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Chauhan A, Praharaj SK, Munoli RN, Udupa ST, Vaidyanathan S, Manjushree MS. Massive, Sustained Aripiprazole-Associated Weight Gain. Am J Ther 2024; 31:e91-e93. [PMID: 38231586 DOI: 10.1097/mjt.0000000000001539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Anisha Chauhan
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Pilunthanakul T, Ting MQJ, Lee J, Gupta B. The impact of adjunctive aripiprazole on QT interval: A 12-week open label study in patients on olanzapine, clozapine or risperidone. Hum Psychopharmacol 2023; 38:e2863. [PMID: 36810742 DOI: 10.1002/hup.2863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To evaluate the effect of adjunct aripiprazole on QT of patients clinically stabilized on atypical antipsychotics. METHODS The dataset was from an open-label 12-week prospective trial that evaluated adjunctive use of 5 mg/day of aripiprazole on metabolic profile in patients with schizophrenia, or schizoaffective disorder stabilized on olanzapine, clozapine, or risperidone. Bazett-corrected QT (QTc) was manually calculated from ECGs measured at baseline (before aripiprazole) and week 12, by two doctors blind to the diagnosis and atypical antipsychotic. The change in QTc (∆QTc: baseline QTc-week 12 QTc) and the number of participants in normal, borderline, prolonged, and pathological groups after 12 weeks were analyzed. RESULTS Fifty-five participants, mean age of 39.3 (SD 8.2) years, were analyzed. The ∆QTc after 12 weeks was 5.9 ms (p = 0.143) for the whole sample; 16.4 ms (p = 0.762), 3.7 ms (p = 0.480) and 0.5 ms (p = 0.449), for the clozapine, risperidone and olanzapine group, respectively. There was no significant statistical difference comparing the change in QTc overall, and between atypical antipsychotic groups, when evaluating from baseline to endpoint. However, stratifying the sample based on sex-dependent QTc cut-offs showed a 45% decrease in abnormal QTc readings (p = 0.049) after aripiprazole initiation; 20 subjects had abnormal QTc at baseline, while only 11 subjects had abnormal QTc at 12 weeks. 25.5% of participants showed a reduction in at least one QTc severity group, while 65.5% had no change and 9.0% worsened in QTc group, after 12 weeks of adjunct aripiprazole. CONCLUSION Low-dose adjunctive aripiprazole did not prolong QTc in patients stabilized on either olanzapine, risperidone, or clozapine. More controlled studies evaluating the QTc effect of adjunctive aripiprazole should be done to confirm and support these findings.
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Affiliation(s)
- Thanita Pilunthanakul
- Department of Emergency and Crisis Care, Institute of Mental Health, Singapore, Singapore
| | - Mable Quek Jing Ting
- Department of Emergency and Crisis Care, Institute of Mental Health, Singapore, Singapore
| | - Jimmy Lee
- Department of Psychosis and Research Division, Institute of Mental Health, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Bhanu Gupta
- Department of Emergency and Crisis Care, Institute of Mental Health, Singapore, Singapore
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Louveau C, Turtuluci MC, Consoli A, Poitou C, Coupaye M, Krebs MO, Chaumette B, Iftimovici A. Prader-Willi syndrome: Symptoms and topiramate response in light of genetics. Front Neurosci 2023; 17:1126970. [PMID: 36814790 PMCID: PMC9939745 DOI: 10.3389/fnins.2023.1126970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/17/2023] [Indexed: 02/09/2023] Open
Abstract
Introduction Prader-Willi Syndrome (PWS) is a rare genetic condition, which affects one in 25,000 births and results in various phenotypes. It leads to a wide range of metabolic and endocrine disorders including growth delay, hypogonadism, narcolepsy, lack of satiety and compulsive eating, associated with mild to moderate cognitive impairment. Prognosis is especially determined by the complications of obesity (diabetes, cardiorespiratory diseases) and by severe behavioral disorders marked by impulsivity and compulsion. This heterogeneous clinical picture may lead to mis- or delayed diagnosis of comorbidities. Moreover, when diagnosis is made, treatment remains limited, with high interindividual differences in drug response. This may be due to the underlying genetic variability of the syndrome, which can involve several different genetic mutations, notably deletion or uniparental disomy (UPD) in a region of chromosome 15. Here, we propose to determine whether subjects with PWS differ for clinical phenotype and treatment response depending on the underlying genetic anomaly. Methods We retrospectively included all 24 PWS patients who were referred to the Reference Center for Rare Psychiatric Disorders (GHU Paris Psychiatrie and Neurosciences) between November 2018 and July 2022, with either deletion (N = 8) or disomy (N = 16). The following socio-demographic and clinical characteristics were recorded: age, sex, psychiatric and non-psychiatric symptoms, the type of genetic defect, medication and treatment response to topiramate, which was evaluated in terms of eating compulsions and impulsive behaviors. We compared topiramate treatment doses and responses between PWS with deletion and those with disomy. Non-parametric tests were used with random permutations for p-value and bootstrap 95% confidence interval computations. Results First, we found that disomy was associated with a more severe clinical phenotype than deletion. Second, we observed that topiramate was less effective and less tolerated in disomy, compared to deletion. Discussion These results suggest that a pharmacogenomic-based approach may be relevant for the treatment of compulsions in PWS, thus highlighting the importance of personalized medicine for such complex heterogeneous disorders.
