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Ji M, Feng J, Liu G. Efficacy and safety of aripiprazole or bupropion augmentation and switching in patients with treatment-resistant depression or major depressive disorder: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2024; 19:e0299020. [PMID: 38669232 PMCID: PMC11051639 DOI: 10.1371/journal.pone.0299020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/03/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES To report the first and largest systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy and safety of aripiprazole or bupropion augmentation and switching in patients with treatment-resistant depression (TRD) or major depressive disorder(MDD). METHODS We conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until April 2023 for RCT, which evaluated the efficacy and safety of aripiprazole or bupropion augmentation and switching for patients with TRD or MDD. Outcomes measured were changes in the Montgomery-Asberg Depression Rating Scale (MADRS), response and remission rate, and serious adverse events. RESULTS Five RCTs, including 4480 patients, were included for meta-analysis. Among them, two RCTs were rated as "high risk" in three aspects (allocation concealment, blinding of participants and personnel and blinding of outcome assessment) because of the non-blind method, and the quality evaluation of the remaining works of literature was "low risk". Augmentation treatment with Aripiprazole (A-ARI) was associated with a significant higher response rate compared with augmentation treatment with bupropion (A-BUP) (RR: 1.15; 95% CI: 1.05, 1.25; P = 0.0007; I2 = 23%). Besides, A-ARI had a significant higher remission rate compared with switching to bupropion (S-BUP) (RR: 1.22; 95% CI: 1.00, 1.49; P = 0.05; I2 = 59%) and A-BUP had a significant higher remission rate compared with S-BUP (RR: 1.20; 95% CI: 1.06, 1.36; P = 0.0004; I2 = 0%). In addition, there was no significant difference in remission rate(RR: 1.05; 95% CI: 0.94, 1.17; P = 0.42; I2 = 33%), improvement of MADRS(WMD: -2.07; 95% CI: -5.84, 1.70; P = 0.28; I2 = 70%) between A-ARI and A-BUP. No significant difference was observed in adverse events and serious adverse events among the three treatment strategies. CONCLUSIONS A-ARI may be a better comprehensive antidepressant treatment strategy than A-BUP or S-BUP for patients with TRD or MDD. More large-scale, multi-center, double-blind RCTs are needed to further evaluated the efficacy and safety of aripiprazole or bupropion augmentation and switching treatment strategies.
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Affiliation(s)
- Mengjia Ji
- Department of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Junfei Feng
- Department of Traditional Chinese Medicine, Shandong Wendeng Osteopath Hospital, Weihai, Shandong Province, China
| | - Guirong Liu
- Department of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
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Zisook S, Moutier CY, Rush AJ, Johnson GR, Tal I, Chen PJ, Davis LL, Hicks PB, Wilcox J, Planeta B, Lauro KW, Scrymgeour AA, Kasckow J, Mohamed S. Effect of next-step antidepressant treatment on suicidal ideation: findings from the VAST-D trial. Psychol Med 2024; 54:1172-1183. [PMID: 37859623 DOI: 10.1017/s0033291723003008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) contributes to suicide risk. Treating MDD effectively is considered a key suicide prevention intervention. Yet many patients with MDD do not respond to their initial medication and require a 'next-step'. The relationship between next-step treatments and suicidal thoughts and behaviors is uncharted. METHOD The VA Augmentation and Switching Treatments for Depression trial randomized 1522 participants to one of three next-step treatments: Switching to Bupropion, combining with Bupropion, and augmenting with Aripiprazole. In this secondary analysis, features associated with lifetime suicidal ideation (SI) and attempts (SA) at baseline and current SI during treatment were explored. RESULTS Compared to those with SI only, those with lifetime SI + SA were more likely to be female, divorced, or separated, unemployed; and to have experienced more childhood adversity. They had a more severe depressive episode and were more likely to respond to 'next-step' treatment. The prevalence of SI decreased from 46.5% (694/1492) at baseline to 21.1% (315/1492) at end-of-treatment. SI during treatment was associated with baseline SI; low positive mental health, more anxiety, greater severity and longer duration of current MDD episode; being male and White; and treatment with S-BUP or C-BUP as compared to A-ARI. CONCLUSION SI declines for most patients during next-step medication treatments. But about 1 in 5 experienced emergent or worsening SI during treatment, so vigilance for suicide risk through the entire 12-week acute treatment period is necessary. Treatment selection may affect the risk of SI.
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Affiliation(s)
- Sidney Zisook
- University of California San Diego, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | | | - A John Rush
- Duke Medical School, Durham, NC, USA
- Duke-National University of Singapore, Singapore
| | - Gary R Johnson
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilanit Tal
- VA San Diego Healthcare System, San Diego, CA, USA
| | - P J Chen
- Department of Psychiatry, VA Northeast Ohio Healthcare System, and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lori L Davis
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
| | - Paul B Hicks
- Department of Psychiatry, Texas A&M College of Medicine, Temple, TX, USA
| | - James Wilcox
- Department of Veterans Affairs, Phoenix, AZ, USA
| | - Beata Planeta
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Alexandra A Scrymgeour
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
| | - John Kasckow
- University of Pittsburgh Physicians, Pittsburgh, PA, USA
| | - Somaia Mohamed
- Veterans Affairs (VA) New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA
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Tural Hesapcioglu S, Kasak M, Abursu H, Kafali S, Ceylan MF, Akyol M. A systematic review and network meta-analysis on comparative efficacy, acceptability, and safety of treatments in acute bipolar mania in youths. J Affect Disord 2024; 349:438-451. [PMID: 38211745 DOI: 10.1016/j.jad.2024.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND The evidence of treatment options' efficacy on acute bipolar manic episodes is relatively less in youths than adults. We aimed to compare and rank the drug's efficacy, acceptability, tolerability, and safety for acute mania in children and adolescents. METHOD We systematically reviewed the double-blinded, randomized controlled trials (RCTs) comparing drugs or placebo for acute manic episodes of bipolar disorder in children and adolescents using PRISMA guidelines. We searched PubMed/MEDLINE, EMBASE, Web of Science, EBSCO, Scopus, the Cochrane Central Register of Controlled Trials, and https://clinicaltrials.gov from inception until November 20, 2022. Response to treatment was the primary outcome, and random-effects network meta-analyses were conducted (PROSPERO 2022: CRD42022367455). RESULTS Of 10,134 citations, we included 15 RCTs, including 2372 patients (47 % female), 15 psychotropic drugs, and the placebo. Risperidone 0.5-2.5 mg/day, aripiprazole 30 mg/day olanzapine, quetiapine 400 mg/day, quetiapine 600 mg/day, asenapine 5 mg/day, asenapine 10 mg, ziprasidone, and aripiprazole 10 mg were found to be effective (in comparison with placebo) in children and adolescents, respectively (τ2 = 0.0072, I2 = 10.2 %). The tolerability of aripiprazole 30 mg/day was lower than risperidone 0.5-2.5 mg/day and olanzapine. Oxcarbazepine had the highest discontinuation due to the adverse effects risk ratio. LIMITATIONS Efficacy ranking of the treatments could be performed by evaluating relatively few RCT results, and only monotherapies were considered. CONCLUSIONS Efficacy, acceptability, tolerability, and safety are changing with the doses of antipsychotics for children and adolescents with acute bipolar manic episodes. Drug selection and optimum dosage should be carefully adjusted in children and adolescents.
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Affiliation(s)
- Selma Tural Hesapcioglu
- Ankara Yildirim Beyazit University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey.
| | - Meryem Kasak
- Ankara Yildirim Beyazit University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey
| | - Helin Abursu
- Ankara Yildirim Beyazit University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey
| | - Seda Kafali
- Ankara Yildirim Beyazit University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey
| | - Mehmet Fatih Ceylan
- Ankara Yildirim Beyazit University, Faculty of Medicine, Department of Child and Adolescent Psychiatry, Ankara, Turkey
| | - Mesut Akyol
- Ankara Yildirim Beyazit University, Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
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Pinci C, Bianciardi E, Sferra I, Castellani G, Santini R, Siracusano A, Niolu C. Switching from paliperidone palmitate 3-monthly long-acting injection to oral aripiprazole in a pregnant woman with schizophrenia: a case report and short review. Riv Psichiatr 2024; 59:75-79. [PMID: 38651776 DOI: 10.1708/4259.42361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Treatment with long-acting injection (LAI) antipsychotics, such as paliperidone palmitate, has improved the quality of life in terms of symptoms and prevention of relapses in patients with schizophrenia. Although there are plenty of evidences about the efficacy and safety of paliperidone palmitate 3-monthly injection (PP3M) in adults with schizophrenia, literature appears lacking about the use of LAIs during pregnancy. We hereby describe the clinical case of a pregnant woman affected by schizophrenia (DSM-5-TR), taking pharmacological treatment of PP3M. Considering the inadequate evidence regarding the use of PP3M in pregnancy in agreement with the patient, we switched PP3M to an oral therapy with aripiprazole. The switch to oral aripiprazole allowed the patient to improve her sense of autonomy and strengthen the therapeutic relationship. To our knowledge, this is the first case report monitoring an entire pregnancy of a women affected by schizophrenia in treatment with PP3M injection and oral aripiprazole. No obstetrical or fetal complications were reported. As the research in this field is very demanding, it would be precipitous to derive final conclusions from the current case report, but we hope to build a growing number of data that would allow us to make more appropriate and safe therapeutic choices in such a vulnerable phase as the peripartum.
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Affiliation(s)
- Carolina Pinci
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Irene Sferra
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giulia Castellani
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Riccardo Santini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Kishi T, Citrome L, Sakuma K, Iwata N. A comparison of recurrence rates after discontinuation of second-generation antipsychotic long-acting injectable versus corresponding oral antipsychotic in the maintenance treatment of bipolar disorder: A systematic review. Psychiatry Res 2024; 333:115761. [PMID: 38301289 DOI: 10.1016/j.psychres.2024.115761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/03/2024]
Abstract
It has been previously reported that among patients with schizophrenia that long-acting injectable (LAI) antipsychotic formulations can delay time to relapse longer when compared to their oral equivalents when patients discontinue therapy. Unanswered is whether this same pattern would be observed for patients with bipolar disorder receiving maintenance treatment. A systematic review was undertaken to identify relevant studies of LAI antipsychotics in maintenance treatment of bipolar disorder, employing a placebo-controlled randomized withdrawal design, and where equivalent studies using the corresponding oral formulation were also available. We found five studies [one aripiprazole monohydrate once monthly (AOM) study, one oral aripiprazole (OARI) study, two 2 weeks risperidone-LAI (RIS-LAI) studies, and one oral paliperidone (OPAL) study]. Numerically lower recurrence rates at 2, 4, 6, 8, 12, 16, 20, and 26 weeks were observed when AOM was discontinued when compared with discontinuation from OARI. Numerically lower recurrence rates at 2, 4, 6, 8, and 16 weeks were observed when RIS-LAI was discontinued when compared with discontinuation from OPAL. These results can be interpreted as a substantial delay in time to recurrence with a LAI antipsychotics formulation compared to the oral equivalent when medication is discontinued in patients with mania who had been stabilized on LAI antipsychotics or corresponding oral antipsychotics.
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Affiliation(s)
- Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, United States
| | - Kenji Sakuma
- Department of Psychiatry, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
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Bandín-Vilar E, Toja-Camba FJ, Vidal-Millares M, Durán-Maseda MJ, Pou-Álvarez M, Castro-Balado A, Maroñas O, Gil-Rodríguez A, Carracedo Á, Zarra-Ferro I, Soy D, Fernández-Ferreiro A, Mangas-Sanjuan V, Mondelo-García C. Towards precision medicine of long-acting aripiprazole through population pharmacokinetic modelling. Psychiatry Res 2024; 333:115721. [PMID: 38245977 DOI: 10.1016/j.psychres.2024.115721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/02/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
Population pharmacokinetic (popPK) models constitute a valuable tool for characterizing the pharmacokinetic properties of once-monthly long-acting injectable aripiprazole (LAI aripiprazole) and quantifying the sources of variability in drug exposure. Our aim is to develop a popPK model of both aripiprazole and its metabolite dehydro-aripiprazole in patients treated with LAI aripiprazole, and to personalize the dosing regimen of aripiprazole across different sub-groups of patients. This is a prospective study investigating the pharmacokinetics of LAI aripiprazole. A total of 93 patients were included, 21 for model development and 71 for external model evaluation. A one-compartment model with linear absorption and elimination adequately described both aripiprazole and dehydro-aripiprazole concentrations. The weight of the patients has been shown to be the factor that most influences the absorption. However, the metabolizing phenotype for CYP2D6 and the concomitant treatment with strong inhibitors of this cytochrome have been shown to be the covariates that most influence total drug exposure. This is the first popPK model developed for LAI aripiprazole that includes aripiprazole and its main active metabolite, dehydroaripiprazole. It provides a personalized dosage recommendation that maximizes the probability of achieving optimal therapeutic concentrations and minimizes the difficulties associated with trial-and-error therapeutic strategies carried out in clinical practice.
