Aripiprazole Long-Acting Injection During First Episode Schizophrenia—An Exploratory Analysis

Gloria Giordano,Emanuela Amici,Ilaria Cuomo,Filippo Perrini,Georgios D Kotzalidis,Gemma Callovini,Alfonso Carannante,Lorenzo Tomassini,Sergio De Filippis

doi:10.3389/fpsyt.2019.00935

Gloria Giordano, Emanuela Amici + Show 7 more

Open Access

https://doi.org/10.3389/fpsyt.2019.00935

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Abstract

Background: Long-acting injectable (LAI) aripiprazole was found to be efficacious in schizophrenia. In common clinical practice, the use of LAIs is often restricted to chronic patients with frequent relapses and poor adherence. Recently, some investigators advanced the idea of early LAI use also in young people with schizophrenia at their first psychotic episode (FEP). Objective: Our study aimed to assess the effect of LAI aripiprazole once monthly (AOM) in the treatment of FEP in patients aged 18–26 years. Methods: We included 50 patients with DSM-5 schizophrenia as assessed with SCID, and used the Clinical Global Impressions Scale-Severity of Illness (CGI-S) and the Positive and Negative Syndrome Scale (PANSS) to assess symptom severity and the World Health Organization Quality of Life (WHOQOL), the Short Form Health Survey (SF-36) and the Personal and Social Performance Scale (PSP) to assess quality of life (QoL) and global health perception at baseline and 3, 6, 9, and 12 months after the first AOM injection. Results: AOM was associated with a progressive improvement, compared to baseline, of both positive (p < 0.001) and negative (p < 0.001) symptoms and in general psychopathology (p < 0.001) and decrease in global severity (p < 0.001). We also observed progressive improvement in QoL and social and personal functioning. Treatment adherence was 78% at study endpoint. Our results support that AOM may improve psychotic symptoms, QoL and social functioning in young FEP patients. Further studies should compare AOM to its oral formulation in the treatment of young patients with schizophrenia at the outset of their illness.

Highlights

Schizophrenia is a psychiatric disorder running a chronic course, often characterized by the alternation of acute and partial remission phases [1, 2]
The study population was composed of 50 first psychotic episode (FEP) inpatients, aged 18–26 years, who met Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for schizophrenia with or without a Substance use disorder (SUD) comorbidity [49], who started treatment with aripiprazole Long-acting injectable (LAI)
Eleven patients dropped-out before the 12-month followup (7 for safety/inefficacy, 2 switched to another LAI, 1 moved to another city, and 1 discontinued due to unbearable akathisia); the final analysis was conducted on 39 participants

Summary

Introduction

Schizophrenia is a psychiatric disorder running a chronic course, often characterized by the alternation of acute and partial remission phases [1, 2] It involves emotional and cognitive impairments [2], and is characterized by positive (hallucinations and delusions, odd and bizarre behavior), negative (e.g., diminished emotional expression, flat affect, alogia, anhedonia, and avolition), as well as cognitive and general symptoms, which are often associated with decline in social and general functioning [3]. Young adults may present with slow and progressive social isolation, deterioration in functioning, and development of positive symptoms over several months or years [1, 7, 8]. Some investigators advanced the idea of early LAI use in young people with schizophrenia at their first psychotic episode (FEP)

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