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Affiliation(s)
- Cécile Louveau
- Centre de Référence pour les Maladies Rares à expression Psychiatrique, GHU Paris Psychiatrie et Neurosciences, Paris, France,*Correspondence: Cécile Louveau,
| | - Mimi-Caterina Turtuluci
- Centre de Référence pour les Maladies Rares à expression Psychiatrique, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Angèle Consoli
- Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France,GRC-15, Dimensional Approach of Child and Adolescent Psychotic Episodes, Faculté de Médecine, Sorbonne Université, Paris, France
| | - Christine Poitou
- Nutrition Department, Rare Diseases Center of Reference “Prader–Willi Syndrome and Obesity With Eating Disorders” (PRADORT), Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, INSERM, Nutriomics, Sorbonne Université, Paris, France
| | - Muriel Coupaye
- Nutrition Department, Rare Diseases Center of Reference “Prader–Willi Syndrome and Obesity With Eating Disorders” (PRADORT), Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, INSERM, Nutriomics, Sorbonne Université, Paris, France
| | - Marie-Odile Krebs
- Centre de Référence pour les Maladies Rares à expression Psychiatrique, GHU Paris Psychiatrie et Neurosciences, Paris, France,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France
| | - Boris Chaumette
- Centre de Référence pour les Maladies Rares à expression Psychiatrique, GHU Paris Psychiatrie et Neurosciences, Paris, France,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Anton Iftimovici
- Centre de Référence pour les Maladies Rares à expression Psychiatrique, GHU Paris Psychiatrie et Neurosciences, Paris, France,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université Paris Cité, Paris, France,Anton Iftimovici,
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Liu X, Sun X, Li L, Zeng K, Li Y, Gao Y, Ma J. Co-prescription of aripiprazole on prolactin levels in long-term hospitalized chronic schizophrenic patients with co-morbid type 2 diabetes: A retrospective clinical study. Front Psychiatry 2023; 14:1124691. [PMID: 36816406 PMCID: PMC9933920 DOI: 10.3389/fpsyt.2023.1124691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND One of the most frequent side effects of atypical antipsychotics is hyperprolactinemia (HPRL), and metformin or aripiprazole co-prescription is regarded as an effective therapy option for reducing prolactin (PRL) levels. However, whether either of the two drugs can reduce PRL levels in patients with long-term hospitalized chronic schizophrenia with co-morbid type 2 diabetes (T2DM) has not been adequately reported. METHODS In our study, long-term hospitalized chronic schizophrenia patients with co-T2DM who were prescribed olanzapine or risperidone as the primary antipsychotic medication were enrolled. A total of 197 of these cases with co-prescribed aripiprazole were set up as the study group (co-Ari group), and the other 204 cases without co-prescribed aripiprazole were set up as the control group (non-Ari group). The two groups' variations in each target parameter were compared, and the variables affecting PRL levels were examined. RESULTS Compared to the non-Ari group, fasting blood glucose (FBG), blood uric acid (UA), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) levels were significantly higher in the co-Ari group, but there was no difference in PRL levels. Co-prescribing aripiprazole had no impact on PRL levels in all patients with co-T2DM, and aripiprazole dose had no impact on PRL levels in the clinical subgroup of the co-Ari group. CONCLUSION Aripiprazole not only worsened the severity of index disturbances associated to metabolism in long-term hospitalized chronic schizophrenia patients with co-T2DM on metformin-based hypoglycemic medications but also failed to lower PRL levels.
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Affiliation(s)
- Xuebing Liu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Xianzhi Sun
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Lu Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Kuan Zeng
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yi Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yujun Gao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Ma
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Wuhan Hospital for Psychotherapy, Wuhan, China.,Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
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Abstract
Antipsychotic polypharmacy in psychotic disorders is widespread despite international guidelines favoring monotherapy. Previous evidence indicates the utility of low-dose partial dopamine agonist (PDAs) add-ons to mitigate antipsychotic-induced metabolic adverse effects or hyperprolactinemia. However, clinicians are often concerned about using PDAs combined with high-potency, full dopaminergic antagonists (FDAs) due to the risk of psychosis relapse. We, therefore, conducted a literature review to find studies investigating the effects of combined treatment with PDAs (i.e. aripiprazole, cariprazine and brexpiprazole) and FDAs having a strong D 2 receptor binding affinity. Twenty studies examining the combination aripiprazole - high-potency FDAs were included, while no study was available on combinations with cariprazine or brexpiprazole. Studies reporting clinical improvement suggested that this may require a relatively long time (~11 weeks), while studies that found symptom worsening observed this happening in a shorter timeframe (~3 weeks). Patients with longer illness duration who received add-on aripiprazole on ongoing FDA monotherapy may be at greater risk for symptomatologic worsening. Especially in these cases, close clinical monitoring is therefore recommended during the first few weeks of combined treatment. These indications may be beneficial to psychiatrists who consider using this treatment strategy. Well-powered randomized clinical trials are needed to derive more solid clinical recommendations.
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