Use Of Aripiprazole Research Articles

TARC: Turkish aripiprazole consensus report- Aripiprazole use and switching from other antipsychotics to aripiprazole- consensus recommendations by a Turkish multidisciplinary panel.

In this review, we have attempted to share our 10 years’ clinical experience with aripiprazole use and switching from other antipsychotics to aripiprazole. There are various reasons for switching, including a partial or complete lack of efficacy, adverse side effects, and partial or noncompliance with medication. Aripiprazole has some unique receptor-binding qualities that provides some advantages over other antipsychotics in certain clinical situations. We have covered potential clinical scenarios for aripiprazole use as a single agent and switching from other agents in inpatient and outpatient settings. Patients switched from other antipsychotics to aripiprazole have been shown to benefit from significant improvements in clinical response and tolerability. This review examines the strategies for switching patients from antipsychotic drugs to aripiprazole.

T231. PALIPERIDONE LONG-ACTING INJECTABLE (LAI) IS ASSOCIATED WITH A LOWER INTAKE OF BENZODIAZEPINES AND A LOWER NUMBER OF ADMISSIONS COMPARED WITH OTHER LAIS IN A COHORT OF PATIENTS WITH SCHIZOPHRENIA

BackgroundSchizophrenia is characterized by a chronic course that in most of cases requires continued and long-term treatment by the use of long acting injectables (LAI). Several LAI formulations have been available and increased the number of pharmacotherapeutic options for schizophrenia. However, there are no formal recommendations regarding the use of specific LAIs for the treatment because there are only a few available studies and even fewer studies assessing which LAI formulation is more effective or suppose an advantage. Many studies has been published regarding the prescription patterns of oral anti-psychotic and the transition to a LAI treatment in real-life settings but the patterns and predictors of use of different LAI formulations, and the effect of introducing new LAI drugs has drawn even less attention. The aim of this study was to analyze the anti-psychotic LAI prescription patterns during a 3-years follow-up period in Murcia, Spain, and to identify predictors of medication changes associated to the use of LAIs.Methodswe designed a non-interventional, naturalistic and retrospective study using all patients from the health department corresponding to the Reina Sofía University Hospital, Murcia, Spain who were diagnosed of schizophrenia and treated with long-acting injectables (LAIs) between the years 2015–2017. Data, pertaining to patients older than 18 years old, were extracted from electronic medical records. Demographic variables, the use of LAIs, the rates for antipsychotic polypharmacy, combined use of different antipsychotic classes with a special focus on atypical antipsychotics, and psychotropic polypharmacy using benzodiazepines, mood stabilizers, and other relevant drugs were identified, as well as, the number of admissions and suicidal attempts.ResultsNo statistical differences were observed regarding demographic variables between LAIs users. However, the number of admissions to a hospital or acute relapses where significantly lower (p<0.05) in the group treated with paliperidone LAI versus the others LAIs. In addition, our results showed that paliperidone, aripiprazole, zuclopentixol and riperidone LAIs are associated with 15.85; 47.86; 25 and 49.25 mg/day of diazepam, respectively. One way ANOVA showed that paliperidone LAI was associated with a significant (p<0.01) less intake of benzodiazepines when compared to others LAIs. ANOVA failed to show differences when the dose of oral anti-psychotics co-administered with LAIS were compared.DiscussionPolypharmacy is the most common pattern of antipsychotic use in this region of Spain. Use of atypical antipsychotics is extensive. Most patients receive psychiatric co-medications such as anxiolytics. Polypharmacy is associated with the use of aripiprazole or zuclopentixol and these groups of patients showed more admissions to a hospital. In contrast, paliperidone LAI group showed less admissions and less use of benzodiazepines. Our results indicate that paliperidone LAI could improve the long-term management of patients with schizophrenia.

