Treatment of psychotic symptoms in bipolar disorder with aripiprazole monotherapy: a meta-analysis

Konstantinos N Fountoulakis,Frank Schmidt,Eduard Vieta,Xenia Gonda

doi:10.1186/1744-859x-8-27

Abstract

BackgroundWe present a systematic review and meta-analysis of the available clinical trials concerning the usefulness of aripiprazole in the treatment of the psychotic symptoms in bipolar disorder.MethodsA systematic MEDLINE and repository search concerning clinical trials for aripiprazole in bipolar disorder was conducted.ResultsThe meta-analysis of four randomised controlled trials (RCTs) on acute mania suggests that the effect size of aripiprazole versus placebo was equal to 0.14 but a more reliable and accurate estimation is 0.18 for the total Positive and Negative Syndrome Scale (PANSS) score. The effect was higher for the PANSS-positive subscale (0.28), PANSS-hostility subscale (0.24) and PANSS-cognitive subscale (0.20), and lower for the PANSS-negative subscale (0.12). No data on the depressive phase of bipolar illness exist, while there are some data in favour of aripiprazole concerning the maintenance phase, where at week 26 all except the total PANSS score showed a significant superiority of aripiprazole over placebo (d = 0.28 for positive, d = 0.38 for the cognitive and d = 0.71 for the hostility subscales) and at week 100 the results were similar (d = 0.42, 0.63 and 0.48, respectively).ConclusionThe data analysed for the current study support the usefulness of aripiprazole against psychotic symptoms during the acute manic and maintenance phases of bipolar illness.

Highlights

We present a systematic review and meta-analysis of the available clinical trials concerning the usefulness of aripiprazole in the treatment of the psychotic symptoms in bipolar disorder
All except the total Positive and Negative Syndrome Scale (PANSS) score showed a significant superiority of aripiprazole over placebo, with d = 0.42, 0.63 and 0.48, respectively [38]
The meta-analysis of the four trials that investigated the efficacy of aripiprazole on psychotic symptoms during acute manic/mixed episodes suggests that the effect size versus placebo was equal to 0.14, but a more reliable and accurate estimation is 0.18 for the total PANSS score

Summary

Introduction

We present a systematic review and meta-analysis of the available clinical trials concerning the usefulness of aripiprazole in the treatment of the psychotic symptoms in bipolar disorder. In the BD clinical picture, psychotic features are a very frequent manifestation they are not considered to constitute a core feature of the disorder. Psychotic features include delusions and hallucinations and both can be mood congruent or non-congruent depending on their content. Overexaggerated thoughts of guilt, sin, worthlessness, poverty and somatic health, or on the contrary thoughts of exceptional mental and physical fitness or special talents, wealth, some kind of grandiose identity or importance are mood congruent delusions, and even persecutory ideas or ideas of reference when in accord with the thought content can be considered to be mood congruent. Psychotic features and the lack of insight might lead to the refusal of any treatment and to the need for an involuntary admission to a hospital

Methods

Results

Conclusion