Open-label study comparing the efficacy and tolerability of aripiprazole and haloperidol in the treatment of pediatric tic disorders

Due to its unique pharmacodynamic properties of dopamine partial agonist activity, and its association with few and mild side effects, aripiprazole is a candidate atypical antipsychotic for patients with tic disorders. This open-label study compared the efficacy and tolerability of aripiprazole with haloperidol, a typical antipsychotic widely used to treat patients with tic disorders. Forty-eight children and adolescents with tic disorders were recruited from the outpatient clinic at South Korea and treated with aripiprazole (initial dose, 5.0 mg/d; maximum dose 20 mg/d) or haloperidol (initial dose, 0.75 mg/d; maximum dose, 4.5 mg/d) for 8 weeks. Treatment efficacy was measured using the yale global tic severity scale (YGTSS), and tolerability was measured using the extrapyramidal symptom rating scale (ESRS) and an adverse effects checklist. Total tic scores as measured by the YGTSS decreased over time in both groups (p < 0.001) without any significant differences between groups. ESRS scores were significantly higher in the haloperidol group during the 4 weeks after commencement of medication (p < 0.05). These results indicate that aripiprazole may be a promising drug in the treatment of children and adolescents with tic disorders. Further controlled studies are needed to determine the efficacy and tolerability of aripiprazole in these patients

Efficacy and safety of aripiprazole in the treatment of bipolar disorder: a systematic review

Abstract BACKGROUND: The current article is a systematic review concerning the efficacy and safety of aripiprazole in the treatment of bipolar disorder. METHODS: A systematic Medline and repositories search concerning the usefulness of aripiprazole in bipolar disorder was performed, with the combination of the words 'aripiprazole' and 'bipolar'. RESULTS: The search returned 184 articles and was last updated on 15 April 2009. An additional search included repositories of clinical trials and previous systematic reviews specifically in order to trace unpublished trials. There were seven placebo-controlled randomised controlled trials (RCTs), six with comparator studies and one with add-on studies. They assessed the usefulness of aripiprazole in acute mania, acute bipolar depression and during the maintenance phase in comparison to placebo, lithium or haloperidol. CONCLUSION: Aripiprazole appears effective for the treatment and prophylaxis against mania. The data on bipolar depression are so far negative, however there is a need for further study at lower dosages. The most frequent adverse effects are extrapyramidal signs and symptoms, especially akathisia, without any significant weight gain, hyperprolactinaemia or laboratory test changes

The emerging modern face of mood disorders: a didactic editorial with a detailed presentation of data and definitions

The present work represents a detailed description of our current understanding and knowledge of the epidemiology, etiopathogenesis and clinical manifestations of mood disorders, their comorbidity and overlap, and the effect of variables such as gender and age. This review article is largely based on the 'Mood disorders' chapter of the Wikibooks Textbook of Psychiatry http://en.wikibooks.org/wiki/Textbook_of_Psychiatry/Mood_Disorders

Effectiveness and tolerability of aripiprazole in a real-world outpatient population of youth