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Affiliation(s)
- Enrique Bandín-Vilar
- Pharmacy Department, University Clinical Hospital Santiago de Compostela (CHUS), Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Spain; Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), Spain
| | - Francisco José Toja-Camba
- Pharmacy Department, University Clinical Hospital Santiago de Compostela (CHUS), Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Spain; Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), Spain
| | - María Vidal-Millares
- Psychiatry Department, University Clinical Hospital of Santiago de Compostela, Spain
| | | | - Marta Pou-Álvarez
- Psychiatry Department, University Clinical Hospital of Santiago de Compostela, Spain
| | - Ana Castro-Balado
- Pharmacy Department, University Clinical Hospital Santiago de Compostela (CHUS), Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Spain; Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), Spain
| | - Olalla Maroñas
- Genomic Medicine Group CIMUS, University of Santiago de Compostela, Santiago de Compostela 15782, Spain; Galician Foundation of Genomic Medicine, Foundation of Health Research Institute of Santiago de Compostela (FIDIS), SERGAS, Santiago de Compostela, Spain; Centre for Biomedical Network Research on Rare Diseases (CIBERER), Carlos III Health Institute, Madrid, Spain; Pharmacogenomics and drug discovery, Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Almudena Gil-Rodríguez
- Genomic Medicine Group CIMUS, University of Santiago de Compostela, Santiago de Compostela 15782, Spain; Pharmacogenomics and drug discovery, Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Ángel Carracedo
- Galician Foundation of Genomic Medicine, Foundation of Health Research Institute of Santiago de Compostela (FIDIS), SERGAS, Santiago de Compostela, Spain; Centre for Biomedical Network Research on Rare Diseases (CIBERER), Carlos III Health Institute, Madrid, Spain; Pharmacogenomics and drug discovery, Health Research Institute of Santiago de Compostela (IDIS), Spain; Genetics group, Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Irene Zarra-Ferro
- Pharmacy Department, University Clinical Hospital Santiago de Compostela (CHUS), Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Dolors Soy
- Pharmacy Department Division of Medicines, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Department of Pharmacology, Toxicology and Chemical Therapeutics, School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Anxo Fernández-Ferreiro
- Pharmacy Department, University Clinical Hospital Santiago de Compostela (CHUS), Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Spain.
| | - Víctor Mangas-Sanjuan
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, University of Valencia, Valencia, Spain; Interuniversity Research Institute for Molecular Recognition and Technological Development, Polytechnic University of Valencia - University of Valencia, Valencia, Spain.
| | - Cristina Mondelo-García
- Pharmacy Department, University Clinical Hospital Santiago de Compostela (CHUS), Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), Spain.
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Hennion V, Scott J, Martinot V, Benizri C, Marie-Claire C, Bellivier F, Etain B. Associations between actigraphy estimates of sleep and circadian rhythmicity and psychotropic medications in bipolar disorders: An exploratory study. J Affect Disord 2024; 348:224-228. [PMID: 38159652 DOI: 10.1016/j.jad.2023.12.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Disturbances in sleep and circadian rhythmicity (CR) are frequent in individuals with bipolar disorders (BD). Very few studies explored the associations between psychotropic medications and these disturbances in euthymic BD. Therefore, we aimed at exploring the associations between several classes of medications (lithium, sedative/non-sedative Atypical Antipsychotics (AAP), anticonvulsants, antidepressants, benzodiazepines) and sleep disturbances and CR dimensions in a sample of euthymic individuals with BD. METHODS We included euthymic adults with BD type 1 or 2 assessed with 21 days of actimetry. We used a Principal Component Analysis (PCA) of sleep and CR estimates to generate dimensions to be studied in association with the current use of psychotropic medications, with adjustments for potential confounding factors. RESULTS We included individuals with BD-1 (n = 116) or BD-2 (n = 37). The PCA led to four dimensions of sleep and CR estimates. Benzodiazepines were associated with better sleep quality (pcorrected = 0.032). Aripiprazole was associated with less robust CR (pcorrected = 0.016), but with earlier peak of activity patterns (pcorrected = 0.020). Sedative AAPs were associated with better sleep quality, which was no longer significant after correction. We found no association between lithium or anticonvulsants and CR. LIMITATIONS The cross-sectional design and the possible non-representativeness of the sample were limitations of our study. CONCLUSIONS In euthymic individuals with BD, benzodiazepines may have a positive effect on sleep quality, while aripiprazole may have mixed effects on CR (less robust but with earlier peak of activity patterns). No association with lithium or anticonvulsants observed. Further studies are warranted to replicate and extend these results.
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Affiliation(s)
- Vincent Hennion
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France; AP-HP Nord, GH Saint-Louis-Lariboisière-Fernand-Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Université Paris Cité, Paris, France.
| | - Jan Scott
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Victoire Martinot
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France; AP-HP Nord, GH Saint-Louis-Lariboisière-Fernand-Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Université Paris Cité, Paris, France
| | - Chloé Benizri
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France; AP-HP Nord, GH Saint-Louis-Lariboisière-Fernand-Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Établissement de SantÉ Mentale de Paris et Ivry-sur-Seine, Groupe MGEN, Paris, France
| | - Cynthia Marie-Claire
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France
| | - Frank Bellivier
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France; AP-HP Nord, GH Saint-Louis-Lariboisière-Fernand-Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Université Paris Cité, Paris, France
| | - Bruno Etain
- Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM U1144, Université de Paris, Paris, France; AP-HP Nord, GH Saint-Louis-Lariboisière-Fernand-Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Université Paris Cité, Paris, France
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Kishi T, Sakuma K, Saito T, Nakagawa A, Kato M, Iwata N. Comparison of brexpiprazole, aripiprazole, and placebo for Japanese major depressive disorder: A systematic review and network meta-analysis. Neuropsychopharmacol Rep 2024; 44:165-175. [PMID: 38219278 PMCID: PMC10932760 DOI: 10.1002/npr2.12414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/16/2024] Open
Abstract
AIM This systematic review and frequentist network meta-analysis used random-effects models is conducted to determine whether there are differences in the efficacy, acceptability, tolerability, and safety profiles of brexpiprazole (BRE) and aripiprazole (ARI) for Japanese with major depressive disorder (MDD) who were inadequately responsive to antidepressants. METHODS Outcome measures were scores on the Montgomery Åsberg Depression Rating Scale (primary), the Clinical Global Impression severity scale, and social functioning scale; the non-response rate; the non-remission rate; all-cause discontinuation; discontinuation due to adverse events (DAE); at least one adverse event (1AE); serious adverse event, akathisia; tremor; weight gain. RESULTS A literature search identified three double-blind, randomized, placebo-controlled trials. These comprised one BRE study (with a 1 mg/day [BRE1] and a 2 mg/day [BRE2]) and two ARI studies (with a 3 mg/day arm and a flexible-dose arm[within the dosage range approved in Japan]) (n = 1736). Both BRE and ARI demonstrated better efficacy than the placebo. BRE but not ARI had a higher DAE than the placebo. ARI but not BRE had a higher 1AE than the placebo. BRE and ARI had a higher risk of akathisia and weight gain than the placebo. There were no significant differences between BRE and ARI for any of the outcomes. Although BRE1 had good efficacy, it carried risk of weight gain. Although BRE2 also had efficacy, it carried risks of DAE, akathisia, and weight gain. However, the risk of akathisia in BRE2 was reduced by an initial dose of 0.5 mg/day rather than 1.0 mg/day. CONCLUSIONS Overall BRE showed similar utility to ARI and a good risk-benefit balance.
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Affiliation(s)
- Taro Kishi
- Department of PsychiatryFujita Health University School of MedicineToyoakeJapan
| | - Kenji Sakuma
- Department of PsychiatryFujita Health University School of MedicineToyoakeJapan
| | - Takeo Saito
- Department of PsychiatryFujita Health University School of MedicineToyoakeJapan
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, School of MedicineSt. Marianna UniversityKawasakiJapan
| | - Masaki Kato
- Department of NeuropsychiatryKansai Medical UniversityOsakaJapan
| | - Nakao Iwata
- Department of PsychiatryFujita Health University School of MedicineToyoakeJapan
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Shamabadi A, Karimi H, Arabzadeh Bahri R, Motavaselian M, Akhondzadeh S. Emerging drugs for the treatment of irritability associated with autism spectrum disorder. Expert Opin Emerg Drugs 2024; 29:45-56. [PMID: 38296815 DOI: 10.1080/14728214.2024.2313650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/30/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Autism spectrum disorder (ASD) is an early-onset disorder with a prevalence of 1% among children and reported disability-adjusted life years of 4.31 million. Irritability is a challenging behavior associated with ASD, for which medication development has lagged. More specifically, pharmacotherapy effectiveness may be limited against high adverse effects (considering side effect profiles and patient medication sensitivity); thus, the possible benefits of pharmacological interventions must be balanced against potential adverse events in each patient. AREAS COVERED After reviewing the neuropathophysiology of ASD-associated irritability, the benefits and tolerability of emerging medications in its treatment based on randomized controlled trials were detailed in light of mechanisms and targets of action. EXPERT OPINION Succeeding risperidone and aripiprazole, monotherapy with memantine may be beneficial. In addition, N-acetylcysteine, galantamine, sulforaphane, celecoxib, palmitoylethanolamide, pentoxifylline, simvastatin, minocycline, amantadine, pregnenolone, prednisolone, riluzole, propentofylline, pioglitazone, and topiramate, all adjunct to risperidone, and clonidine and methylphenidate outperformed placebo. These effects were through glutamatergic, γ-aminobutyric acidergic, inflammatory, oxidative, cholinergic, dopaminergic, and serotonergic systems. All medications were reported to be safe and tolerable. Considering sample size, follow-up, and effect size, further studies are necessary. Along with drug development, repositioning and combining existing drugs supported by the mechanism of action is recommended.
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Affiliation(s)
- Ahmad Shamabadi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanie Karimi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Razman Arabzadeh Bahri
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Samalin L, Boudieu L, Llorca PM. Evaluating the efficacy and safety of the currently available once-every-two months long-acting injectable formulations of aripiprazole for the treatment of schizophrenia or as a maintenance monotherapy for bipolar I disorder in adults. Expert Rev Neurother 2024; 24:291-298. [PMID: 38299536 DOI: 10.1080/14737175.2024.2313550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/30/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION An aripiprazole long-acting injectable (LAI) antipsychotic is now available for gluteal administration every 2 months via two different formulations: aripiprazole lauroxil (AL) and aripiprazole monohydrate (Ari 2MRTU). These longer dosing regimens of aripiprazole LAI offer new potential benefits for patients. AREAS COVERED The authors review the evidence supporting the efficacy and safety of aripiprazole LAIs given every 2 months for the treatment of schizophrenia or bipolar disorder (BD) in adults. The article culminates with the authors' expert perspectives on the subject. EXPERT OPINION AL 1064 mg every 2 months has established efficacy for the treatment of schizophrenia based on pharmacokinetic bridging studies and prospective data for treatment of an acute exacerbation of schizophrenia. In an open-label trial, Ari 2MRTU showed efficacy for the treatment of schizophrenia and BD type I based on pharmacokinetic parameters (comparable to aripiprazole once-monthly 400 mg); it also showed efficacy regarding the secondary endpoints. Multiple doses of AL 1064 mg or Ari 2MRTU 960 mg are generally well tolerated, in line with the safety profile of oral aripiprazole, with the exception of the injection-site reactions. While AL may require a 1-day initiation regimen, Ari 2MRTU 960 covers all the recommended doses of oral aripiprazole (10-20 mg).
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Affiliation(s)
- Ludovic Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Ludivine Boudieu
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Pierre Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
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Citrome L, Yagoda S, Bidollari I, Wang M. Safety and Tolerability of Starting Aripiprazole Lauroxil With Aripiprazole Lauroxil NanoCrystal Dispersion in 1 Day Followed by Aripiprazole Lauroxil Every 2 Months Using Paliperidone Palmitate Monthly as an Active Control in Patients With Schizophrenia: A Post Hoc Analysis of a Randomized Controlled Trial. J Clin Psychiatry 2024; 85:23m15095. [PMID: 38416865 DOI: 10.4088/jcp.23m15095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Background: Aripiprazole lauroxil (AL) 1064 mg every 2 months following initiation using the AL NanoCrystal Dispersion formulation (ALNCD) plus 30-mg oral aripiprazole was efficacious and well tolerated in a 25-week, randomized, double-blind phase 3 trial in adults with acute schizophrenia. This post hoc analysis further characterized the safety of AL 1064 mg administered every 2 months and that of active control paliperidone palmitate (PP) 156 mg monthly based on occurrence, timing, and severity of adverse events (AEs) associated with antipsychotic medications. Methods: This study was conducted between November 2017 and March 2019. AL or PP was initiated during an inpatient stay of ≥ 2 weeks with transition to outpatient treatment thereafter. Rates of AEs of clinical interest, including injection site reactions (ISRs), motor AEs, sedation, hypotension, prolactin level increase, weight gain, and suicidal ideation/behavior, were summarized through weeks 4, 9, and 25 for each treatment. Results: Of 200 patients who received ≥ 1 dose of study treatment, 99 (49.5%) completed the study (AL, 57%; PP, 43%). Mean (SD) baseline Positive and Negative Syndrome Scale total scores were 94.1 (9.04) and 94.6 (8.41) in the AL and PP treatment groups, respectively. AEs were reported by 69/99 (70%) patients administered AL and 72/101 (71%) administered PP; most AEs were mild or moderate in severity. ISRs (AL, 18.2%; PP, 26.7%) occurred primarily on days 1 and 8. All akathisia/restlessness AEs (AL, 10.1%; PP, 11.9%) occurred during the first 4 weeks; <10% of patients (either treatment) experienced hypotension, sedation, or suicidal ideation/behavior events. Weight gain of ≥ 7% from baseline occurred in 9.3% of AL- and 23.8% of PP-treated patients. Median prolactin concentrations changed by -4.60 and -3.55 ng/mL among AL-treated males and females, respectively, and did not exceed 2 times normal levels in any AL-treated patients. In PP-treated patients, changes were 21.20 and 80.40 ng/mL and concentrations exceeded 2 times normal in 38% and 88% of males and females, respectively. Conclusions: No new early- or late-emerging safety concerns were observed through 25 weeks of treatment with AL 1064 mg every 2 months following initiation using ALNCD plus 30-mg oral aripiprazole. Results were consistent with known safety profiles of AL and PP and support the safety of AL 1064 mg every 2 months initiated using ALNCD plus 30-mg oral aripiprazole. Trial Registration: ClinicalTrials.gov identifier: NCT03345979.
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Affiliation(s)
- Leslie Citrome
- New York Medical College, Valhalla, New York
- Corresponding Author: Leslie Citrome, MD, MPH, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595
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Hart XM, Spangemacher M, Uchida H, Gründer G. Update Lessons from Positron Emission Tomography Imaging Part I: A Systematic Critical Review on Therapeutic Plasma Concentrations of Antipsychotics. Ther Drug Monit 2024; 46:16-32. [PMID: 38018857 DOI: 10.1097/ftd.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/06/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Positron emission tomography (PET) and single photon emission tomography (SPECT) of molecular drug targets (neuroreceptors and transporters) provide essential information for therapeutic drug monitoring-guided antipsychotic drug therapy. The optimal therapeutic windows for D 2 antagonists and partial agonists, as well as their proposed target ranges, are discussed based on an up-to-date literature search. METHODS This part I of II presents an overview of molecular neuroimaging studies in humans and primates involving the target engagement of amisulpride, haloperidol, clozapine, aripiprazole, olanzapine, quetiapine, risperidone, cariprazine, and ziprasidone. The systemic review particularly focused on dopamine D 2 -like and 5-HT 2A receptors. Target concentration ranges were estimated based on receptor occupancy ranges that relate to clinical effects or side effects (ie, extrapyramidal side effects). In addition, findings for other relevant receptor systems were included to further enrich the discussion. RESULTS The reported reference ranges for aripiprazole and clozapine align closely with findings from PET studies. Conversely, for haloperidol, risperidone, and olanzapine, the PET studies indicate that a lowering of the previously published upper limits would be necessary to decrease the risk of extrapyramidal side effect. CONCLUSIONS Molecular neuroimaging studies serve as a strong tool for defining target ranges for antipsychotic drug treatment and directing therapeutic drug monitoring.
