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Role of aripiprazole in treatment-resistant schizophrenia

About one third of patients with schizophrenia respond unsatisfactorily to antipsychotic treatment and are termed “treatment-resistant”. Clozapine is still the gold standard in these cases. However, 40%–70% of patients do not improve sufficiently on clozapine either. In the search for more efficacio...

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Autores principales: Mossaheb, Nilufar, Kaufmann, Rainer M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373202/
https://www.ncbi.nlm.nih.gov/pubmed/22701324
http://dx.doi.org/10.2147/NDT.S13830
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author Mossaheb, Nilufar
Kaufmann, Rainer M
author_facet Mossaheb, Nilufar
Kaufmann, Rainer M
author_sort Mossaheb, Nilufar
collection PubMed
description About one third of patients with schizophrenia respond unsatisfactorily to antipsychotic treatment and are termed “treatment-resistant”. Clozapine is still the gold standard in these cases. However, 40%–70% of patients do not improve sufficiently on clozapine either. In the search for more efficacious strategies for treatment-resistant schizophrenia, drugs with different pharmacological profiles seem to raise new hopes, but are they valid? The aim of this review was to evaluate the evidence for aripiprazole as a potential strategy in monotherapy or combination therapy for patients with treatment-resistant schizophrenia. The evidence for aripiprazole monotherapy and for the combination of aripiprazole with psychotropics other than clozapine is scant, and no recommendation can be made on the basis of the currently available data. More effort has been made in describing combinations of aripiprazole and clozapine. Most of the open-label and case studies as well as case reports have shown positive effects of this combination on overall psychopathology and to some extent on negative symptoms. Several reports describe the possibility of dose reduction for clozapine in combination with aripiprazole, a strategy that might help so-called “treatment-intolerant” patients. The findings of four randomized controlled trials with respect to changes in psychopathology seem less conclusive. The most commonly found beneficial effects are better metabolic outcomes and indicators of the possibility of reducing the clozapine dose. However, other side effects, such as akathisia, are repeatedly reported. Further, none of the studies report longer-term outcomes. In the absence of alternatives, polypharmacy is a common strategy in clinical practice. Combining aripiprazole with clozapine in clozapine-resistant or clozapine-intolerant patients seems to be worthy of further investigation from the pharmacological and clinical points of view.
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spelling pubmed-33732022012-06-13 Role of aripiprazole in treatment-resistant schizophrenia Mossaheb, Nilufar Kaufmann, Rainer M Neuropsychiatr Dis Treat Review About one third of patients with schizophrenia respond unsatisfactorily to antipsychotic treatment and are termed “treatment-resistant”. Clozapine is still the gold standard in these cases. However, 40%–70% of patients do not improve sufficiently on clozapine either. In the search for more efficacious strategies for treatment-resistant schizophrenia, drugs with different pharmacological profiles seem to raise new hopes, but are they valid? The aim of this review was to evaluate the evidence for aripiprazole as a potential strategy in monotherapy or combination therapy for patients with treatment-resistant schizophrenia. The evidence for aripiprazole monotherapy and for the combination of aripiprazole with psychotropics other than clozapine is scant, and no recommendation can be made on the basis of the currently available data. More effort has been made in describing combinations of aripiprazole and clozapine. Most of the open-label and case studies as well as case reports have shown positive effects of this combination on overall psychopathology and to some extent on negative symptoms. Several reports describe the possibility of dose reduction for clozapine in combination with aripiprazole, a strategy that might help so-called “treatment-intolerant” patients. The findings of four randomized controlled trials with respect to changes in psychopathology seem less conclusive. The most commonly found beneficial effects are better metabolic outcomes and indicators of the possibility of reducing the clozapine dose. However, other side effects, such as akathisia, are repeatedly reported. Further, none of the studies report longer-term outcomes. In the absence of alternatives, polypharmacy is a common strategy in clinical practice. Combining aripiprazole with clozapine in clozapine-resistant or clozapine-intolerant patients seems to be worthy of further investigation from the pharmacological and clinical points of view. Dove Medical Press 2012 2012-05-29 /pmc/articles/PMC3373202/ /pubmed/22701324 http://dx.doi.org/10.2147/NDT.S13830 Text en © 2012 Mossaheb and Kaufmann, publisher and licensee Dove Medical Press Ltd This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
spellingShingle Review
Mossaheb, Nilufar
Kaufmann, Rainer M
Role of aripiprazole in treatment-resistant schizophrenia
title Role of aripiprazole in treatment-resistant schizophrenia
title_full Role of aripiprazole in treatment-resistant schizophrenia
title_fullStr Role of aripiprazole in treatment-resistant schizophrenia
title_full_unstemmed Role of aripiprazole in treatment-resistant schizophrenia
title_short Role of aripiprazole in treatment-resistant schizophrenia
title_sort role of aripiprazole in treatment-resistant schizophrenia
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373202/
https://www.ncbi.nlm.nih.gov/pubmed/22701324
http://dx.doi.org/10.2147/NDT.S13830
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