Identifying dopamine supersensitivity through a randomized controlled study of switching to aripiprazole from other antipsychotic agents in patients with schizophrenia.
aripiprazole
dopamine supersensitivity psychosis
switching
Journal
Therapeutic advances in psychopharmacology
ISSN: 2045-1253
Titre abrégé: Ther Adv Psychopharmacol
Pays: England
ID NLM: 101555693
Informations de publication
Date de publication:
2022
2022
Historique:
received:
05
11
2021
accepted:
16
11
2021
entrez:
3
2
2022
pubmed:
4
2
2022
medline:
4
2
2022
Statut:
epublish
Résumé
Aripiprazole has been reported to worsen psychotic symptoms when switching from other antipsychotics, possibly due to dopamine supersensitivity psychosis. This study aimed to explore the predictors and possible underlying mechanisms of aripiprazole-related psychotic exacerbation. We conducted an 8-week, open-label, randomized controlled study from October 2007 to September 2009, assigning patients with a primary diagnosis of schizophrenia or schizoaffective disorder to switch from other antipsychotics to aripiprazole with 2-week dual administration, and then to taper off the original agents in fast (n = 38, within 1 week) or slow (n = 41, within 4 weeks) strategies. Positive and Negative Syndrome Scale (PANSS) was examined at day 0, 7, 14, 28, 56. Aripiprazole-related exacerbation (ARE) was defined positive as a 2-point increase in delusion/hallucination dimension score within 28 days compared with baseline. Baseline demographic, clinical and intervention-related variables were compared between the ARE+ and ARE- groups. Of the 79 randomized patients, 21 fulfilled the criteria of ARE+ , and 46 were classified as ARE-. Fourteen patients in the ARE+ group had worsening psychotic symptoms in the first and second weeks. Compared with the ARE- group, the ARE+ group had a higher baseline chlorpromazine equivalent dose (405.8 ± 225.8 mg vs 268.1 ± 165.4 mg, A higher dose of original antipsychotics and prescription of first-generation antipsychotics may be associated with a higher risk of ARE. The underlying mechanism might be covert dopamine supersensitivity psychosis. These findings may help to identify high-risk patients and guide appropriate treatment strategies. ClinicalTrials.gov, identifier: NCT00545467.
Sections du résumé
BACKGROUND
BACKGROUND
Aripiprazole has been reported to worsen psychotic symptoms when switching from other antipsychotics, possibly due to dopamine supersensitivity psychosis.
OBJECTIVE
OBJECTIVE
This study aimed to explore the predictors and possible underlying mechanisms of aripiprazole-related psychotic exacerbation.
METHODS
METHODS
We conducted an 8-week, open-label, randomized controlled study from October 2007 to September 2009, assigning patients with a primary diagnosis of schizophrenia or schizoaffective disorder to switch from other antipsychotics to aripiprazole with 2-week dual administration, and then to taper off the original agents in fast (n = 38, within 1 week) or slow (n = 41, within 4 weeks) strategies. Positive and Negative Syndrome Scale (PANSS) was examined at day 0, 7, 14, 28, 56. Aripiprazole-related exacerbation (ARE) was defined positive as a 2-point increase in delusion/hallucination dimension score within 28 days compared with baseline. Baseline demographic, clinical and intervention-related variables were compared between the ARE+ and ARE- groups.
RESULTS
RESULTS
Of the 79 randomized patients, 21 fulfilled the criteria of ARE+ , and 46 were classified as ARE-. Fourteen patients in the ARE+ group had worsening psychotic symptoms in the first and second weeks. Compared with the ARE- group, the ARE+ group had a higher baseline chlorpromazine equivalent dose (405.8 ± 225.8 mg vs 268.1 ± 165.4 mg,
CONCLUSIONS
CONCLUSIONS
A higher dose of original antipsychotics and prescription of first-generation antipsychotics may be associated with a higher risk of ARE. The underlying mechanism might be covert dopamine supersensitivity psychosis. These findings may help to identify high-risk patients and guide appropriate treatment strategies.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov, identifier: NCT00545467.
Identifiants
pubmed: 35111295
doi: 10.1177/20451253211064396
pii: 10.1177_20451253211064396
pmc: PMC8801645
doi:
Banques de données
ClinicalTrials.gov
['NCT00545467']
Types de publication
Journal Article
Langues
eng
Pagination
20451253211064396Informations de copyright
© The Author(s), 2022.
Déclaration de conflit d'intérêts
Conflict of interest statement: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Tzung-Jeng Hwang has received a research grant from AstraZeneca and honoraria from AstraZeneca, Taiwan Otsuka Pharmaceutical Co., and Eli Lilly and Company. Drs. Chia-Hao Ma, Hung-Yu Chan, Ming H. Hsieh, Chen-Chun Liu, Chih-Min Liu, Hai-Gwo Hwu, Ching-Hua Kuo, and Wei J. Chen report no other financial disclosures relevant to the subject of this article.
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