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Affiliation(s)
- Xenia M Hart
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Moritz Spangemacher
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Central Institute of Mental Health, Department of Psychiatry, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; and
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Gerhard Gründer
- Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Pan S, Li W, Shi L, Li Y, Wang X, Zhou Y, Wu Y, Chen J, Lv M, Li Y, Yang X, Zhu X, Zhang Y, Yu T, Huang J, Yang K, Tan Y. Relationship between C-reactive protein and antipsychotics levels in schizophrenic patients infected with COVID-19. J Psychiatr Res 2024; 170:297-301. [PMID: 38185075 DOI: 10.1016/j.jpsychires.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
In the context of the COVID-19, inflammation emerges as a prominent characteristic. C-reactive protein (CRP) serves as a commonly employed marker for the evaluation of inflammation. This study aimed to examine the correlation between CRP levels and antipsychotic drug concentrations in patients diagnosed with SCZ during the COVID-19 pandemic. A total of 186 SCZ patients were included in this study, which utilized electronic medical records. The collected data encompassed SCZ diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, respiratory symptoms, and treatments. Laboratory assessments involved the measurement of CRP levels and monitoring of blood drug concentrations. The most prevalent symptoms observed in the patient cohort were fever (59.14%), cough (52.15%), fatigue (45.7%), sore throat (46.24%), runny nose (28.49%), and stuffy nose (25.27%). The levels of CRP during the infection period were significantly higher compared to both the prophase and anaphase of infection (all p < 0.001). The serum levels of clozapine, olanzapine, aripiprazole, quetiapine, and risperidone were elevated during the infection period (all p < 0.001). During the anaphase of infection, patients exhibited higher serum levels of clozapine, olanzapine, and risperidone (all p < 0.001) compared to the infection period, but there was no significant change in serum levels of aripiprazole and quetiapine. Multiple regression analysis revealed a statistically significant positive correlation (P < 0.0001) between CRP and clozapine concentration. In light of the COVID-19 pandemic, it is crucial to adjust the dosage based on drug serum concentration to prevent intoxication or adverse drug reactions.
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Affiliation(s)
- Shujuan Pan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China.
| | - Wei Li
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Li Shi
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Yanli Li
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Xiaoyu Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Yangfang Zhou
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Yaxue Wu
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Jingxu Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Menghan Lv
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Yonggang Li
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Xingjie Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Xiaoyu Zhu
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Yong Zhang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Ting Yu
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Junchao Huang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Kebing Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, China.
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Belge JB, Sabbe BGCC. Long-acting second-generation injectable antipsychotics for the maintenance treatment of bipolar disorder: a narrative review. Expert Opin Pharmacother 2024; 25:295-299. [PMID: 38465894 DOI: 10.1080/14656566.2024.2329743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/08/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Non-adherence to medication significantly affects bipolar disorder outcomes. Long-Acting Injectable antipsychotics show promise by ensuring adherence and averting relapses. AREAS COVERED This narrative review sought to evaluate the efficacy of second-generation injectable antipsychotics in bipolar disorder through searches in Embase, MEDLINE, and PsycInfo for randomized controlled trials and mirror-image studies.Risperidone and aripiprazole Long-Acting Injectables demonstrated effectiveness in preventing mood recurrences compared to placebos in adults with bipolar disorder. They showed superiority in preventing mania/hypomania relapses over placebos but did not appear to significantly outperform active oral controls. Notably, active controls seem to be more effective in preventing depression relapses than Long-Acting Injectables. Mirror-Image studies point toward the reduction of hospitalization rates following LAI initiation. EXPERT OPINION The available evidence points thus toward the efficacy of LAIs, especially in managing manic episodes and reducing hospitalizations, The current evidence does not however immediately support prioritizing LAIs over oral medications in bipolar disorder treatment. More high-quality studies, especially comparing LAIs directly with active controls, are crucial to gain a comprehensive understanding of their efficacy. These findings highlight the need for further research to guide clinicians in optimizing treatment strategies for bipolar disorder.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bernard G C C Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Dorozhenok IY, Strukova AV. [Atypical antipsychotics in the treatment of depression in affective disorders and schizophrenia (using the aripiprazole model)]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:36-42. [PMID: 38676675 DOI: 10.17116/jnevro202412404136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
The review discusses aspects of the use of atypical antipsychotics in the treatment of depression in affective disorders and schizophrenia using the model of aripiprazole, a partial agonist of dopamine receptors. According to numerous studies, aripiprazole is the drug of choice for augmentative therapy of major depressive disorder, as well as for relieving and long-term maintenance monotherapy and combination therapy of various affective episodes of bipolar affective disorder and depression in schizophrenia.
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Affiliation(s)
- I Yu Dorozhenok
- Sechenov First Moscow Medical University (Sechenov University), Moscow, Russia
- Mental Health Research Center, Moscow, Russia
| | - A V Strukova
- Sechenov First Moscow Medical University (Sechenov University), Moscow, Russia
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Dul M, Walczewski K. Patient with Asperger's Syndrome, with episodes of fantasizing and rocking of body, treated with aripiprazole - a case report. Psychiatr Pol 2023; 57:1135-1142. [PMID: 38564518 DOI: 10.12740/pp/152316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
In this article, we present the case of an adult patient, whose main problem is episodes of fantasizing and rocking lasting up to 12 hours a day and completely preventing school development. The nature of the disorder in the patient is related to the sinking into fantasies, and not typical obsessions as in OCD. The patient was previously treated with drugs from the SSRI group, neuroleptics (without aripiprazole) and methylphenidate. Only methylphenidate showed some improvement; however, it made the patient feel ‟stiff in thinking". The patient was hospitalized because of a suicide attempt, which, as it later turned out, was self-harm with no intention of killing himself. During hospitalization, a differential diagnosis was performed and the diagnosis of Asperger's syndrome was made, which was accompanied by immersion in the world of one's fantasies and stereotypical behavior. The patient was administered aripiprazole at a dose of 15 mg/d and after three weeks, a significant improvement in health was achieved, including a reduction in the duration of episodes from several hours to several dozen seconds. The drug is well tolerated by the patient. The patient was discharged from the hospital and continues his school education. In the article, we present single case reports in which similar spectacular results were achieved in similar cases. We also describe a possible physiological explanation for this response to this drug.
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Affiliation(s)
- Maciej Dul
- Szpital Kliniczny im. dr Józefa Babińskiego w Krakowie
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Mani V, Alshammeri BS. Aripiprazole Attenuates Cognitive Impairments Induced by Lipopolysaccharide in Rats through the Regulation of Neuronal Inflammation, Oxidative Stress, and Apoptosis. Medicina (Kaunas) 2023; 60:46. [PMID: 38256307 PMCID: PMC10819006 DOI: 10.3390/medicina60010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Aripiprazole (APZ), an atypical antipsychotic, is mainly prescribed for conditions such as schizophrenia and bipolar disorder, while ongoing research indicates promising neuroprotective qualities. APZ's mechanism of action, involving the regulation of neurotransmitter levels, appears to contribute to its potential to shield neural tissues from specific forms of harm and degeneration. Materials and Methods: To investigate its neuroprotective mechanisms, groups of rats were orally administered APZ at 1 or 2 mg/kg once daily for a 30-day period. In addition, neuronal toxicity was induced through intraperitoneal injection of four doses of lipopolysaccharide (LPS) at a concentration of 1 mg/kg. To evaluate cognitive function, particularly, short-term recognition memory, the procedure implemented the novel object recognition (NOR) task. Subsequently, brain tissues were gathered to examine markers linked with neuroinflammation, oxidative stress, and apoptosis. Results: The administration of LPS led to a decline in memory performance during the NOR tasks. Simultaneously, this LPS treatment raised inflammatory markers like cyclooxygenase (COX)-2, tumor necrosis factor (TNF)-α, and nuclear factor kappa B (NF-κB), increased oxidative markers such as malondialdehyde (MDA), and triggered apoptosis markers like Caspase-3 and Bcl2 associated X protein (Bax) within the brain. Furthermore, it decreased levels of antioxidants like reduced glutathione (GSH) and catalase, as well as the anti-apoptotic marker B-cell lymphoma (Bcl)-2 in brain tissue. The use of APZ resulted in enhanced recognition memory performance, as indicated by improved exploration and discrimination abilities of the objects in the NOR task. Moreover, APZ lowered the markers associated with neuronal vulnerability, such as COX-2, NF-κB, MDA, Caspase-3, and Bax. Additionally, it increased the levels of protective markers, including GSH, catalase, and Bcl-2 in LPS-challenged brains. Conclusions: In summary, the findings suggest that APZ exhibits protective properties against neuronal inflammation, oxidative stress, and apoptosis markers in the context of inflammatory-related neurodegeneration. Additional in-depth investigations are needed to further explore potential applications.
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Affiliation(s)
- Vasudevan Mani
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 51452, Saudi Arabia
| | - Bander Shehail Alshammeri
- Pharmacy Department, Maternity and Children Hospital, Qassim Cluster, Ministry of Health, Buraydah 52384, Saudi Arabia;
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Lebel C, Endomba FT, Chabridon G, Chauvet-Gélinier JC. Efficacy and Safety of Loxapine in Acute Agitation: A Systematic Review of Interventional Studies. Prim Care Companion CNS Disord 2023; 25:23r03552. [PMID: 38134395 DOI: 10.4088/pcc.23r03552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
Objective: To assess the efficacy and safety of loxapine in acute agitation. Data Sources: PubMed, Cochrane database, EMBASE, PsycINFO, and ClinicalTrials.gov were searched to identify relevant articles published in English or French from inception to March 15, 2022. The term "Loxap*" was searched in titles and abstracts. Study Selection and Data Extraction: Interventional studies that compared the effectiveness of loxapine to any other intervention (including another administration route or dosage of loxapine, other drugs, and placebo) in acute agitation were included. From the 1,435 articles initially identified, and after the assessment of 73 full texts, 7 articles were selected, encompassing 1,276 participants. Two reviewers independently extracted data of interest using a predefined form. Results: Among included studies, 5 were double-blind, 2 were open-label, and all were randomized. The risk of bias was low for 2 studies, involving 658 participants. Four articles compared loxapine to placebo, and 3 compared it with haloperidol, aripiprazole, and droperidol. Loxapine was found to be more effective and faster regarding acute agitation control. Also, across included studies, loxapine was well-tolerated, with mildly or moderately severe adverse effects. Conclusions: Notwithstanding methodological limitations of the included studies, this systematic review provides reassuring results regarding the use of loxapine in acute agitation. However, further studies with methodological optimizations might be of interest. Prim Care Companion CNS Disord 2023;25(6):23r03552. Author affiliations are listed at the end of this article.
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Affiliation(s)
- Camille Lebel
- Psychiatry Internship Program, University of Burgundy, Dijon, France
- Corresponding Author: Camille Lebel, MD, Psychiatry Internship Program, University of Burgundy, 21000 Dijon, France
| | | | - Guillaume Chabridon
- Service de Psychiatrie Adultes, Centre Hospitalier Universitaire, Dijon, France
| | - Jean-Christophe Chauvet-Gélinier
- Service de Psychiatrie Adultes, Centre Hospitalier Universitaire, Dijon, France
- INSERM, LNC-UMR 1231, University of Burgundy, Dijon, France
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Su W, Zhao D, Zhao H, Zheng W, Zhang W. A 28-Year-Old Man with Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, and Dissociative Identity Disorder Responding to Aripiprazole Augmentation of Clomipramine Combined with Psychoeducation and Exposure and Response Prevention. Am J Case Rep 2023; 24:e941534. [PMID: 38100391 PMCID: PMC10728879 DOI: 10.12659/ajcr.941534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/08/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND We report the case of a 28-year-old man with comorbidity of OCD, PTSD, and DID responding to aripiprazole augmentation of clomipramine combined with psychoeducation and exposure and response prevention (ERP). CASE REPORT A 28-year-old, well-educated man presented with depression, obsessive thoughts, behavioral impulsivity, and suicidal thoughts/behavior. He was known to be stubborn and sensitive to criticism since childhood. The obsessive thoughts and compulsive behaviors also started at an early age. He had 4 past psychiatric hospitalizations, mostly for dissociative episodes and bizarre behaviors, complicated with significant anxiety and distress from traumatic experiences during doctoral study. He had no-to-minimal responses to various psychotropics and traditional Chinese medicine. A thorough assessment showed he met the diagnostic criteria for OCD, PTSD, and DID. He was then treated with clomipramine in combination with aripiprazole, plus psychoeducation and exposure and response prevention (ERP). His anxiety and irritability significantly improved within 2 months and his obsessive thoughts faded away. At 6-month follow-up, the patient achieved clinical remission. One year later, he remained stable and reported having a normal life. CONCLUSIONS The case illustrates both how impairing the comorbidity of OCD, PTSD, and DID can be and how concurrent use of tricyclic antidepressant (TCA) clomipramine and partial dopamine agonist aripiprazole, together with psychoeducation and ERP, can improve outcomes when other treatment choices fail to be effective.
