Aripiprazole psychosis

Extrapyramidal side-effects generally appear with blockade of dopamine D2 receptors in excess of 80%, whereas clinical efficacy in treating psychosis is associated with 60-70% D2 receptor blockade [12]. Recently, a partial agonist for the D2 receptor known as aripiprazole has been developed, which results in approximately 70% antagonism/30% agonism at the D2 receptor. It is an effective antipsychotic, has low risk for extrapyramidal symptoms, and does not cause elevated levels of prolactin as do the full antagonists at D2 receptors. 

Atypical antipsychotics may be helpful in managing the delusions and agitated behavior that can accompany dementia. These medications, include risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and olanzapine (Zyprexa). All antipsychotics, typical and atypical, appear to increase the risk of death in patients with dementia and psychosis. This appears as a warning in the package inserts of the newer drugs. A prudent approach is to discuss this risk with the caregiver, use the lowest effective dose, and monitor for effectiveness. 

Atypical antipsychotics cause fewer EPS than do conventional antipsychotics. Clozapine and quetiapine are the least likely to cause EPS and are therefore recommended for treatment of psychosis in patients with Parkinson s disease. With the notable exception of risperidone, atypical antipsychotics cause substantially less hyperprolactinemia than do conventional antipsychotics. Weight gain is a side effect of all atypical antipsychotics except ziprasidone and aripiprazole. Concerns about cardiac conduction delay with ziprasidone therapy exist and warrant consideration in patients who have... 

Although relatively little has thus far been written about it, the newer neuroleptics can also cause akinesia, depression, psychosis, and suicidality. Aripiprazole (Abilify) has already been reported to cause or worsen psychosis (Grover et al., 2006 Raja, 2007). I have seen several cases in which olanzapine (Zyprexa) has caused zombielike behavior and profound depression. As chapter 2 also documented, all of the newer neuroleptics, including Risperdal, Geodon, and Seroquel, suppress dopaminergic function (dopamine D2), the most probable neurochemical cause of these clinical states (Wu et al., 2007). 

Grover, S., Sharan, P., Gupta, N. (2006). Aripiprazole worsens psychosis A case report. Primary Care Companion Journal of Clinical Psychiatry 8, 380-381. 

Worsening of a psychosis has also been reported in four patients who took aripiprazole, two during tapering reduction of a previous atypical antipsychotic drug and two when aripiprazole was added to an atypical antipsychotic (12). 

Ramaswamy S, Vijay D, William M, Sattar SP, Praveen F, Petty F. Aripiprazole possibly worsens psychosis. Int Clin Psychopharmacol 2004 19(l) 45-8. 

No placebo-controUed trials are currently available evaluating quetiapine, ziprasidone, or aripiprazole in psychosis of dementia. An open-label study suggests possible effect and good tolerability with quetiapine. For patients who respond inadequately, have elevated cardiovascular risk, or who have unacceptable side effects... 

Bandelow B, Meier A. Aripiprazole, a dopaminergic-serotonin system stabilizer in the treatment of psychosis. German J Psychiatry 2003 6 9-16. 

Selvaraj V, Ramaswamy S, Sharma A, Wilson D. New-onset psychosis and emergence of suicidal ideation with aripiprazole. Am J Psychiatry 2010 167 1535-6. 

Lin WC, Chou YH. Aripiprazole effects on psychosis and chorea in a patient with... 

A 19-year-old white male with a history of multiple drug abuse, psychosis, depression and attention-deficit hyperactivity disorder used an unknown quantity of MXE IV for abuse shortly before he was discharged from an inpatient detoxification facility. He was on bupropion, aripiprazole and chlorprothixene. About 30 min after the injection, he presented to the ER of the hospital with extreme agitation, ataxia and semistuporous state. 

Hyperprolactinemia can lead to hypogonadism secondary to prolactin s inhibitory effects on the hypothalamic-pituitary-gonadal hormonal axis. A 35-year-old female with psychosis and history of 7years of treatment with different antipsychotics presented with hypogonadism and radiological evidence of a pituitary microadenoma while on amisulpride and aripiprazole [53 ]. The authors did not relate the microadenoma to the hyperprolactinema and commented on the difficulty of treating these disorders. 

Crespo-Facorro B, P4rez-Iglesias R, Mata 1, Ortiz-Garcia de la Foz V, Martinez-Garcia O, Valdizan EM, et al. Aripiprazole, ziprasidone, and quetiapine in the treatment of first-episode nonaffective psychosis results of a 6-week, randomized, flexible-dose, open-label comparison. J CHn Psychopharmacol 2013 33(2) 215-20. 

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