covert DSP and such state is highly associated with psychotic worsening following ARI treatment.

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“…The relatively fewer metabolic side effects might be one of the reasons explaining the recent finding by Azekawa et al of a significantly longer time to discontinuation of treatment compared with olanzapine, risperidone, and blonanserin in patients with schizophrenia and schizoaffective disorder 45. This is of great relevance because nonadherence and early discontinuation of treatment can be in a causal relationship with supposed treatment resistance.…”

Section: Rationale For Aripiprazole In Treatment-resistant Schizophreniamentioning

confidence: 98%

Role of aripiprazole in treatment-resistant schizophrenia

Mossaheb¹

2012

NDT

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About one third of patients with schizophrenia respond unsatisfactorily to antipsychotic treatment and are termed “treatment-resistant”. Clozapine is still the gold standard in these cases. However, 40%–70% of patients do not improve sufficiently on clozapine either. In the search for more efficacious strategies for treatment-resistant schizophrenia, drugs with different pharmacological profiles seem to raise new hopes, but are they valid? The aim of this review was to evaluate the evidence for aripiprazole as a potential strategy in monotherapy or combination therapy for patients with treatment-resistant schizophrenia. The evidence for aripiprazole monotherapy and for the combination of aripiprazole with psychotropics other than clozapine is scant, and no recommendation can be made on the basis of the currently available data. More effort has been made in describing combinations of aripiprazole and clozapine. Most of the open-label and case studies as well as case reports have shown positive effects of this combination on overall psychopathology and to some extent on negative symptoms. Several reports describe the possibility of dose reduction for clozapine in combination with aripiprazole, a strategy that might help so-called “treatment-intolerant” patients. The findings of four randomized controlled trials with respect to changes in psychopathology seem less conclusive. The most commonly found beneficial effects are better metabolic outcomes and indicators of the possibility of reducing the clozapine dose. However, other side effects, such as akathisia, are repeatedly reported. Further, none of the studies report longer-term outcomes. In the absence of alternatives, polypharmacy is a common strategy in clinical practice. Combining aripiprazole with clozapine in clozapine-resistant or clozapine-intolerant patients seems to be worthy of further investigation from the pharmacological and clinical points of view.

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Comparative study of treatment continuation using second-generation antipsychotics in patients with schizophrenia or schizoaffective disorder

Cited by 10 publications

References 16 publications

Antipsychotic Induced Dopamine Supersensitivity Psychosis: A Comprehensive Review

Antipsychotic Induced Dopamine Supersensitivity Psychosis: A Comprehensive Review

Dopamine supersensitivity psychosis and dopamine partial agonist: A retrospective survey of failure of switching to aripiprazole in schizophrenia

Role of aripiprazole in treatment-resistant schizophrenia

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