Problem Gambling Associated with Aripiprazole: A Nested Case-Control Study in a First-Episode Psychosis Program

Corbeil, Olivier; Corbeil, Stéphanie; Dorval, Michel; Carmichael, Pierre‐Hugues; Giroux, Isabelle; Jacques, Christian; Demers, Marie-France; Roy, Marc‐André

doi:10.1007/s40263-021-00801-4

Cited by 15 publications

(50 citation statements)

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“…The primary outcome is the occurrence of a DSM-5 diagnosis of gambling disorder established by the treating psychiatrist. The secondary outcome is the occurrence of PBG, as defined by a score greater than or equal to 8 on the Problem Gambling Severity Index (PGSI) [ 3 ], a reliable and validated screening instrument in general population samples which has also been used in previous studies conducted in patients with psychotic disorders [ 5 , 7 , 8 ]. As previously stated, these outcomes are assessed by the case managers and treating psychiatrists using a screening procedure for PBG that has been developed in collaboration with experts on gambling from the Centre Québécois d’Excellence pour la Prévention et le Traitement du Jeu .…”

Section: Methodsmentioning

confidence: 99%

“…In order to detect a hazard ratio greater than 4 between the use of aripiprazole and the primary outcome with a statistical power of 90% and a bilateral significance level of 5%, 25 events are needed through the follow-up period. The hazard ratio of 4 is considered conservative considering that an odds ratio of 8.6 was observed in our previous nested case-control study [ 8 ]. The expected sample size of 800 patients is considered sufficient to observe at least 25 cases of gambling disorder (primary outcome) over the follow-up period given the 3-year prevalence of PBG of 6.4% previously revealed in a similar population [ 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…There is also evidence to suggest that the prevalence of PBG may be up to 4 times higher in people with psychotic disorders compared to the general population [ 5 – 7 ]. This proportion seems to be even greater among young people with first-episode psychosis (FEP), as suggested by the only study to date examining PBG among this population [ 8 ]. In this study, the prevalence of PBG of 6.4% among 219 patients was found to be 16 times higher than the 0.4% found in the general population [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, among the 14 FEP patients who developed PBG, 12 cases occurred during aripiprazole treatment, resulting in an adjusted odds ratio of 8.6 ( p -value = 0.012). However, the retrospective design of this study, preventing the assessment of a potential causal link, and the limited existing literature do not allow firm conclusions to be drawn about this possible association [ 8 ]. Furthermore, there was no systematic screening for PBG at the study site at that time, which may have led to detection and monitoring bias.…”

Section: Introductionmentioning

confidence: 99%

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Problem gambling among people with first-episode psychosis: protocol for a prospective multicenter cohort study

et al. 2023

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Background The limited available data suggest that the prevalence of problem gambling is increased among young adults with first-episode psychosis, possibly due in part to several risk factors for problem gambling that are common in this population. Aripiprazole, a widely used antipsychotic drug, has also been linked to cases of problem gambling, but causality remains uncertain. Although the consequences of problem gambling further hinder the recovery of people with first-episode psychosis, there is a paucity of research about this comorbidity and its risk factors. Additionally, to our knowledge, no screening instrument for problem gambling tailored to these individuals exists, contributing to its under-recognition. Further, treatment approaches for problem gambling adapted to this population are at an embryonic stage, while existing treatments effectiveness remains to be documented. Using an innovative screening and assessment procedure for problem gambling, this study aims to identify risk factors for problem gambling among people with first-episode psychosis and to document the effectiveness of standard treatment approaches. Methods This is a multicenter prospective cohort study conducted in two first-episode psychosis clinics, including all patients admitted between November 1st, 2019, and November 1st, 2023, followed for up to 3 years until May 1st, 2024. These 2 clinics admit approximately 200 patients annually, for an expected sample size of 800 individuals. The primary outcome is the occurrence of a DSM-5 diagnosis of gambling disorder. All patients are screened and evaluated for problem gambling using a systematic procedure at admission, and every 6 months thereafter. Socio-demographic and clinical variables are prospectively extracted from the patients’ medical records. The nature and effectiveness of treatments for problem gambling offered to affected individuals are also documented from medical records. Survival analyses with Cox regression models will be used to identify potential risk factors for problem gambling. Descriptive statistics will document the effectiveness of treatments for problem gambling in this population. Discussion A better understanding of potential risk factors for problem gambling among people with first-episode psychosis will allow for better prevention and detection of this neglected comorbidity. Results of this study will also hopefully raise clinicians’ and researchers’ awareness and serve as the basis to adapted treatments that will better support recovery. Trial registration ClinicalTrials.gov, NCT05686772. Retrospectively registered, 9 January 2023.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Problem gambling among people with first-episode psychosis: protocol for a prospective multicenter cohort study

et al. 2023

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“…With respect to QTc prolongation, epidemiological studies have linked aripiprazole to weak/moderate tosardogenicity ( Polcwiartek et al, 2015 ). Further, recent evidence points to an association between D 2 partial agonists and the development of impulse control disorders ( Corbeil et al, 2021 ; Grall-Bronnec et al, 2016 ). Therefore, as is the case for all antipsychotic medications, the decision to prescribe aripiprazole should take into consideration the potential harms associated with this medication and ongoing clinical review is essential.…”

Section: Efficacy and Tolerability Of Aripiprazole As Monotherapymentioning

confidence: 99%

High dose antipsychotic polypharmacy and dopamine partial agonists - time to rethink guidelines?

Reynolds

2021

J Psychopharmacol

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Guidelines for the treatment of schizophrenia limit the use of antipsychotic agents to clinically-established maximum doses. This acknowledges both the absence of additional efficacy of dopamine D2 receptor antagonists above a receptor occupancy threshold, and the increases in side effects that can occur at higher doses. These limits restrict the dosing of combinations of antipsychotics as they do single agents; drugs sharing the major antipsychotic mechanism of D2 receptor antagonism will act additively in blocking these receptors. Several newer antipsychotic drugs, including aripiprazole and cariprazine, act as partial agonists at the D2 receptor site and avoid action at several other receptors, effects at which are responsible for some non-dopaminergic adverse effects. This pharmacology imparts different characteristics to the drugs resulting often in a more favourable side effect profile. Their partial agonism, along with high affinities for the D2 receptor, also means that these drugs given adjunctively may in part replace, rather than enhance, the D2 antagonism of other antipsychotic agents. This can result in an improvement in certain side effects without loss of antipsychotic efficacy. This article makes the case for distinguishing the D2 partial agonists from antagonists in defining maximum doses of combined treatments, which would increase the options available to the prescriber, emphasising that pharmacological mechanisms need to be understood in identifying optimal treatments for psychotic illness.

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Aripiprazole and its adverse effects in the form of impulsive-compulsive behaviors: A systematic review of case reports

Akbari,

Jamshidi,

Sheikhi

et al. 2024

Psychopharmacology

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Problem Gambling Associated with Aripiprazole: A Nested Case-Control Study in a First-Episode Psychosis Program

Cited by 15 publications

References 29 publications

Problem gambling among people with first-episode psychosis: protocol for a prospective multicenter cohort study

Problem gambling among people with first-episode psychosis: protocol for a prospective multicenter cohort study

High dose antipsychotic polypharmacy and dopamine partial agonists - time to rethink guidelines?

Aripiprazole and its adverse effects in the form of impulsive-compulsive behaviors: A systematic review of case reports

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