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Affiliation(s)
- Wei Su
- Department of Psychology, The Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, PR China
| | - Dan Zhao
- Department of Psychology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, PR China
| | - Hongmei Zhao
- Psychology Department Outpatient, Tianping Street Community Health Service Center, Taian, Shandong, PR China
| | - Wanhong Zheng
- Departmanr of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Wangxin Zhang
- Department of Psychology, The Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, PR China
- School of Clinical and Basic Medical Sciences, Shandong First Medical University& Shandong Academy of Medical Sciences, Jinan, Shandong, PR China
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Husain MI, Foster JA, Mason BL, Chen S, Zhao H, Wang W, Rotzinger S, Rizvi S, Ho K, Lam R, MacQueen G, Milev R, Frey BN, Müller D, Turecki G, Jha M, Trivedi M, Kennedy SH. Pro-inflammatory markers are associated with response to sequential pharmacotherapy in major depressive disorder: a CAN-BIND-1 report. CNS Spectr 2023; 28:739-746. [PMID: 37218291 DOI: 10.1017/s109285292300233x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE There is limited literature on associations between inflammatory tone and response to sequential pharmacotherapies in major depressive disorder (MDD). METHODS In a 16-week open-label clinical trial, 211 participants with MDD were treated with escitalopram 10-20 mg daily for 8 weeks. Responders continued escitalopram while non-responders received adjunctive aripiprazole 2-10 mg daily for 8 weeks. Plasma levels of pro-inflammatory markers-C-reactive protein, interleukin (IL)-1β, IL-6, IL-17, interferon-gamma (IFN)-Γ, tumor necrosis factor (TNF)-α, and Chemokine C-C motif ligand-2 (CCL-2)-measured at baseline, and after 2, 8 and 16 weeks were included in logistic regression analyzes to assess associations between inflammatory markers and treatment response. RESULTS Pre-treatment IFN-Γ and CCL-2 levels were significantly associated with a lower of odds of response to escitalopram at 8 weeks. Increases in CCL-2 levels from weeks 8 to 16 in escitalopram non-responders were significantly associated with higher odds of non-response to adjunctive aripiprazole at week 16. CONCLUSION Higher pre-treatment levels of IFN-Γ and CCL-2 were associated with non-response to escitalopram. Increasing levels of these pro-inflammatory markers may be associated with non-response to adjunctive aripiprazole. These findings require validation in independent clinical populations.
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Affiliation(s)
- M Ishrat Husain
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jane A Foster
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Brittany L Mason
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sheng Chen
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Haoyu Zhao
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Susan Rotzinger
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
| | - Sakina Rizvi
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
| | - Keith Ho
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
| | - Raymond Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Daniel Müller
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Gustavo Turecki
- The Douglas Hospital, Montreal, QC, Canada
- Department of Psychiatry. McGill University, Toronto, ON, Canada
| | - Manish Jha
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States
| | - Madhukar Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Depression and Suicide Studies, Unity Health, Toronto, ON, Canada
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21
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Alvarez-Vazquez J, Grande-Seijo M, Martinez Agulleiro L, Crespo Iglesias JM. Aripiprazole for the Treatment of Landolt's Forced Normalization. J Clin Psychopharmacol 2023; 43:534-535. [PMID: 37930207 DOI: 10.1097/jcp.0000000000001744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
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22
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Wilson M, Harris M, Pereira M, Buckle J, Forshall E, Murphy T, Thompson A, Kavanagh G, Whale R. Predictors of hospitalisation and recovery following full antipsychotic discontinuation in first episode psychosis. A naturalistic retrospective cohort study. Schizophr Res 2023; 261:269-274. [PMID: 37862826 DOI: 10.1016/j.schres.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/30/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
Whilst antipsychotic medication reduces risk of relapse following a first episode of psychosis (FEP), some individuals can discontinue medication and remain relapse free. We aimed to identify patient and service-specific factors which influence clinical outcome following antipsychotic discontinuation. The outcomes 'admission to hospital' and 'remaining free from psychotic symptoms', both within one year from discontinuation, were explored retrospectively in an established naturalistic cohort of 354 patients with FEP. Logistic regression analysis was used to explore influence of routinely available baseline and treatment course variables on these outcomes. Seventy-seven individuals (22 %) fully discontinued antipsychotic treatment within a year, at mean 102 days from initiation. Only antipsychotic type had significant association with discontinuation; aripiprazole was discontinued more than olanzapine (p = 0.028). Seventeen individuals required admission to hospital; significantly associated with prior admission at first illness onset (p = 0.004), and prior legal detention to hospital (p = 0.001). Admission was less likely in those discontinuing aripiprazole vs olanzapine (p = 0.044). Twenty-four patients remained psychosis symptom free and were most significantly likely to have received clinician support in discontinuation; this group had no association with either initial duration of untreated psychosis or prior duration of antipsychotic treatment. Future studies exploring outcomes following antipsychotic discontinuation require consistency of choice of outcome measures and sample stratification by vulnerability factors including severity of first illness episode, whether remaining symptom free after first episode, which medication switched from and baseline functioning. The impact and nature of clinician support to discontinue requires further exploration alongside its association with abruptness of discontinuation.
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Affiliation(s)
| | | | - Marco Pereira
- University of Coimbra, Faculty of Psychology and Educational Sciences, Portugal
| | | | | | | | | | | | - Richard Whale
- Brighton and Sussex Medical School, UK; Sussex Partnership NHS Foundation Trust, UK.
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23
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Flores-Gómez GD, Apam-Castillejos DJ, Juárez-Díaz I, Fuentes-Medel E, Díaz A, Tendilla-Beltrán H, Flores G. Aripiprazole attenuates the medial prefrontal cortex morphological and biochemical alterations in rats with neonatal ventral hippocampus lesion. J Chem Neuroanat 2023; 132:102316. [PMID: 37481172 DOI: 10.1016/j.jchemneu.2023.102316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
Schizophrenia is a neurodevelopmental disorder characterized by a loss of dendritic spines in the medial prefrontal cortex (mPFC). Multiple subclinical and clinical studies have evidenced the ability of antipsychotics to improve neuroplasticity. In this study, it was evaluated the effect of the atypical antipsychotic aripiprazole (ARI) on the behavioral and mPFC neuronal disturbances of rats with neonatal ventral hippocampus lesion (nVHL), which is a heuristic developmental model relevant to the study of schizophrenia. ARI attenuated open field hyperlocomotion in the rats with nVHL. Also, ARI ameliorated structural neuroplasticity disturbances of the mPFC layer 3 pyramidal cells, but not in the layer 5 neurons. These effects can be associated with the ARI capability of increasing brain-derived neurotrophic factor (BDNF) levels. Moreover, in the animals with nVHL, ARI attenuated the immunoreactivity for some oxidative stress-related molecules such as the nitric oxide synthase 2 (NOS-2), 3-nitrotyrosine (3-NT), and cyclooxygenase 2 (COX-2), as well as the reactive astrogliosis in the mPFC. These results contribute to current knowledge about the neurotrophic, anti-inflammatory, and antioxidant properties of antipsychotics which may be contributing to their clinical effects and envision promising therapeutic targets for the treatment of schizophrenia.
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Affiliation(s)
| | | | - Ismael Juárez-Díaz
- Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla (BUAP), Puebla, Mexico
| | - Estefania Fuentes-Medel
- Facultad de Ciencias Químicas (FCQ), Benemérita Universidad Autónoma de Puebla (BUAP), Puebla, Mexico
| | - Alfonso Díaz
- Facultad de Ciencias Químicas (FCQ), Benemérita Universidad Autónoma de Puebla (BUAP), Puebla, Mexico
| | - Hiram Tendilla-Beltrán
- Instituto de Fisiología, Benemérita Universidad Autónoma de Puebla (BUAP), Puebla, Mexico
| | - Gonzalo Flores
- Instituto de Fisiología, Benemérita Universidad Autónoma de Puebla (BUAP), Puebla, Mexico.
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Thurstone C, Loh R, Foreman K, Thurstone CA, Wolf C. Program Evaluation to Aid Choice of Aripiprazole or Risperidone for Hospitalized Adolescents with Cannabis Use Disorder and Psychosis. J Child Adolesc Psychopharmacol 2023; 33:332-336. [PMID: 37861990 DOI: 10.1089/cap.2023.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Introduction: Co-occurring cannabis use and psychosis is an increasing problem. No single behavioral or pharmacologic treatment has emerged as clearly superior. To address the gap, this nonrandomized, quality improvement project compares outcomes for adolescents with co-occurring cannabis use disorder and psychosis prescribed risperidone or aripiprazole. Materials and Methods: This project is a retrospective chart review of 110 adolescents (ages 13-21 years) hospitalized for psychosis and co-occurring cannabis use disorder. The primary outcomes are length of stay and length of stay index. Results: Adolescents prescribed risperidone compared with aripiprazole had a significantly greater length of stay (9.7 days vs. 5.8 days, p = 0.002) and length of stay index (1.4 vs. 0.79, p = 0.004). Conclusions: Adolescents hospitalized for co-occurring psychosis and cannabis use disorder had a significantly longer length of stay and length of stay index. These data are consistent with a more rapid reduction in acute psychotic symptoms for aripiprazole compared with risperidone in the context of co-occurring cannabis use disorder.
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Affiliation(s)
- Christian Thurstone
- Denver Health and Hospital Authority, Denver, Colorado, USA
- University of Colorado, Department of Psychiatry, Aurora, Colorado, USA
| | - Ryan Loh
- Denver Health and Hospital Authority, Denver, Colorado, USA
- University of Colorado, Department of Psychiatry, Aurora, Colorado, USA
| | | | | | - Chelsea Wolf
- Denver Health and Hospital Authority, Denver, Colorado, USA
- University of Colorado, Department of Psychiatry, Aurora, Colorado, USA
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25
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Ebell MH. Augmentation With Aripiprazole or Bupropion, or a Switch to Nortriptyline, Effective for Treatment-Resistant Depression in Older Adults. Am Fam Physician 2023; 108:Online. [PMID: 37725473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
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26
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Hosokawa T, Miyaji C, Yoshimura Y, Washida K, Yada Y, Sakamoto S, Okahisa Y, Takao S, Nomura A, Kishi Y, Harada T, Takaki M, Takeda T, Yamada N. Comparison between olanzapine and aripiprazole treatment for 104 weeks after hospital discharge in schizophrenia spectrum disorders: a multicenter retrospective cohort study in a real-world setting. Psychopharmacology (Berl) 2023; 240:1911-1920. [PMID: 37460628 DOI: 10.1007/s00213-023-06407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 06/12/2023] [Indexed: 09/01/2023]
Abstract
RATIONALE The long-term effectiveness of olanzapine and aripiprazole in real clinical conditions at flexible doses in patients after hospital discharge has not been evaluated yet. OBJECTIVES This study was a multicenter retrospective cohort study. Patients with schizophrenia (n = 398) were prescribed olanzapine (n = 303) or aripiprazole (n = 95) at hospital discharge. The continuation of olanzapine or aripiprazole at 26, 52, or 104 weeks after the hospital discharge were compared using a Cox proportional hazards model and adjusted for possible confounders. RESULTS The Kaplan-Meier survival curves revealed that the continuation of olanzapine at 26 (P = 0.001) and 52 weeks (P = 0.018) was significantly higher than that of aripiprazole but not at 104 weeks. Olanzapine was better than aripiprazole in efficacy at 26 (hazard ratio: 0.321, 95% confidence interval: 0.159-0.645, P = 0.001), 52 (hazard ratio: 0.405, 95% confidence interval: 0.209-0.786, P = 0.008), and 104 weeks (hazard ratio: 0.438, 95% confidence interval: 0.246-0.780, P = 0.005). Aripiprazole was better than olanzapine in tolerability at 104 weeks (hazard ratio: 4.574, 95% confidence interval: 1.415-14.787, P = 0.011). Rates after two years continuation of olanzapine and aripiprazole were not significantly different in patients with less than five years' duration of illness, but olanzapine was more commonly maintained for more than two years in those patients who had been ill for over five years' due to its greater efficacy. CONCLUSION Olanzapine treatment showed better continuation rates at 26 and 52 after hospital discharge than aripiprazole, whereas maintenance with the two antipsychotics did not differ significantly at 104 weeks, due reduced tolerability of long-term olanzapine treatment.
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Affiliation(s)
- Tomonari Hosokawa
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
- Department of Psychiatry, Zikei Hospital/Zikei Institute of Psychiatry, Okayama, Japan
| | - Chikara Miyaji
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yusaku Yoshimura
- Department of Psychiatry, Zikei Hospital/Zikei Institute of Psychiatry, Okayama, Japan
| | - Kenji Washida
- Department of Psychiatry, Zikei Hospital/Zikei Institute of Psychiatry, Okayama, Japan
| | - Yuji Yada
- Okayama Psychiatric Medical Center, Okayama, Japan
| | - Shinji Sakamoto
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Yuko Okahisa
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Soshi Takao
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | | | | | - Manabu Takaki
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
| | - Toshihiko Takeda
- Department of Psychiatry, Zikei Hospital/Zikei Institute of Psychiatry, Okayama, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
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27
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Sampedro-Viana D, Cañete T, Sanna F, Oliveras I, Lavín V, Torrecilla P, Río-Álamos C, Tapias-Espinosa C, Sánchez-González A, Tobeña A, Fernández-Teruel A. Atypical antipsychotics attenuate MK801-induced social withdrawal and hyperlocomotion in the RHA rat model of schizophrenia-relevant features. Psychopharmacology (Berl) 2023; 240:1931-1945. [PMID: 37442829 DOI: 10.1007/s00213-023-06411-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
RATIONALE The administration of NMDA receptor (NMDAR) antagonists constitutes a widely used model that produce both positive (e.g., hyperactivity) and negative (e.g., social withdrawal) symptoms relevant for schizophrenia in rodents. These effects can be reversed with the administration of atypical (second and third generation) antipsychotics. OBJECTIVES In this study we combined the NMDAR-antagonist model with the Roman High-Avoidance (RHA) strain, a psychogenetically selected model of schizophrenia-relevant features. We also studied whether some atypical antipsychotic drugs (clozapine, ziprasidone, and aripiprazole) would be able to attenuate or reverse the behavioural alterations induced by MK801 and whether such effects might be dependent on the rat strain. METHODS MK801 dose-response study was conducted in RHA and Roman Low-Avoidance (RLA) male rats. After that, the 0.15 mg/kg MK801 dose was selected to carry out pharmacological studies versus atypical antipsychotics. RESULTS In the first experiment we establish that MK801 (dizocilpine), a NMDAR antagonist, produces dose-related hyperactivity and social withdrawal, which are more marked in RHA than RLA rats. The administration of the atypical antipsychotics clozapine (2.5 mg/kg) or ziprasidone (2.5 mg/kg) partially reversed or attenuated some of the social behaviour deficits and hyperactivity induced by the administration of MK801. Aripiprazole (3 mg/kg), a third-generation antipsychotic, reversed or attenuated the social preference deficit, the hyperactivity and the impairment of social latency induced by MK801. CONCLUSIONS These results seem to be in line with previous studies with the NMDAR-antagonist model and add face (MK801-induced social withdrawal and hyperactivity) and predictive (attenuation of MK801-induced effects by atypical antipsychotics) validity to the RHA rat strain as a model of schizophrenia-relevant features.