T230. DOSE TRENDS OF ARIPIPRAZOLE FROM 2004 TO 2014 IN PSYCHIATRIC INPATIENTS IN KOREA

BackgroundThe purpose of the present study was to evaluate the initial and maximum doses of aripiprazole over a decade to estimate appropriate dosage in clinical practice. We hypothesized that there was a measurable change in dosing patterns during 2004–2014 in Korean psychiatric inpatients.MethodsIn this retrospective study, we reviewed the medical records of patients who were hospitalized in the psychiatric ward of five university hospitals in Korea from March 2004 to December 2014. The patients were at least 18 years of age, prescribed aripiprazole during the index hospitalization and were given at least one prescription for oral aripiprazole. We compared baseline demographic variables among Waves 1 (2004–2006), 2 (2007–2010) and 3 (2011–2014) using univariate one-way analysis of variance (ANOVA) with Bonferroni correction for continuous variables and a chi-square test for categorical variables.ResultsThere was a significant difference in mean age among waves (p = 0.012). The use of concomitant medications with aripiprazole was significantly different among waves, as well. The use of other atypical antipsychotics in Wave 1 was 27.0% (n = 20) and 27.4% (n = 55) in Wave 2 and increased to 36.5% (n = 129) in Wave 3, but the difference between Waves 1 and 3 (p = 0.118) and 2 and 3 (p = 0.027) did not reach statistical significance after Bonferroni’s correction. In total, the initial dose of aripiprazole was significantly lower in Wave 3 (7.0 ± 3.9 mg/day) when compared to Waves 1 (10.9 ± 4.6 mg/day, p<0.001) and 2 (10.7 ± 5.6 mg/day, p<0.001). The initial doses of aripiprazole in all diagnostic groups were significantly lower in Wave 3 than in Wave 2.DiscussionThe results from the present study show that the initial doses of aripiprazole, and not the maximum doses, decreased in hospitalized psychiatric patients with the accumulation of clinical experience in aripiprazole use.

T229. ANTIPSYCHOTIC DRUG USE AND THYROID FUNCTION IN PATIENTS WITH SEVERE MENTAL DISORDERS

BackgroundAltered levels of free Thyroxin (fT4) and Thyroid Stimulating Hormone (TSH) have been associated with severe mental disorders and the use of antipsychotic drugs. Still, there is a lack of studies systematically investigating commonly prescribed antipsychotic drugs and thyroid function. We investigated the association of antipsychotic drugs and thyroid hormones levels in patients with severe mental disorders and compared thyroid function tests between patients and healthy controls under real-life conditions.MethodsWe included 1345 patients with schizophrenia or bipolar disorders and 989 healthy controls from the on-going Thematically Organized Psychosis (TOP) study, recruiting participants between 18–65 years of age in and around Oslo, Norway. All patients underwent a thorough clinical investigation including diagnostic evaluation, somatic screening and assessment of medication data. Serum drug concentrations were measured. Plasma levels of fT4 and TSH were measured in patients and healthy controls, and thyroid status was determined based on the combined hormone levels. Participants with known thyroid function disorders (N=28) were excluded. Mann-Whitney U tests and chi-square tests were performed for comparison between groups. For evaluation of influence from antipsychotics, multiple linear regression analyses were performed, adjusting for patient/control status, age, sex and use of other psychopharmacological agents. Associations with the use of olanzapine, quetiapine, aripiprazole or risperidone in monotherapy were analyzed in a subsample of patients (N=480), adjusting for age, sex and diagnosis. Spearman correlation analyses were performed for hormone levels and drug serum concentrations.ResultsWe found significant lower levels of fT4 (median 13.70 vs 14.00, p<0.001) and higher levels of TSH (median 1.92 vs 1.57, p<0.001) in patients compared to healthy controls. A significant difference between patients and controls in occurrence of hyper- and hypothyreosis was observed (p<0.001), with more than three times as many patients compared to controls with hypothyroid status (11.1% vs 3.4%), and a doubling of hyperthyroid status (2.3% vs. 1.2%). Use of antipsychotics was significantly associated with lower fT4 level (p=0.001), but not with the TSH level. We also found significant associations between lower fT4 level and current use of quetiapine (p=0.005) and olanzapine (p=0.018), but again no significant associations were found with TSH level. No significant correlations were found between drug serum concentrations and fT4 or TSH. In the regression analyses we also observed that female sex and increasing age was associated with lower levels of both fT4 and TSH.DiscussionIn this large, cross-sectional study we found significant differences in thyroid hormone levels between patients with schizophrenia and bipolar disorders and healthy controls, and our data indicate a notable prevalence of undetected deviant thyroid function in the patient population. There was a significant association between fT4 level and the use of antipsychotics, particularly with the use of quetiapine and olanzapine. This suggests a possible contribution to altered thyroid hormone levels from the use of commonly prescribed antipsychotic agents. These findings call for renewed attention towards the role of thyroid function in severe mental disorders and the associations with antipsychotic drugs.