Amaç: Ayaktan tedavi edilen ergen hastalarda aripipra- zolün endikasyon dışı kullanım özelliklerini belirlemek ve geniş bir yelpazede ruhsal belirti ve bozukluk gösteren ergenlerin tedavisinde aripiprazolün etkinliğini ve tolerabi- litesini saptamaktır. Yöntem: Hasta dosyaları geriye dönük kayıt taraması yöntemiyle değerlendirilmiştir. Klinik Global izlenim (KGİ) ölçekleri, Kısa Semptom Envanteri (KSE) ve Extrapyramidal Belirtileri Değerlendirme Ölçeği kullanılmıştır. Bulgular: Otuz bir hastanın verisine ulaşıldı. Örneklemin çoğu kız hastadan oluşmaktadır (%87.1). Ortalama yaş 16.38±1.14’dir ve 15-19 yaş arasındadır. Hastaların %67,8’inin en az bir komorbid bozukluğu vardır. En sık komorbid bozukluk, major depresif bozukluktur. Aripiprazolün ortala- ma başlangıç dozu 4.83±3.59 mg’dır (ranj:2,5-20 mg/ gün) ve son vizitteki ortalama doz 8.62±3.46 mg’dır. (ranj:2,5-15 mg/ gün). Ortalama aripiprazol tedavi süresi 19.56±1.23 aydır (ranj:4-48 ay). Son vizit KGİ şiddet puanları, başlangıç puanlarına göre anlamlı derecede daha düşüktür (p<0.001). Benzer şekilde, KSE depresyon (z: -3.232; p:0.001), KSE ank- siyete (z: -3.004; p:0.003), KSE hostilite (z:-3.207; p:0.001), KSE psikotisizm (z: -1.973; p:0.049), and KSE paranoid düşünceler (z:2.733; p:0.006) alt ölçek puanları istatiksel açıdan anlamlı farklılık göstermiştir. KSE Global Rahatsızlık Ölçek puanları arasında da, istatiksel açıdan anlamlı fark- lılık bulunmuştur (Rahatsızlık ciddiyeti indeksi: z: -2.987; p:0.003, Semptom rahatsızlık indeksi: z:-3.435; p:0.001 ve Belirti toplamı: z: -3.023; p:0.003). Altı hasta ilaç tedavisini kesmiştir. En sık istenmeyen etkiler yorgunluk (%50.0), uyuşukluk hali (%42.9) ve sersemliktir (%39.30). En şid- detli ekstrapiramidal belirtiler yavaşlık ve zafiyet olduğu izlenimi, günlük işleri yapmada güçlük (%11.5) ve bacakta, sırtta veya boyunda kramp ya da ağrı (%11.5)’dır. Olguların hiçbirinde bedende veya uzuvlarda anormal istem dışı hareketler saptanmamıştır. Sonuç: Aripiprazol, hastalar tarafından klinik pratiğimiz- de oldukça iyi tolere edilmiştir ve ayaktan tedavi edilen ergenlerde güvenli ve etkili bir seçenek olarak görünmek- tedir. Ancak, ileriye dönük randomize kontrollü çalışmaların yapılması gereklidir.Objectives: To identify the pattern of initiation for off- label use of aripiprazole among adolescent outpatients; determine whether or not aripiprazole is effective and tolerable for the treatment of adolescents with a wide range of psychiatric symptoms and disorders or not. Methods: Medical charts were retrospectively reviewed for the effectiveness and tolerability of aripiprazole. The Clinical Global Impression Scale (CGI), the Brief Symptom Inventory (BSI), and the Extrapyramidal Symptom Rating Scale were used. Results: The data were available on 31 patients. The sample consisted of mostly females (87.1%). The mean age was 16.38&plusmn;1.14 years, and the ages range was 15-19 years. Twenty-one patients (67.8%) had at least one comorbid disorder. The most common comorbid disorder was major depressive disorder. The mean initial dosage of aripiprazole was 4.83&plusmn;3.59 mg (2.50 mg - 20.00 mg), and the mean endpoint dosage was 8.62&plusmn;3.46 mg (2.50 mg - 15.00 mg). The mean duration of aripiprazole medication was 19.56&plusmn;1.23 months (range: 4-48 months). Endpoint CGI-S scores were significantly lower compared with baseline CGI-S score (p&lt;0.001). Similarly, the difference between depression severity (z=-3.232; p=0.001), anxiety severity (z=-3.004; p=0.003), hostility severity (z=-3.207; p=0.001), psychoticism severity (z=-1.973; p=0.049), and paranoid ideation severity (z=2.733; p=0.006) scores were statistically significant. The difference between the baseline and endpoint BSI Global Indices of distress scores were found to be statistically significant (The Global Severity Index: z=-2.987; p=0.003, the Positive Symptom Distress Index: z=-3.435; p=0.001, and the Positive Symptom Total: z=-3.023; p=0.003). Six cases (20.0%) discontinued the treatment. The most frequent adverse effects were asthenia (50.0%), somnolence (42.9%), and dizziness (39.30%). The most severe extrapyramidal symptoms were: impression of slowness or weakness, difficulty in carrying out routine tasks (11.5%), and tonic muscular contractions localized to one or several muscle groups, particularly in the throat, neck or back (11.5%). None of the cases had abnormal involuntary movements (dyskinesia) of the extremities or trunk. Conclusion: Aripiprazole was well tolerated and effective in our clinical practice and appears to be a safe and efficacious alternative in adolescents. However, a prospective clinical trial with a randomized controlled design is warranted