Principles of treatment for the mentally disordered offender
John C. Gunn, Pamela J. Taylor in Forensic Psychiatry, 2014
There is worldwide consensus that aripiprazole is effective against positive and negative symptoms of schizophrenia or schizo-affective disorder, and is safe and well-tolerated (Kane et al., 2002; Swainston et al., 2004; Sullivan et al., 2007). It may have an advantage over typical and atypical antipsychotics other than clozapine in medication resistant schizophrenia (Kane et al., 2007). Its effectiveness in agitation with mania (Zimbroff et al., 2007) or other psychosis (Tran-Johnson et al., 2007) has been demonstrated when used in injectable form. In the latter study, 50 centres collaborated, yielding 357 patient participants. The Positive and Negative Syndrome Scale-Excited Component score was reduced after 45 minutes, compared with 105 minutes for haloperidol.
Depressive Phase of Bipolar Disorder
Dr. Ather Muneer in Mood Disorders, 2018
Aripiprazole is also referred to as a “third generation antipsychotic” and shows the pharmacodynamic characteristics of partial agonism, functional selectivity and serotonin-dopamine activity modulation. It is well studied in different phases of BD and is FDA licensed for manic and mixed episodes of BD type I as monotherapy, and as maintenance treatment in conjunction with a mood stabilizer. Two RCTs of aripiprazole (flexibly dosed from 5–30 mg/d) were conducted in bipolar depression as standalone therapy in comparison to placebo. These were multicenter, eight-week trials of outpatients with nonpsychotic bipolar I depression; the studies were well-powered and utilized change in MADRS total score as the primary outcome measure. CGI-BP depression severity sub-score was the chief secondary assessment parameter; LOCF was used to account for drop-outs. The active agent showed an early difference from placebo treatment, but at week 8 failed to demonstrate statistically significant superiority on both key primary and secondary efficacy measures. Aripiprazole was less well tolerated than placebo, with a higher incidence of akathisia, insomnia, nausea, fatigue, restlessness and dry mouth. In controlled conditions, aripiprazole was not found to be effective for the treatment of acute depressive episodes in BD type I.34
Stimulant Use Disorder
James MacKillop, George A. Kenna, Lorenzo Leggio, Lara A. Ray in Integrating Psychological and Pharmacological Treatments for Addictive Disorders, 2017
Aripiprazole acts primarily as a partial agonist at D2 receptors on dopamine [77, 78]. It is also a 5-hydroxytryptamine (5-HT)1A agonist and a 5-HT2A receptor antagonist. As a partial D2 agonist, aripiprazole should function as a replacement medication when dopamine levels are low, as in withdrawal, and as an antagonist when dopamine levels are high, as is the case during active use. However, results of randomized, placebo-controlled trials of aripiprazole in PUD did not show reduction in drug use, and a worsening in craving measures was reported [79, 80]. The trials were stopped early. A similar pattern of results was found for risperidone, an atypical antipsychotic. Open-label studies were positive with reduction in drug use from an average of 4.1 days of use per week to one day [81, 82]; however, one double-blind randomized trial found no effect on cocaine use or treatment retention [83].
An aripiprazole related false positive amphetamine case in urine drug screen
Published in Journal of Substance Use, 2020
Urine drug screens (UDSs) are widely used methods to determine substance use in psychiatry practice given that substance use contributes to relapses, poor prognosis, behavioral disturbances and low adherence to treatments in psychiatric disorders (Bagoien et al., 2009). However, recent studies have shown that the accuracy of on-site drug screening tests might be confounding, emphasizing the importance of interpreting laboratory findings in a comprehensive manner that includes an individual’s clinical presentation (Moeller et al., 2017). Some commonly prescribed medications, including antipsychotics, were reported to be associated with false positive results in UDSs (Brahm et al., 2010). Aripiprazole is a partial dopamine agonist antipsychotic medication used in the treatment of schizophrenia and bipolar disorders. Relative to other antipsychotics, aripiprazole has been reported to have a more advantageous side effect profile, including a lower incidence of extrapyramidal symptoms, and to even have the ability to improve the parameters of metabolic profiles (Hirose et al., 2004; Wani et al., 2015). In this report, we present a case diagnosed with bipolar disorder who was admitted to hospital after a manic episode and found to have an aripiprazole-related positive amphetamine urine drug test in follow-up.
Aripiprazole for the treatment of Tourette syndrome
Published in Expert Review of Neurotherapeutics, 2021
Joanna H. Cox, Andrea E. Cavanna
A full picture of the multiple mechanisms of action of aripiprazole is yet to be fully elucidated, although it is thought to act on various receptors within the dopaminergic and serotonergic pathways. Its primary mechanism of action at the level of D2 dopamine receptors is thought to affect mesolimbic and mesocortical dopaminergic pathways [53]. There is also evidence that aripiprazole works as a partial receptor agonist at the 5-HT1A serotonergic receptor [54]. Serotoninergic underactivity has been implicated in the pathophysiology of depression and anxiety, and thus partial agonism at this level is likely to improve affective symptoms, which are prominent in both psychotic disorders and neurodevelopmental disorders including TS. Aripiprazole has also been shown to act as an antagonist at the 5-HT2A serotonergic receptor. In addition to actions on the dopaminergic and serotonergic pathways, animal studies have shown that aripiprazole acts on a wide variety of other relevant central nervous system receptors including those involved in adrenergic and histaminergic pathways.
An update on pharmacotherapy of autism spectrum disorder in children and adolescents
Published in International Review of Psychiatry, 2018
Ritu Goel, Ji Su Hong, Robert L. Findling, Na Young Ji
Aripiprazole was approved by the FDA for treatment of irritability in children with ASD following two large RDBPC trials that demonstrated its efficacy in the reduction of irritability, hyperactivity, and stereotypy (Marcus et al., 2009; Owen et al., 2009). The effects of aripiprazole were maintained long-term in one of the clinical trials (Findling et al., 2014). Similarly, another recent large RDBPC trial found that aripiprazole improved irritability, hyperactivity, and global functioning, and was well tolerated in a paediatric ASD population in Japan (Ichikawa et al., 2016). This study also found that aripiprazole decreased prolactin levels compared to placebo, possibly due to its dopamine D2 receptor partial agonist action. Common side-effects across trials of aripiprazole were sedation, somnolence, weight gain, increased appetite, vomiting, and extrapyramidal symptoms (EPS) (see Table 1). Significant lowering of high-density lipoprotein was reported, but only a small increase in total cholesterol, low-density lipoprotein, triglycerides, and blood glucose were observed (Marcus et al., 2011). No significant differences were observed in the improvement of irritability measures in a head-to-head trial of risperidone and aripiprazole (Ghanizadeh, Sahraeizadeh, & Berk, 2014).
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