Hyponatremia in Association With Second-Generation Antipsychotics: A Systematic Review of Case Reports.

Hyponatremia is generally defined as a serum sodium level <135 mmol/L and is considered severe if serum sodium is <125 mmol/L. Hyponatremia is a potentially life-threatening medical comorbidity for patients with schizophrenia. The incidence of hyponatremia in patients with schizophrenia who are taking second-generation antipsychotics (SGAs) has not been well established. We conducted a systematic review of case reports of hyponatremia associated with the use of SGAs in patients with schizophrenia. We searched MEDLINE (from 1946 through September 2016) using the medical subject headings antipsychotic agents, hyponatremia, and water intoxication to identify reported diagnoses of hyponatremia following treatment with SGAs in patients with schizophrenia. We abstracted 12 potentially relevant case reports from 157 records. Nine case reports met the selection criteria. Three cases involved the use of aripiprazole (Abilify), 3 involved the use of risperidone (Risperdal), and the other 3 cases involved ziprasidone, olanzapine, and clozapine. Approximately equal numbers of males and females were represented, and 2 of the 9 patients were aged ≥60 years. The average patient age was 47 years, and the average time to the hyponatremia event was 17 days. The average serum sodium was 138 mmol/L at baseline, 112 mmol/L at treatment nadir, and 138 mmol/L after treatment discontinuation. Hyponatremia can result from the use of SGAs in patients with schizophrenia and can be avoided with proper management of treatment. Physicians, psychiatrists, and other healthcare workers should be aware of the potential for severe hyponatremia with the use of commonly prescribed SGAs. SGA-induced hyponatremia is generally reversible after discontinuing treatment.

Add-on Aripiprazole for Atypical Antipsychotic-induced, Clinically Significant Hyperprolactinemia.

Background:Antipsychotic treatment-induced hyperprolactinemia is a highly distressing and disabling side effect for patients. The use of add-on aripiprazole has been identified as a possible treatment strategy in this situation. However, data on prolactin changes with add-on aripiprazole in a real-world naturalistic clinical setting from India are sparse.Materials and Methods:The retrospective chart review was conducted at the specialty metabolic clinic at the National Institute of Mental Health and Neurosciences, Bengaluru, India. Sixteen patients (female: male = 13:3) who were on a stable dose of antipsychotic medications, complaining of either sexual dysfunction or menstrual irregularities, were prescribed add-on aripiprazole. The serum prolactin values were obtained before the initiation of aripiprazole and during the follow-up.Results:Patients were on treatment with risperidone, amisulpride, and olanzapine and had a prolactin level of 87.1 ± 60.7 ng/ml. Add-on aripiprazole treatment was given with a mean dose of 13.8 ± 7.4 mg/day. Patients had a significant reduction in prolactin level (35.6 ± 29.1 ng/ml) following treatment with aripiprazole (P = 0.004).Conclusions:Add-on aripiprazole could be a clinically useful strategy in patients who develop antipsychotic-induced hyperprolactinemia.

A case of an 11-year-old girl diagnosed with OCD developing giggle incontinence following addition of aripiprazole to treatment

ABSTRACTGiggle incontinence (GI) is characterized by involuntary and generally unpredictable release of urine during giggling or laughter. It has been suggested that GI may be a centrally mediated disorder and may share a common pathophysiology with narcolepsy and cataplexy. The fact that methylphenidate reduces some symptoms suggests that the condition may be a cataplexy. While alpha 1 and dopamine D2 antagonists exacerbate cataplexy, alpha 1 and dopamine D2 agonists produce a marked improvement. Aripiprazole, frequently used to augment treatment of obsessive compulsive disorder, may have exhibited an alpha 1 and D2 receptor antagonist effect and have caused GI. We describe a case of GI occurring following aripiprazole use in an 11-year-old female obsessive compulsive disorder patient resistant to treatment.