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Affiliation(s)
- Daniel Sampedro-Viana
- Department of Psychiatry & Forensic Medicine, Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
| | - Toni Cañete
- Department of Psychiatry & Forensic Medicine, Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
| | - Francesco Sanna
- Department of Life & Environmental Sciences, University of Cagliari, 09042, Monserrato, CA, Italy
| | - Ignasi Oliveras
- Department of Psychiatry & Forensic Medicine, Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
| | - Valeria Lavín
- Department of Clinical & Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
| | - Pilar Torrecilla
- Department of Clinical & Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
| | - Cristóbal Río-Álamos
- Department of Psychology, School of Medicine, Austral University of Chile, Valdivia, Chile
| | - Carles Tapias-Espinosa
- Department of Psychiatry & Forensic Medicine, Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
| | - Ana Sánchez-González
- Department of Psychiatry & Forensic Medicine, Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
| | - Adolf Tobeña
- Department of Psychiatry & Forensic Medicine, Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain
| | - Alberto Fernández-Teruel
- Department of Psychiatry & Forensic Medicine, Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain.
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28
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Goto J, Shono M, Abe Y, Fujita Y, Ueda K, Yoshida B, Nabeshima Y. Preventive effect of aripiprazole once monthly on rehospitalization for bipolar disorder: A multicenter 1-year retrospective mirror image study. Neuropsychopharmacol Rep 2023; 43:425-433. [PMID: 37560818 PMCID: PMC10496053 DOI: 10.1002/npr2.12371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
AIM We conducted a 1-year retrospective mirror-image study to investigate the effect of aripiprazole once monthly (AOM) on rehospitalization for bipolar disorder. METHODS Participants were recruited from psychiatric emergency and acute care hospitals in western Japan. We included 39 participants with bipolar disorder who had been administered AOM for at least 1 year with no missing medical records during the observational period. The primary outcomes were rehospitalization rate, number of rehospitalizations, total hospitalization days, and time to rehospitalization in the context of overall psychiatric readmissions. The significance level was set at p < 0.05. RESULTS AOM significantly reduced the rehospitalization rate from 23/39 (59%) to 7/39 (18%) (p = 0.001). The number of rehospitalizations decreased significantly from a mean of 0.85 per person-year to 0.41 per person-year (p = 0.048). The total hospitalization days significantly decreased from a mean of 34.9 days to 14.4 days (p = 0.008). AOM significantly prolonged the time to rehospitalization (p < 0.001). CONCLUSION This study found that AOM reduces overall psychiatric rehospitalization for bipolar disorder based on data from 1 year before and after AOM administration in the real-world setting. Future studies should examine the robustness and persistence of the rehospitalization preventive effect of AOM with larger sample sizes and longer observation periods beyond 1 year.
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29
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Lu C, Li S, Kang L, Li Q, Chen H, Lin Y, Zhang H, Tang Z, Bai M, Xiong P. Aripiprazole combined with nerve growth factor improves cognitive function in mice with schizophrenia model. Neurosci Lett 2023; 812:137410. [PMID: 37495071 DOI: 10.1016/j.neulet.2023.137410] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/05/2023] [Accepted: 07/23/2023] [Indexed: 07/28/2023]
Abstract
The pathogenesis and treatment of cognitive dysfunction in patients with schizophrenia (SCZ) remains a challenge. Exploring new effective treatment strategies is relevant for the improvement of cognitive function. Aripiprazole (ARI) is an atypical antipsychotic that improves some cognitive functions. Nerve growth factor (NGF) has been shown to improve cognitive function in certain neurological impairments and partial neurological deficits, but its mechanism of action in cognitive dysfunction in SCZ is unclear. In this study, we established schizophrenia mouse model with dizocilpine (MK-801); treated mice with ARI alone or in combination with NGF; assessed spontaneous activity and cognitive function using open field test and Morris water maze test; and measured brain-derived neurotrophic factor (BDNF) protein and mRNA expression levels using immunohistochemistry and molecular biology assays. The results showed that ARI alone or in combination with NGF can improve increased spontaneous activity and spatial learning memory deficits in model mice by elevating BDNF expression levels in prefrontal cortex (PFC) and hippocampus (HIP). The results suggest that ARI combined with NGF can improve cognitive function in SCZ, which provides new ideas and directions for the clinical treatment of cognitive dysfunction in SCZ.
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Affiliation(s)
- Cailian Lu
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Shan Li
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Lin Kang
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Qianqian Li
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hongxu Chen
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yanwen Lin
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Han Zhang
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ziling Tang
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Meiyan Bai
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Peng Xiong
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China; Yunnan Clinical Research Center for Mental Health, Kunming, Yunnan, China.
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30
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Hardy RE, Chung I, Yu Y, Loh SHY, Morone N, Soleilhavoup C, Travaglio M, Serreli R, Panman L, Cain K, Hirst J, Martins LM, MacFarlane M, Pryde KR. The antipsychotic medications aripiprazole, brexpiprazole and cariprazine are off-target respiratory chain complex I inhibitors. Biol Direct 2023; 18:43. [PMID: 37528429 PMCID: PMC10391878 DOI: 10.1186/s13062-023-00375-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 08/03/2023] Open
Abstract
Antipsychotic drugs are the mainstay of treatment for schizophrenia and provide adjunct therapies for other prevalent psychiatric conditions, including bipolar disorder and major depressive disorder. However, they also induce debilitating extrapyramidal syndromes (EPS), such as Parkinsonism, in a significant minority of patients. The majority of antipsychotic drugs function as dopamine receptor antagonists in the brain while the most recent 'third'-generation, such as aripiprazole, act as partial agonists. Despite showing good clinical efficacy, these newer agents are still associated with EPS in ~ 5 to 15% of patients. However, it is not fully understood how these movement disorders develop. Here, we combine clinically-relevant drug concentrations with mutliscale model systems to show that aripiprazole and its primary active metabolite induce mitochondrial toxicity inducing robust declines in cellular ATP and viability. Aripiprazole, brexpiprazole and cariprazine were shown to directly inhibit respiratory complex I through its ubiquinone-binding channel. Importantly, all three drugs induced mitochondrial toxicity in primary embryonic mouse neurons, with greater bioenergetic inhibition in ventral midbrain neurons than forebrain neurons. Finally, chronic feeding with aripiprazole resulted in structural damage to mitochondria in the brain and thoracic muscle of adult Drosophila melanogaster consistent with locomotor dysfunction. Taken together, we show that antipsychotic drugs acting as partial dopamine receptor agonists exhibit off-target mitochondrial liabilities targeting complex I.
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Affiliation(s)
- Rachel E Hardy
- MRC Toxicology Unit, University of Cambridge, Gleeson Building, Tennis Court Road, Cambridge, CB2 1QR, UK
| | - Injae Chung
- MRC Mitochondrial Biology Unit, University of Cambridge, The Keith Peters Building, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0XY, UK
| | - Yizhou Yu
- MRC Toxicology Unit, University of Cambridge, Gleeson Building, Tennis Court Road, Cambridge, CB2 1QR, UK
| | - Samantha H Y Loh
- MRC Toxicology Unit, University of Cambridge, Gleeson Building, Tennis Court Road, Cambridge, CB2 1QR, UK
| | - Nobuhiro Morone
- MRC Toxicology Unit, University of Cambridge, Gleeson Building, Tennis Court Road, Cambridge, CB2 1QR, UK
| | - Clement Soleilhavoup
- MRC Toxicology Unit, University of Cambridge, Gleeson Building, Tennis Court Road, Cambridge, CB2 1QR, UK
| | - Marco Travaglio
- MRC Toxicology Unit, University of Cambridge, Gleeson Building, Tennis Court Road, Cambridge, CB2 1QR, UK
| | - Riccardo Serreli
- MRC Mitochondrial Biology Unit, University of Cambridge, The Keith Peters Building, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0XY, UK
| | - Lia Panman
- MRC Toxicology Unit, University of Cambridge, Gleeson Building, Tennis Court Road, Cambridge, CB2 1QR, UK
| | - Kelvin Cain
- MRC Toxicology Unit, University of Cambridge, Gleeson Building, Tennis Court Road, Cambridge, CB2 1QR, UK
| | - Judy Hirst
- MRC Mitochondrial Biology Unit, University of Cambridge, The Keith Peters Building, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0XY, UK
| | - Luis M Martins
- MRC Toxicology Unit, University of Cambridge, Gleeson Building, Tennis Court Road, Cambridge, CB2 1QR, UK.
| | - Marion MacFarlane
- MRC Toxicology Unit, University of Cambridge, Gleeson Building, Tennis Court Road, Cambridge, CB2 1QR, UK.
| | - Kenneth R Pryde
- MRC Toxicology Unit, University of Cambridge, Gleeson Building, Tennis Court Road, Cambridge, CB2 1QR, UK.
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Bechdolf A, Müller H, Hellmich M, de Millas W, Falkai P, Gaebel W, Gallinat J, Hasan A, Heinz A, Janssen B, Juckel G, Karow A, Krüger-Özgürdal S, Lambert M, Maier W, Meyer-Lindenberg A, Pützfeld V, Rausch F, Schneider F, Stützer H, Wobrock T, Wagner M, Zink M, Klosterkötter J. Prevention of First-Episode Psychosis in People at Clinical High Risk: A Randomized Controlled, Multicentre Trial Comparing Cognitive-Behavioral Therapy and Clinical Management Plus Low-Dose Aripiprazole or Placebo (PREVENT). Schizophr Bull 2023; 49:1055-1066. [PMID: 37021666 PMCID: PMC10318879 DOI: 10.1093/schbul/sbad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND There is limited knowledge of whether cognitive-behavioral therapy (CBT) or second-generation antipsychotics (SGAs) should be recommended as the first-line treatment in individuals at clinical high risk for psychosis (CHRp). HYPOTHESIS To examine whether individual treatment arms are superior to placebo and whether CBT is non-inferior to SGAs in preventing psychosis over 12 months of treatment. STUDY DESIGN PREVENT was a blinded, 3-armed, randomized controlled trial comparing CBT to clinical management plus aripiprazole (CM + ARI) or plus placebo (CM + PLC) at 11 CHRp services. The primary outcome was transition to psychosis at 12 months. Analyses were by intention-to-treat. STUDY RESULTS Two hundred eighty CHRp individuals were randomized: 129 in CBT, 96 in CM + ARI, and 55 in CM + PLC. In week 52, 21 patients in CBT, 19 in CM + ARI, and 7 in CM + PLC had transitioned to psychosis, with no significant differences between treatment arms (P = .342). Psychopathology and psychosocial functioning levels improved in all treatment arms, with no significant differences. CONCLUSIONS The analysis of the primary outcome transition to psychosis at 12 months and secondary outcomes symptoms and functioning did not demonstrate significant advantages of the active treatments over placebo. The conclusion is that within this trial, neither low-dose aripiprazole nor CBT offered additional benefits over clinical management and placebo.
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Affiliation(s)
- Andreas Bechdolf
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Hendrik Müller
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin Hellmich
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Walter de Millas
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin Campus Mitte, Berlin, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin Campus Mitte, Berlin, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy and Psychosomatics Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin Campus Mitte, Berlin, Germany
| | - Birgit Janssen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Seza Krüger-Özgürdal
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, Rhineland Friedrich Wilhelms University of Bonn, Bonn, Germany
| | | | - Verena Pützfeld
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Franziska Rausch
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Frank Schneider
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
- Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen, Aachen, Germany
| | - Hartmut Stützer
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany
- Centre of Mental Health, County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, Rhineland Friedrich Wilhelms University of Bonn, Bonn, Germany
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, Rhineland Friedrich Wilhelms University of Bonn, Bonn, Germany
| | - Mathias Zink
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
- District Hospital for Psychiatry, Psychotherapy, and Psychosomatics, Ansbach, Germany
| | - Joachim Klosterkötter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Silva C, Rebelo M, Chendo I. Managing antipsychotic-related sexual dysfunction in patients with schizophrenia. Expert Rev Neurother 2023; 23:1147-1155. [PMID: 37941377 DOI: 10.1080/14737175.2023.2281399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/06/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Schizophrenia is a psychotic disorder and one of the most severe and impactful mental illnesses. Sexual dysfunction is highly prevalent in patients with schizophrenia but remains underdiagnosed and undertreated. Sexual dysfunction is frequently attributed to antipsychotics which may reduce medication adherence, but negative symptoms can also reduce sexual drive. AREAS COVERED This review provides an overview of the current knowledge about sexual dysfunction in patients with schizophrenia. The authors first review the literature concerning the mechanisms of sexual dysfunction and explore the impact of antipsychotics on sexual function. Finally, they present the available non-pharmacological and pharmacological treatment strategies for sexual dysfunction in patients with schizophrenia. EXPERT OPINION Sexual dysfunction in patients with schizophrenia is still underrated by clinicians despite having a negative impact on the quality of life and therapeutic adherence. Antipsychotic treatment is still perceived as a major cause of sexual impairment. Psychiatrists must be aware of this condition and actively question the patients. A comprehensive approach, addressing pharmacological and non-pharmacological aspects, is fundamental for managing sexual dysfunction in schizophrenia. Pharmacological strategies include (1) Serum-level adjustment of the antipsychotic dose, if possible (2) switching to a well-tolerable antipsychotic (aripiprazole, brexpiprazole) and (3) adding a coadjuvant drug (phosphodiesterase-5 inhibitors).
