Intramuscular Aripiprazole in the Acute Management of Psychomotor Agitation

Filippis, Sergio De; Cuomo, Ilaria; Lionetto, Luana; Janiri, Delfina; Simmaco, Maurizio; Caloro, Matteo; Persis, Simone De; Piazzi, G; Simonetti, Alessio; Telesforo, Carla Ludovica; Sciarretta, Antonio; Caccia, Federica; Gentile, Giovanna; Kotzalidis, Georgios D.; Girardi, Paolo

doi:10.1002/phar.1260

Cited by 29 publications

(19 citation statements)

References 56 publications

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“…In some published observational studies the levels of agitation are similar to those presented here (23)(24)(25)(26)(27). These studies have demonstrated various degrees of effect of intramuscular psychotropics.…”

Section: Resultssupporting

confidence: 80%

“…In several previous observational studies post-injection assessment has been recorded with frequent intervals, usually after 15, 30, 60, 90, and 120 min (23,25,26). We were not able to obtain such frequent recordings, but aimed to achieve PANSS-EC at least once within the first 2 h following injection.…”

Section: Resultsmentioning

confidence: 95%

“…One study focused on the effect of intramuscular ziprasidone on severe agitation in a naturalistic setting using a different score (Behavioural Activity Rating Scale) and demonstrated effectiveness also in cases of substance abuse (25). Another study found a reduction from 23.3 to 7.27 on PANSS-EC when 201 patients with schizophrenia or bipolar disorder and agitation received intramuscular injections with aripiprazole 9.75 mg (26). In this study, mean response ratedefined as a reduction of at least 40% in PANSS-EC score within 2 h-was 83.6%.…”

Section: Resultsmentioning

confidence: 97%

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Treatment of agitation in the acute psychiatric setting. An observational study of the effectiveness of intramuscular psychotropic medication

Bauer¹,

Stenborg²,

Lodahl³

et al. 2016

Nordic Journal of Psychiatry

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Section: Resultssupporting

confidence: 80%

Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 97%

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Treatment of agitation in the acute psychiatric setting. An observational study of the effectiveness of intramuscular psychotropic medication

Bauer¹,

Stenborg²,

Lodahl³

et al. 2016

Nordic Journal of Psychiatry

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“…After the first month, the patient is discharged and AOM is administered monthly thereafter. In fact, we found repeated administration of 9.75 aripiprazole IM to be effective in treating acute psychomotor agitation in acutely psychotic patients (83); this formulation has shown anti-aggressive effects in psychosis-elicited aggression, although the quality of evidence of the studies considered in this systematic review was quite poor (84).…”

Section: Other Issuesmentioning

confidence: 90%

Aripiprazole Long-Acting Injection During First Episode Schizophrenia—An Exploratory Analysis

Giordano¹,

Tomassini²,

Cuomo

et al. 2020

Front. Psychiatry

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Background: Long-acting injectable (LAI) aripiprazole was found to be efficacious in schizophrenia. In common clinical practice, the use of LAIs is often restricted to chronic patients with frequent relapses and poor adherence. Recently, some investigators advanced the idea of early LAI use also in young people with schizophrenia at their first psychotic episode (FEP). Objective: Our study aimed to assess the effect of LAI aripiprazole once monthly (AOM) in the treatment of FEP in patients aged 18-26 years. Methods: We included 50 patients with DSM-5 schizophrenia as assessed with SCID, and used the Clinical Global Impressions Scale-Severity of Illness (CGI-S) and the Positive and Negative Syndrome Scale (PANSS) to assess symptom severity and the World Health Organization Quality of Life (WHOQOL), the Short Form Health Survey (SF-36) and the Personal and Social Performance Scale (PSP) to assess quality of life (QoL) and global health perception at baseline and 3, 6, 9, and 12 months after the first AOM injection. Results: AOM was associated with a progressive improvement, compared to baseline, of both positive (p < 0.001) and negative (p < 0.001) symptoms and in general psychopathology (p < 0.001) and decrease in global severity (p < 0.001). We also observed progressive improvement in QoL and social and personal functioning. Treatment adherence was 78% at study endpoint. Our results support that AOM may improve psychotic symptoms, QoL and social functioning in young FEP patients. Further studies should compare AOM to its oral formulation in the treatment of young patients with schizophrenia at the outset of their illness.

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“…Because of the strength of evidence for efficacy in alleviating agitation in this population, aripiprazole IM (level 2),125, 126 lorazepam IM (level 2),125, 127 loxapine inhaled (Level 1)128, 129 and olanzapine IM (level 2)127, 130, 131, 132, 133 are recommended as the first‐line option. Sublingual asenapine (level 3),134 haloperidol IM (level 3),131, 135, 136 haloperidol IM + midazolam IM (level 3),131, 137 haloperidol IM + promethazine IM (level 3),131, 137, 138 risperidone ODT (level 3),136 and ziprasidone IM (level 3)131, 137, 139 are recommended as a second‐line treatment.…”

Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Intramuscular Aripiprazole in the Acute Management of Psychomotor Agitation

Cited by 29 publications

References 56 publications

Treatment of agitation in the acute psychiatric setting. An observational study of the effectiveness of intramuscular psychotropic medication

Treatment of agitation in the acute psychiatric setting. An observational study of the effectiveness of intramuscular psychotropic medication

Aripiprazole Long-Acting Injection During First Episode Schizophrenia—An Exploratory Analysis

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

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