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Affiliation(s)
- Carlos Silva
- Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Marta Rebelo
- Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
| | - Inês Chendo
- Psychiatry Department, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Stabell L, Johnsen E, Kroken RA, Løberg E, Blindheim A, Joa I, Reitan S, Rettenbacher M, Munk-Jørgensen P, Gjestad R. Clinical insight among persons with schizophrenia spectrum disorders treated with amisulpride, aripiprazole or olanzapine: a semi-randomised trial. BMC Psychiatry 2023; 23:482. [PMID: 37386462 PMCID: PMC10311854 DOI: 10.1186/s12888-023-04981-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Antipsychotic treatment may improve clinical insight. However, previous studies have reported inconclusive findings on whether antipsychotics improve insight over and above the reduction in symptoms of psychosis. These studies assessed homogeneous samples in terms of stage of illness. Randomised studies investigating a mixed population of first- and multiepisode schizophrenia spectrum disorders might clarify this disagreement. METHODS Our data were derived from a pragmatic, rater-blinded, semi-randomised trial that compared the effectiveness of amisulpride, aripiprazole and olanzapine. A sample of 144 patients with first- or multiepisode schizophrenia spectrum disorders underwent eight assessments during a 1-year follow-up. Clinical insight was assessed by item General 12 from the Positive and Negative Syndrome Scale (PANSS). We analysed latent growth curve models to test if the medications had a direct effect on insight that was over and above the reduction in total psychosis symptoms. Furthermore, we investigated whether there were differences between the study drugs in terms of insight. RESULTS Based on allocation analysis, all three drugs were associated with a reduction in total psychosis symptoms in the initial phase (weeks 0-6). Amisulpride and olanzapine were associated with improved insight over and above what was related to the reduction in total psychosis symptoms in the long-term phase (weeks 6-52). However, these differential effects were lost when only including the participants that chose the first drug in the randomisation sequence. We found no differential effect on insight among those who were antipsychotic-naïve and those who were previously medicated with antipsychotics. CONCLUSIONS Our results suggest that antipsychotic treatment improves insight, but whether the effect on insight surpasses the effect of reduced total psychosis symptoms is more uncertain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01446328, 05.10.2011.
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Affiliation(s)
- L.A Stabell
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Research Department, Sandviken sykehus, Haukeland University Hospital, P. Box 1400, Bergen, 5021 Norway
| | - E. Johnsen
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R. A Kroken
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - E.M. Løberg
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - A. Blindheim
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - I. Joa
- Network for Clinical Research in psychosis, TIPS, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - S.K. Reitan
- Department of Mental Health, St. Olav University Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - M. Rettenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innrain 52, Innsbruck, Austria
| | - P. Munk-Jørgensen
- Department of Psychiatry, University of Southern Denmark, Odense, Denmark
| | - R. Gjestad
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic psychiatry, Haukeland University Hospital, Bergen, Norway
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Li Q, Su Y, Liao X, Fang M, Gao J, Xu J, Duan M, Yu H, Yang Y, Chen Z, Liu J, Yan S, Yao P, Li S, Wang C, Wu B, Zhang C, Si T. Aripiprazole in the treatment of acute episode of schizophrenia: a real-world study in China. Chin Med J (Engl) 2023; 136:1126-1128. [PMID: 37014776 PMCID: PMC10228474 DOI: 10.1097/cm9.0000000000002551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Indexed: 04/05/2023] Open
Affiliation(s)
- Qian Li
- Department of Psychopharmacology, Peking University Sixth Hospital (Institute of Mental Health), NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Yun’ai Su
- Department of Psychopharmacology, Peking University Sixth Hospital (Institute of Mental Health), NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Xuemei Liao
- Department of Psychopharmacology, Peking University Sixth Hospital (Institute of Mental Health), NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Maosheng Fang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei 430012, China
| | - Jianliang Gao
- Department of Child and Adolescent Psychology, the Fourth People's Hospital of Hefei, Hefei, Anhui 230022, China
| | - Jia Xu
- Mental Health Center, the First Psychiatric Hospital of Harbin, Harbin, Heilongjiang 150056, China
| | - Mingjun Duan
- Department of Science and Education, the Fourth People's Hospital of Chengdu, Chengdu, Sichuan 610036, China
| | - Haiying Yu
- Department of Psychiatry, the Chinese People's Liberation Army 904th Hospital, Changzhou, Jiangsu 213003, China
| | - Yang Yang
- Department of Psychiatry, Beijing Anding Hospital, Beijing 100029, China
| | - Zhiyu Chen
- Department of Psychiatry, Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang 310063, China
| | - Jintong Liu
- Department of Adolescent and Child Psychological Behavior, Shandong Mental Health Center, Jinan, Shandong 250014, China
| | - Shaoxiao Yan
- Department of Integrated Chinese and Western Medicine, Beijing Huilongguan Hospital, Beijing 102208, China
| | - Peifen Yao
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai 201109, China
| | - Shuying Li
- Department of Psychiatry, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Changhong Wang
- Department of Psychiatry, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 456750, China
| | - Bin Wu
- Department of Psychiatry, Xi’an Mental Health Center, Xi’an, Shaanxi 710067, China
| | - Congpei Zhang
- Mental Health Center, the First Psychiatric Hospital of Harbin, Harbin, Heilongjiang 150056, China
| | - Tianmei Si
- Department of Psychopharmacology, Peking University Sixth Hospital (Institute of Mental Health), NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
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de Oliveira Ferreira E, Pessoa Gomes JM, Neves KRT, Lima FAV, de Barros Viana GS, de Andrade GM. Maternal treatment with aripiprazole prevents the development of a valproic acid-induced autism-like phenotype in juvenile male mice. Behav Pharmacol 2023; 34:154-168. [PMID: 36853856 DOI: 10.1097/fbp.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Autism spectrum disorder (ASD) describes a heterogeneous group of neurodevelopmental conditions characterized by deficits in social communication and repetitive behaviors. Aripiprazole (APZ) is an atypical antipsychotic that can safeguard mice against autism-like behavior induced by valproic acid (VPA). In the present study, we examined the effects of maternal treatment with APZ (10 mg/kg) in juvenile mice prenatally exposed to VPA on neurodevelopmental behaviors, social interactions, communication, and working memory, as well as synaptophysin (SYP), synaptosomal-associated protein, 25 kDa (SNAP-25) and microtubule-associated protein 2 (MAP-2) expression in the medial prefrontal cortex (mPFC) and cell viability in the hippocampus. In addition, to evaluate possible APZ interference with the anticonvulsant properties of VPA on pentylenetetrazole (PTZ)-induced seizures were evaluated. Maternal treatment with APZ significantly prevented body weight loss, self-righting, eye-opening, social interactions, social communication, and working memory deficits in mice prenatally exposed to VPA. Additionally, the decrease in the SYP, SNAP-25, and MAP-2 expressions in the mPFC and cell death in the hippocampus was prevented by APZ. Furthermore, APZ (10 mg/kg) did not interfere with the anticonvulsant effect of VPA (15 mg/kg) in animals with PTZ-induced seizures. These findings indicate that maternal treatment with APZ in pregnant mice exposed to VPA protects animals against the ASD-like behavioral phenotype, and this effect may be related, at least in part, to synaptic plasticity and neuronal protection in the PFC and hippocampus. APZ may serve as an effective pharmacological therapeutic target against autistic behaviors in the VPA animal model of ASD, which should be further investigated to verify its clinical relevance.
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Affiliation(s)
| | | | | | | | - Glauce Socorro de Barros Viana
- Department of Physiology and Pharmacology
- Center for Research and Drug Development (NPDM), Federal University of Ceara, Fortaleza, Brazil
| | - Geanne Matos de Andrade
- Department of Clinical Medicine
- Department of Physiology and Pharmacology
- Center for Research and Drug Development (NPDM), Federal University of Ceara, Fortaleza, Brazil
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Cai J, Li L, Shao T, Sun M, Wang W, Xie P, Wang X, Yang Y, Long Y, Kang D, Xiao J, Su Y, Peng X, Huang Y, Gao M, Wu Q, Song C, Liu F, Shao P, Ou J, Shen Y, Huang J, Wu R. Relapse in patients with schizophrenia and amisulpride-induced hyperprolactinemia or olanzapine-induced metabolic disturbance after switching to other antipsychotics. Psychiatry Res 2023; 322:115138. [PMID: 36871411 DOI: 10.1016/j.psychres.2023.115138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Abstract
Hyperprolactinemia and metabolic disturbance are common side effects of antipsychotics that cause intolerance. Despite its potential influence on relapse, there are no established guidelines for antipsychotic switching. This naturalistic study explored the association between antipsychotic switching, baseline clinical status, metabolic changes, and relapse in patients with schizophrenia. In total, 177 patients with amisulpride-induced hyperprolactinemia and 274 with olanzapine-induced metabolic disturbance were enrolled. Relapse was determined by assessing changes in Positive and Negative Syndrome Scale (PANSS) total scores from baseline to 6 months (increased over 20% or 10% reaching 70). Metabolic indices were measured at baseline and 3 months. Patients with baseline PANSS >60 were more likely to relapse. Further, patients switching to aripiprazole had a higher risk of relapse regardless of their original medication. Participants who originally used amisulpride had reduced prolactin levels following medication change, while switching to olanzapine caused increased weight and blood glucose levels. In patients originally using olanzapine, only switching to aripiprazole reduced insulin resistance. Adverse effects on weight and lipid metabolism were observed in patients who switched to risperidone, while amisulpride improved lipid profiles. Changing schizophrenia treatment requires careful consideration of multiple variables, particularly the choice of substituted drug and the patient's baseline symptoms.
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Affiliation(s)
- Jingda Cai
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Li Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Tiannan Shao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Mengxi Sun
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Weiyan Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Peng Xie
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xiaoyi Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Ye Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yujun Long
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Dongyu Kang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jingmei Xiao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yuhan Su
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xingjie Peng
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yuyan Huang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Menghui Gao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Qiongqiong Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Chuhan Song
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Furu Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Ping Shao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jianjun Ou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Yidong Shen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jing Huang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Renrong Wu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
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Lenze EJ, Mulsant BH, Roose SP, Lavretsky H, Reynolds CF, Blumberger DM, Brown PJ, Cristancho P, Flint AJ, Gebara MA, Gettinger TR, Lenard E, Miller JP, Nicol GE, Oughli HA, Pham VT, Rollman BL, Yang L, Karp JF. Antidepressant Augmentation versus Switch in Treatment-Resistant Geriatric Depression. N Engl J Med 2023; 388:1067-1079. [PMID: 36867173 PMCID: PMC10568698 DOI: 10.1056/nejmoa2204462] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND The benefits and risks of augmenting or switching antidepressants in older adults with treatment-resistant depression have not been extensively studied. METHODS We conducted a two-step, open-label trial involving adults 60 years of age or older with treatment-resistant depression. In step 1, patients were randomly assigned in a 1:1:1 ratio to augmentation of existing antidepressant medication with aripiprazole, augmentation with bupropion, or a switch from existing antidepressant medication to bupropion. Patients who did not benefit from or were ineligible for step 1 were randomly assigned in step 2 in a 1:1 ratio to augmentation with lithium or a switch to nortriptyline. Each step lasted approximately 10 weeks. The primary outcome was the change from baseline in psychological well-being, assessed with the National Institutes of Health Toolbox Positive Affect and General Life Satisfaction subscales (population mean, 50; higher scores indicate greater well-being). A secondary outcome was remission of depression. RESULTS In step 1, a total of 619 patients were enrolled; 211 were assigned to aripiprazole augmentation, 206 to bupropion augmentation, and 202 to a switch to bupropion. Well-being scores improved by 4.83 points, 4.33 points, and 2.04 points, respectively. The difference between the aripiprazole-augmentation group and the switch-to-bupropion group was 2.79 points (95% CI, 0.56 to 5.02; P = 0.014, with a prespecified threshold P value of 0.017); the between-group differences were not significant for aripiprazole augmentation versus bupropion augmentation or for bupropion augmentation versus a switch to bupropion. Remission occurred in 28.9% of patients in the aripiprazole-augmentation group, 28.2% in the bupropion-augmentation group, and 19.3% in the switch-to-bupropion group. The rate of falls was highest with bupropion augmentation. In step 2, a total of 248 patients were enrolled; 127 were assigned to lithium augmentation and 121 to a switch to nortriptyline. Well-being scores improved by 3.17 points and 2.18 points, respectively (difference, 0.99; 95% CI, -1.92 to 3.91). Remission occurred in 18.9% of patients in the lithium-augmentation group and 21.5% in the switch-to-nortriptyline group; rates of falling were similar in the two groups. CONCLUSIONS In older adults with treatment-resistant depression, augmentation of existing antidepressants with aripiprazole improved well-being significantly more over 10 weeks than a switch to bupropion and was associated with a numerically higher incidence of remission. Among patients in whom augmentation or a switch to bupropion failed, changes in well-being and the occurrence of remission with lithium augmentation or a switch to nortriptyline were similar. (Funded by the Patient-Centered Outcomes Research Institute; OPTIMUM ClinicalTrials.gov number, NCT02960763.).
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Affiliation(s)
- Eric J Lenze
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Benoit H Mulsant
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Steven P Roose
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Helen Lavretsky
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Charles F Reynolds
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Daniel M Blumberger
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Patrick J Brown
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Pilar Cristancho
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Alastair J Flint
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Marie A Gebara
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Torie R Gettinger
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Emily Lenard
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - J Philip Miller
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Ginger E Nicol
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Hanadi A Oughli
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Vy T Pham
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Bruce L Rollman
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Lei Yang
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Jordan F Karp
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
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Lewis G, Lewis G. Aripiprazole Augmentation in Older Persons with Treatment-Resistant Depression. N Engl J Med 2023; 388:1137-1138. [PMID: 36867178 DOI: 10.1056/nejme2301045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Gemma Lewis
- From the Division of Psychiatry, Faculty of Brain Sciences, University College London, London
| | - Glyn Lewis
- From the Division of Psychiatry, Faculty of Brain Sciences, University College London, London
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Schöttle D, Janetzky W, Therrien F, Wiedemann K. BPRS domains, items and subgroups analyses, and CGI-I ratings in pooled data from non-interventional studies of aripiprazole once-monthly in schizophrenia (REACT study). BMC Psychiatry 2023; 23:162. [PMID: 36918846 PMCID: PMC10015766 DOI: 10.1186/s12888-023-04651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Patients with schizophrenia may benefit from treatment with long-acting injectable (LAI) formulations of antipsychotics. Aripiprazole once-monthly (AOM) is an LAI that was tested in two non-interventional studies in Germany and Canada. METHODS Here, we report on analyses of pooled data from the two non-interventional studies. Patients were treated with AOM under real-life conditions. Data were analyzed for a timeframe of 6 months. We analyzed data on Brief Psychiatric Rating Scale (BPRS) domains and items, BPRS total scores in various patient subgroups (male vs. female patients, patients with disease duration ≤ 5 years and > 5 years, patients with different levels of disease severity at baseline), Clinical Global Impression - Improvement (CGI-I) ratings for the total population and subgroups, and comorbidities for the total population. RESULTS Data from 409 patients were included. 65.5% of the patients had comorbidities. Improvements were found in all BPRS domains and items. Furthermore, improvements were similar for male and female patients, patients with disease duration ≤ 5 years and > 5 years, and across different levels of disease severity at baseline. Numerically, more favorable results were found for younger patients, female patients, and those with shorter disease duration. CONCLUSIONS AOM can be an effective treatment in the broad range of patients, across sexes, regardless of patient age and duration of disease, independently of disease severity, and across symptoms. TRIAL REGISTRATION NCT02131415 (May 6, 2014), vfa non-interventional studies registry 15960N.
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Affiliation(s)
- Daniel Schöttle
- Klinik Für Psychiatrie Und Psychotherapie, Zentrum Für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | | | - Francois Therrien
- Otsuka Canada Pharmaceutical Inc., 2250 Alfred-Nobel Boulevard, Saint-Laurent, Québec, H4S 2C9, Canada
| | - Klaus Wiedemann
- Klinik Für Psychiatrie Und Psychotherapie, Zentrum Für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Abstract
Schizophrenia is a prevalent psychiatric illness, which causes significant financial and social burden on the population overall. The development of second generation antipsychotics, such as Aripiprazole, Risperidone, and Paliperidone, has changed treatment practice for many psychiatrists. Aripiprazole has extremely high binding affinity for the dopamine D2 receptor, which is the receptor thought to be responsible for the antipsychotic effect, although Aripiprazole is not the most potent of the second generation antipsychotics. In theory, Aripiprazole could displace or outcompete other, more potent antipsychotics, prompting decreased antipsychotic effect. We describe a proposed case of this phenomenon, Ms. A. We describe how Aripiprazole may have caused a worsening of psychiatric symptoms by blocking the antipsychotic effects of Paliperidone due to its strong binding affinity for the D2 receptor. Aripiprazole has a high affinity for the D2 receptor, but may have a lesser reduction of psychotic symptoms compared to other antipsychotics. Prescribers should be aware of this potential interaction and carefully consider initiating long-acting injectable forms of Aripiprazole to avoid this phenomenon.
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Affiliation(s)
- Adiba Anam
- Mount Sinai Beth Israel, Department of Psychiatry
| | - Sean Lynch
- Mount Sinai Beth Israel, Department of Psychiatry
| | | | - Chloe Soukas
- Mount Sinai Beth Israel, Department of Psychiatry
| | - Dmitriy Gekhman
- Mount Sinai Beth Israel, Department of Psychiatry
- Icahn School of Medicine at Mount Sinai Department of Psychiatry, New York, USA
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Husak N, Laudone TW, Leonard JB. A descriptive study of aripiprazole, brexpiprazole, and cariprazine exposures in children ages 0 to 5 years reported to United States poison centers. Clin Toxicol (Phila) 2023; 61:110-115. [PMID: 36762866 DOI: 10.1080/15563650.2022.2163901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Increased prescribing of antipsychotics and availability of new antipsychotics has resulted in increased exposures in children. Current data on aripiprazole, brexpiprazole, and cariprazine are limited. METHODS This was a retrospective database study utilizing the National Poison Data System from 2015 through 2021. We included cases of single substance exposures to aripiprazole, brexpiprazole, cariprazine, or lumateperone in children ages 0 to 5 years old with follow-up to a known outcome. Key outcomes were medical outcomes, clinical effects, and level of care if treated in a healthcare facility. RESULTS There were 3,573 aripiprazole, 137 brexpiprazole, 249 cariprazine, and one lumateperone exposure over the period. Primary outcomes were evaluated in 2,655 cases (2,390 aripiprazole, 96 brexpiprazole, and 169 cariprazine). Fifty-one percent were male and 77% were between 0 and 2 years old. Moderate effect was coded in 16.6% of aripiprazole, 23% of brexpiprazole, and 12% of cariprazine exposures. Major effect was coded in 0.6% of aripiprazole, 1% of brexpiprazole, and 2.4% of cariprazine exposures. Duration of symptoms was mostly between 8 and 24 h for 34.6% of aripiprazole, 30% of brexpiprazole, and 32% of cariprazine exposures. Over 60% of the children seen in a health care facility were discharged from the emergency department. The lowest doses resulting in at least a moderate effect and admission to a health care facility was 0.46 mg/kg for aripiprazole, 2.1 mg/kg for brexpiprazole, and 1.9 mg/kg for cariprazine. Important clinical effects included central nervous system depression, tremors, tachycardia, agitation, and vomiting. CONCLUSION Reported ingestions of aripiprazole, brexpiprazole, or cariprazine may result in neurologic symptoms like central nervous system depression or seizures in children. The prolonged duration of symptoms resulted in admission for at least a day for many cases. Further research should address optimal monitoring time and location for these exposures.
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Affiliation(s)
- Nicholas Husak
- Department of Pharmacy, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Thomas W Laudone
- Deparment of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
| | - James B Leonard
- Maryland Poison Center, Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Fieiras C, Chen MH, Escobar Liquitay CM, Meza N, Rojas V, Franco JVA, Madrid E. Risperidone and aripiprazole for autism spectrum disorder in children: an overview of systematic reviews. BMJ Evid Based Med 2023; 28:7-14. [PMID: 35101925 DOI: 10.1136/bmjebm-2021-111804] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To assess the effectiveness and safety of risperidone and aripiprazole in children with autism spectrum disorder (ASD). DESIGN AND SETTING Overview of systematic reviews (SRs). SEARCH METHODS In October 2021, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycInfo and Epistemonikos placing no restrictions on language or date of publication. PARTICIPANTS Children aged 12 years or less with ASD. INTERVENTIONS Risperidone and aripiprazole with no dosage restrictions. DATA COLLECTION AND ANALYSIS We rated the methodological quality of the included SRs using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We reported the Grading of Recommendations, Assessment, Development and Evaluation certainty of the evidence according to the analysis conducted by the authors of the included SRs. MAIN OUTCOMES MEASURED A multidisciplinary group of experts agreed on analysing nine critical outcomes evolving core and non-core ASD symptoms. PATIENT AND PUBLIC INVOLVEMENT Organisations of parents of children with ASD were involved during part of the process, participating in external revision of the final version of the report for the Chilean Ministry of Health with no additional comments (ID 757-22-L120 DIPRECE, Ministry of Health, Chile). The organisations involved were: Fundación Unión Autismo y Neurodiversidad, Federación Nacional de Autismo, Vocería Autismo del Sur, and Vocería Autismo del Norte. RESULTS We identified 22 SRs within the scope of this overview, of which 16 were of critically low confidence according to AMSTAR 2 and were excluded from the analysis. Both aripiprazole and risperidone were effective for reducing autism symptoms severity, repetitive behaviours, inappropriate language, social withdrawal and behavioural problems compared with placebo. The certainty of the evidence for most outcomes was moderate. Risperidone and aripiprazole are associated with metabolic and neurological adverse events. Follow-up was short termed. CONCLUSIONS We found that aripiprazole and risperidone probably reduce symptom severity at short-term follow-up but may also cause adverse events. High-quality and updated SRs and larger randomised controlled trials with longer term follow-up are needed on this topic. OVERVIEW PROTOCOL PROSPERO CRD42020206535.
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Affiliation(s)
- Cecilia Fieiras
- School of Medicine, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Nicolás Meza
- Interdisciplinary Centre for Health Studies (CIESAL) - Cochrane Chile Associate Centre, Universidad de Valparaíso, Viña del Mar, Chile
| | - Valeria Rojas
- School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
- Autism program, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Juan Victor Ariel Franco
- Associate Cochrane Centre-Research Department, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Eva Madrid
- Interdisciplinary Centre for Health Studies (CIESAL) - Cochrane Chile Associate Centre, Universidad de Valparaíso, Viña del Mar, Chile
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Waters HC, Touya M, Wee SN, Ng M, Thadani S, Surendran S, Rentería M, Rush AJ, Patel R, Sarkar J, Fitzgerald HM, Han X. Psychiatric healthcare resource utilization following initiation of aripiprazole once-monthly: a retrospective real-world study. Curr Med Res Opin 2023; 39:299-306. [PMID: 36380678 DOI: 10.1080/03007995.2022.2148461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This observational retrospective real-world study examined changes in healthcare resource utilization (HCRU) pre- and post-initiation of aripiprazole once-monthly (AOM 400) in patients with schizophrenia or bipolar I disorder. METHODS Electronic health record-derived, de-identified data from the NeuroBlu Database (2013-2020) were used to identify patients ≥18 years with schizophrenia (n = 222) or bipolar I disorder (n = 129) who were prescribed AOM 400, and had visit data within 3, 6, 9, or 12 months pre- and post-initial AOM 400 prescription. Rates of inpatient hospitalization, emergency department visits, inpatient readmissions, and average length of stay were examined and compared over 3, 6, 9, and 12 months pre-/post-AOM 400 using a McNemar test. RESULTS Statistically significant differences were seen in both schizophrenia and bipolar I disorder patient cohorts pre- and post-AOM 400 in inpatient hospitalization rates (p < .001 all time points, both cohorts) and 30-day readmission per patient rates (p < .001 all time points, both cohorts). Statistically significant improvement in mean length of stay was observed in both cohorts at all time points, except for at six months in patients with schizophrenia. Emergency department visit rates were significantly lower after AOM 400 initiation for both cohorts at all time points (p < .001). CONCLUSIONS A reduction in the rate of hospitalizations, emergency department visits, 30-day readmissions, and average length-of-stay was observed for patients diagnosed with either schizophrenia or bipolar I disorder, which suggests a positive effect of AOM 400 treatment on HCRU outcomes and is supportive of earlier analyses from different data sources.
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Affiliation(s)
- Heidi C Waters
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
| | | | | | | | | | | | | | - A John Rush
- Department of Psychiatry, Duke-National University of Singapore (NUS), Singapore
- Duke University School of Medicine, Durham, NC, USA
- Texas Tech Health Sciences Center, Odessa, TX, USA
| | - Rashmi Patel
- Holmusk Technologies Inc, New York, NY, USA
- King's College London, London, UK
| | | | | | - Xue Han
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
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Yu CL, Carvalho AF, Thompson T, Tsai TC, Tseng PT, Hsu CW, Hsu TW, Liang CS. Comparison of antipsychotic dose equivalents for acute bipolar mania and schizophrenia. BMJ Ment Health 2023; 26:e300546. [PMID: 36789916 PMCID: PMC10035777 DOI: 10.1136/bmjment-2022-300546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/01/2022] [Indexed: 02/10/2023]
Abstract
QUESTION Are antipsychotic dose equivalents between acute mania and schizophrenia the same? STUDY SELECTION AND ANALYSIS Six databases were systematically searched (from inception to 17 September 2022) to identify blinded randomised controlled trials (RCTs) that used a flexible-dose oral antipsychotic drug for patients with acute mania. The mean and SD of the effective dose and the pre-post changes in manic symptoms were extracted. A network meta-analysis (NMA) under a frequentist framework was performed to examine the comparative efficacy between the antipsychotics. A classic mean dose method (sample size weighted) was used to calculate each antipsychotic dose equivalent to 1 mg/day olanzapine for acute mania. The antipsychotic dose equivalents of acute mania were compared with published data for schizophrenia. FINDINGS We included 42 RCTs which enrolled 11 396 participants with acute mania. The NMA showed that risperidone was superior to olanzapine (reported standardised mean difference: -022, 95% CI -0.41 to -0.02), while brexpiprazole was inferior to olanzapine (standardised mean difference: 0.36, 95% CI 0.08 to 0.64). The dose equivalents to olanzapine (with SD) were 0.68 (0.23) for haloperidol, 0.32 (0.07) for risperidone, 0.60 (0.11) for paliperidone, 8.00 (1.41) for ziprasidone, 41.46 (5.98) for quetiapine, 1.65 (0.32) for aripiprazole, 1.23 (0.20) for asenapine, 0.53 (0.14) for cariprazine and 0.22 (0.03) for brexpiprazole. Compared with the olanzapine dose equivalents for schizophrenia, those of acute mania were higher for quetiapine (p<0.001, 28.5%) and aripiprazole (p<0.001, 17.0%), but lower for haloperidol (p<0.001, -8.1%) and risperidone (p<0.001, -15.8%). CONCLUSIONS Antipsychotic drugs have been considered first-line treatment for acute mania, warranting specific dose equivalence for scientific and clinical purposes.
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Affiliation(s)
- Chia-Ling Yu
- Department of Pharmacy, Chang Gung Memorial Hospital Linkou, Taipei, Taiwan
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, UK
| | - Tzu-Cheng Tsai
- Department of Pharmacy, Chang Gung Memorial Hospital Linkou, Taipei, Taiwan
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chih-Wei Hsu
- Deaparment of Psychiatry, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - Tien-Wei Hsu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
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Okada Y, Inada K, Akazawa M. Comparative effectiveness of long-acting injectable antipsychotics in patients with schizophrenia in Japan. Schizophr Res 2023; 252:300-308. [PMID: 36706475 DOI: 10.1016/j.schres.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/31/2022] [Accepted: 01/15/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To compare the effectiveness of different long-acting injectable antipsychotics (LAIs) (aripiprazole, paliperidone, risperidone, and fluphenazine/haloperidol) in patients with schizophrenia in Japan. METHODS We conducted a retrospective cohort study using two administrative claims databases. The study population consisted of outpatients with schizophrenia who initiated LAIs between May 1, 2015, and November 30, 2019. We directly compared the risk of psychiatric hospitalization and LAI discontinuation among the LAIs based on hazard ratios (HRs) using Cox proportional hazards regression models. RESULTS The numbers of eligible patients who initiated aripiprazole, paliperidone, risperidone, and fluphenazine/haloperidol were 303, 124, 73, and 123, respectively. Regarding psychiatric hospitalization, aripiprazole and paliperidone were associated with significantly lower risk compared to fluphenazine/haloperidol (HR of aripiprazole: 0.47, 95 % CI: 0.28-0.78, HR of paliperidone: 0.50, 95 % CI: 0.28-0.89); HR of risperidone showed the same trend as the aripiprazole and paliperidone. Regarding LAI discontinuation, aripiprazole and paliperidone were associated with significantly lower risk of LAI discontinuation compared to fluphenazine/haloperidol (HR of aripiprazole: 0.53, 95 % CI: 95 % CI: 0.35-0.80, HR of paliperidone: 0.57, 95 % CI: 0.35-0.92). Aripiprazole was also associated with a significantly lower risk compared to risperidone (HR: 0.56, 95 % CI: 0.32-0.98). CONCLUSION Our study suggests that aripiprazole and paliperidone are superior to fluphenazine/haloperidol in the risk of psychiatric hospitalization and LAI discontinuation. Aripiprazole is superior to risperidone in the risk of LAI discontinuation.
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Affiliation(s)
- Yusuke Okada
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, Kitasato University School of Medicine, Kanagawa, Japan
| | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan.
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Ramos-Marcuse F, Kverno K. Evidence-Based Use of Atypical Antipsychotics in the Care of Children and Adolescents. J Psychosoc Nurs Ment Health Serv 2023; 61:8-11. [PMID: 36595307 DOI: 10.3928/02793695-20221207-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Atypical antipsychotics are increasingly used to treat children and adolescents with a variety of mental and behavioral symptoms, despite restrictive U.S. Food and Drug Administration indications. A recent taskforce advocates for a symptom-based approach to atypical antipsychotic use, rather than by diagnosis alone. Cautious prescribing of atypical antipsychotics should only take place after careful diagnostic assessment, review of prior treatments, and trials of other evidence-based medications. When used, monitoring metabolic indicators is crucial for the health and safety of patients. Risperidone and aripiprazole are highlighted as two different types of atypical antipsychotics commonly used to treat youth. [Journal of Psychosocial Nursing and Mental Health Services, 61(1), 8-11.].
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Ghosh P, Martinez J, Shah N, Kenan W, Fowler A, Limdi N, Burns L, Cogan ES, Gardiner A, Hain D, Johnson H, Lewis D, Shelton R, Liebelt E. Pharmacogenomic Profiling of Pediatric Patients on Psychotropic Medications in an Emergency Department. Pediatr Emerg Care 2023; 39:6-12. [PMID: 36413430 PMCID: PMC9815804 DOI: 10.1097/pec.0000000000002871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the ability of a combinatorial pharmacogenomic test to predict medication blood levels and relative clinical improvements in a selected pediatric population. METHODS This study enrolled patients between ages 3 to 18 years who presented to a pediatric emergency department with acute psychiatric, behavioral, or mental health crisis and/or concerns, and had previously been prescribed psychotropic medications. Patients received combinatorial pharmacogenomic testing with medications categorized according to gene-drug interactions (GDIs); medications with a GDI were considered "incongruent," and medications without a GDI were considered "congruent." Blood levels for escitalopram, fluoxetine, aripiprazole, and clonidine were evaluated according to level of GDI. Relative clinical improvements in response to the prescribed psychotropic medications were measured using a parent-rated Clinical Global Impression of Improvement (CGI-I) assessment, where lower scores corresponded with greater improvement. RESULTS Of the 100 patients enrolled, 73% reported taking ≥1 incongruent medication. There was no significant difference in CGI-I scores between patients prescribed congruent versus incongruent medications (3.37 vs 3.68, P = 0.343). Among patients who presented for depression or suicidal ideation, those prescribed congruent medications had significantly lower CGI-I scores compared with those taking incongruent medications ( P = 0.036 for depression, P = 0.018 for suicidal ideation). There was a significant association between medication GDI and blood levels for aripiprazole (n = 15, P = 0.01) and escitalopram (n = 10, P = 0.01). CONCLUSIONS Our preliminary findings suggest that combinatorial pharmacogenomic testing can predict medication blood levels and relative outcomes based on medication congruency in children presenting to an emergency department with acute psychiatric/behavioral crises. Additional studies will be needed to confirm these findings.
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Affiliation(s)
- Pallavi Ghosh
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine
| | - Jesse Martinez
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham Heersink School of Medicine
| | - Nipam Shah
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine
| | - Will Kenan
- Department of Biomedical and Health Sciences, The University of Alabama at Birmingham, School of Health Processions, Birmingham, AL
| | - Andrew Fowler
- Pediatric Residency Program at Arkansas Children's Hospital, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, AR
| | - Nita Limdi
- Department of Neurology, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | | | | | | | | | | | | | - Richard Shelton
- Department of Psychiatry, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | - Erica Liebelt
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine
- Department of Pediatrics, Section of Pediatric Emergency Medicine and Pharmacology and Medical Toxicology, University of Arkansas for Medical Sciences, Little Rock, AR
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Waters HC, Stellhorn R, Touya M, Fitzgerald H, Bhattacharjee S, Citrome L. The effects of early initiation of aripiprazole once-monthly on healthcare resource utilization and healthcare costs in individuals with schizophrenia: real-world evidence from US claims data. J Med Econ 2023; 26:316-325. [PMID: 36780296 DOI: 10.1080/13696998.2023.2178770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
AIM To evaluate the impact of timing of aripiprazole once-monthly (AOM) initiation on healthcare resource utilization (HCRU), risk of hospitalization, and healthcare costs in patients with schizophrenia. METHODS A retrospective cohort study was conducted using data from the Merative MarketScan database (01/01/2013-12/31/2019). Adults aged ≥18 years with a new episode of care for schizophrenia and an AOM claim were included. Patients were classified into two cohorts based on the time between the first schizophrenia diagnosis and the first AOM claim (early cohort: ≤1 year; late cohort: >1 year). All-cause and psychiatric-specific HCRU, risk of hospitalization, and healthcare costs were evaluated over 1-year post-AOM initiation. The relationship between the timing of AOM initiation and HCRU was evaluated using negative binomial regression, and healthcare costs using generalized linear models (log-link with gamma distribution). Logistic regression was used to estimate the likelihood of hospitalization during the follow up period for both all-cause and psychiatric-specific hospitalization. RESULTS A total of 945 patients were included (early cohort: n = 525; late cohort: n = 420). At baseline, the early cohort had lower mean age, a greater proportion of males, and a lower mean Charlson Comorbidity Index score than the late cohort (all p < .05). After adjusting for baseline demographic and clinical characteristics, all-cause and psychiatric-specific hospitalization during the 1-year follow-up period were statistically significantly higher for the late cohort versus the early cohort (all-cause: incident rate ratio [IRR] = 1.63, 95% confidence interval [CI]: 1.28-2.07, p < .01; psychiatric-specific: IRR = 1.93, 95% CI: 1.46-2.55, p < .01). The early cohort had statistically significantly lower adjusted all-cause ($21,686 versus $29,033; p = .0002) and psychiatric-specific ($24,414 versus $32,461; p = .0002) healthcare costs versus the late cohort. LIMITATIONS This study utilized claims data, which are intended for administrative purposes rather than for research. CONCLUSIONS This analysis extends previous evidence for the benefits of AOM in patients with new episodes of schizophrenia, by demonstrating lower HCRU, risk of hospitalization, and healthcare costs with early AOM initiation compared with later initiation.
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Affiliation(s)
- Heidi C Waters
- Otsuka Pharmaceutical Development and Commercialization Inc, Princeton, NJ, USA
| | - Robert Stellhorn
- Otsuka Pharmaceutical Development and Commercialization Inc, Princeton, NJ, USA
| | | | | | | | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
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Tang Y, Wu Y, Li X, Hao Q, Deng W, Yue W, Yan H, Zhang Y, Tan L, Chen Q, Yang G, Lu T, Wang L, Yang F, Zhang F, Yang J, Li K, Lv L, Tan Q, Zhang H, Ma X, Li L, Wang C, Ma X, Zhang D, Yu H, Zhao L, Ren H, Wang Y, Zhang G, Li C, Du X, Hu X, Li T, Wang Q. Early Efficacy of Antipsychotic Medications at Week 2 Predicts Subsequent Responses at Week 6 in a Large-scale Randomized Controlled Trial. Curr Neuropharmacol 2023; 21:424-436. [PMID: 36411567 PMCID: PMC10190139 DOI: 10.2174/1570159x21666221118164612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/25/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Since the early clinical efficacy of antipsychotics has not yet been well perceived, this study sought to decide whether the efficacy of antipsychotics at week 2 can predict subsequent responses at week 6 and identify how such predictive capacities vary among different antipsychotics and psychotic symptoms. METHODS A total of 3010 patients with schizophrenia enrolled in a randomized controlled trial (RCT) and received a 6-week treatment with one antipsychotic drug randomly chosen from five atypical antipsychotics (risperidone 2-6 mg/d, olanzapine 5-20 mg/d, quetiapine 400-750 mg/d, aripiprazole 10-30 mg/d, and ziprasidone 80-160 mg/d) and two typical antipsychotics (perphenazine 20-60 mg/d and haloperidol 6-20 mg/d). Early efficacy was defined as the reduction rate using the Positive and Negative Syndrome Scale (PANSS) total score at week 2. With cut-offs at 50% reduction, logistic regression, receiver operating characteristic (ROC) and random forests were adopted. RESULTS The reduction rate of PANSS total score and improvement of psychotic symptoms at week 2 enabled subsequent responses to 7 antipsychotics to be predicted, in which improvements in delusions, lack of judgment and insight, unusual thought content, and suspiciousness/ persecution were endowed with the greatest weight. CONCLUSION It is robust enough to clinically predict treatment responses to antipsychotics at week 6 using the reduction rate of PANSS total score and symptom relief at week 2. Psychiatric clinicians had better determine whether to switch the treatment plan by the first 2 weeks.
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Affiliation(s)
- Yiguo Tang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Yulu Wu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Xiaojing Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - QinJian Hao
- The Center of Gerontology and Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Deng
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weihua Yue
- Peking University Sixth Hospital, Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Hao Yan
- Peking University Sixth Hospital, Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Yamin Zhang
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Liwen Tan
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qi Chen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guigang Yang
- Beijing Anding Hospital, Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Tianlan Lu
- Peking University Sixth Hospital, Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Lifang Wang
- Peking University Sixth Hospital, Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Fude Yang
- Beijing HuiLongGuan Hospital, Beijing, China
| | - Fuquan Zhang
- Wuxi Mental Health Center, Nanjing Medical University, Wuxi, China
| | - Jianli Yang
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China
- Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Keqing Li
- Hebei Mental Health Center, Baoding, Hebei, China
| | - Luxian Lv
- Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Qingrong Tan
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Hongyan Zhang
- Wuxi Mental Health Center, Nanjing Medical University, Wuxi, China
| | - Xin Ma
- Beijing Anding Hospital, Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Lingjiang Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chuanyue Wang
- Beijing Anding Hospital, Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Xiaohong Ma
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Dai Zhang
- Peking University Sixth Hospital, Institute of Mental Health, Beijing, China
- National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Hao Yu
- Department of Psychiatry, Jining Medical University, Jining, China
| | - Liansheng Zhao
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Hongyan Ren
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Yingcheng Wang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Guangya Zhang
- Department of Psychiatry, Suzhou Psychiatric Hospital, Suzhou, China
- The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Chuanwei Li
- Department of Psychiatry, Suzhou Psychiatric Hospital, Suzhou, China
- The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- Department of Psychiatry, Suzhou Psychiatric Hospital, Suzhou, China
- The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xun Hu
- The Clinical Research Center and the Department of Pathology, Affiliated Second Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tao Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qiang Wang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
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Dashti S, Nahavandi A. Neuroprotective effects of aripiprazole in stress-induced depressive-like behavior: Possible role of CACNA1C. J Chem Neuroanat 2022; 126:102170. [PMID: 36270562 DOI: 10.1016/j.jchemneu.2022.102170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/07/2022] [Accepted: 10/15/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Depression is the most common psychiatric disorder. Recently, aripiprazole, a novel antipsychotic drug, has been approved as the adjunctive therapy for the Treatment-Resistant Depression (TRD). However, the mechanisms underlying the antidepressant effects of aripiprazole are not fully known. Besides the involvement of calcium signaling dysregulations in the pathophysiology of depression, there is some evidence of overexpressed CACNA1C (the gene encoding the Cav1.2 channels) following chronic stress in the brain regions, which involved in emotional and stress responses. Based on the data indicating the aripiprazole's effects on intracellular calcium levels, this study aimed to investigate the mechanisms of therapeutic effects of aripiprazole, by a focus on the modulation of CACNA1C expression, in the rat stress-induced model of depression. METHODS Using Chronic Unpredictable Mild Stress (CUMS) model of depression, we examined the effects of aripiprazole on depressive and anxiety-like behaviors (by forced swimming test and elevated plus maze), serum IL-6 (Elisa), and cell survival (Nissl staining). In addition, CACNA1C, BDNF, and TrkB expression in the PFC and hippocampus (RT-qPCR), as well as BDNF and GAP-43 protein levels in the hippocampus (Immunohistofluorescence), have been assayed. RESULTS Our data indicated that aripiprazole could improve anxiety and depressive-like behaviors, decrease the serum levels of IL-6 and hippocampal cell death following CUMS. In addition, we showed the significant modulation on overexpressed CACNA1C, as well as downregulated BDNF and GAP-43 expression DISCUSSION: These results demonstrate that aripiprazole may promote synaptic plasticity by improving the expression of BDNF and gap-43. In addition, inflammation reduction and CACNA1C expression downregulation may be some of mechanisms by which aripiprazole alleviates chronic stress-induced hippocampal cell death and play its pivotal antidepressant role.
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Affiliation(s)
- Somayeh Dashti
- Department of Physiology, Faculty of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Arezo Nahavandi
- Department of Physiology, Faculty of Medicine, Iran University of Medical Science, Tehran, Iran; Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Science, Tehran, Iran; Neuroscience Research Center, Iran University of Medical Science, Tehran, Iran.
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