Diurnal enuresis developing in association with risperidone and aripiprazole use in a child with autism spectrum disorder: a case report

Autism spectrum disorder (ASD) is a complex heterogeneous neurodevelopmental disorder. Risperidone and Aripiprazole appear to be effective in associated behavioural problems with ASDs, including ir...

Resolution of antipsychotic-induced amenorrhea using aripiprazole

Summary of the clinical algorithm used patients are suspected of antipsychotic-induced amenorrhea 7 . Amenorrhea during antipsychotics treatment In full remission psychotic patientCheck plasma prolactin levelHyperprolactinemiaHypophiseal MRI to r/o prolactinomaNormal prolactin serum level1. At first initiate switching protocols: AripiprazoleQuietiapine Olanzapine Clozapine 2. Secondly Delete SSRI Shift to NDRI or NaSSA ≥ 100 ng/ml Consultation YesNo< 100 ng/ml the resolution of hyperprolactinemia has attracted the most attention. Aripiprazole can be used to resolve hyperprolactinemia induced by risperidone 8 , amisulpride, and ziprasidone 9 . However, the use of aripiprazole to resolve MARTA-induced amenorrhea has rarely been reported, especially in amenorrhea without hyperprolactinemia. Some may believe that since aripiprazole can reduce amenorrhea, we should attempt to use it in the early stages of disease onset in women. It should be noted that in Case 2, aripiprazole was used during the early stages of disease onset. However, due to its slow antimanic effect, it was combined with zotepine after four weeks, and was only completely replaced by zotepine (100 mg/d) after eight weeks, followed by a switch to aripiprazole after the unexpected occurrence of amenorrhea. In both cases, full D2 antagonists were used initially for rapid therapeutic effect until full remission of the mental disorder, and then were successfully replaced by aripiprazole completely over one to two months. This was a viable therapeutic strategy.

Aripiprazole prevents renal ischemia/reperfusion injury in rats, probably through nitric oxide involvement

Renal ischemia/reperfusion (I/R) injury is strongly related to morbidity and mortality. Oxidative stress, inflammation, and apoptosis play key roles in renal dysfunction following renal I/R. Aripiprazole is an atypical antipsychotic which used for the treatment of schizophrenia and bipolar disorder. Recent studies have reported aripiprazole as displaying certain anti-inflammatory effects. Regarding the underlying mechanisms of renal ischemia-reperfusion, therefore, nephroprotective effects might be predicted to be seen with aripiprazole. I/R injury was induced by bilateral clamping of the renal pedicles (45min) followed by reperfusion (24h). The mechanism of aripiprazole-mediated nephroprotection was explored by a combined use of aripiprazole and L-NAME (non-selective nitric oxide synthase inhibitor). Animals were given aripiprazole (2.5, 5, 10 and 20mg/kg) intraperitoneally, 30min before ischemia. L-NAME was administered before the aripiprazole injection. Serum creatinine and blood urea nitrogen were assessed after 24h of reperfusion. Serum levels of malondialdehyde (MDA), TNF-α and IL-1β were measured for rats treated with aripiprazole. The extent of necrosis was measured by the stereology method. Ischemia/reperfusion caused significant renal dysfunction and marked renal injury. Aripiprazole reduced creatinine and blood urea nitrogen. Serum levels of MDA, IL-1β and TNF-α were significantly lower in the aripiprazole group. Aripiprazole treatment also decreased the volume of kidney necrosis. The administration of L-NAME reversed the renoprotective effect of aripiprazole on BUN and creatinine, but enhanced the anti-necrotic effect of aripiprazole. The results show that a single dose of aripiprazole significantly improved renal function following ischemia/reperfusion injury – probably through the involvement of nitric oxide.

Signal of Miscarriage with Aripiprazole: A Disproportionality Analysis of the Japanese Adverse Drug Event Report Database

With recent advances in medicines, many patients with schizophrenia have become able to conceive. One common second-generation antipsychotic given to patients with schizophrenia is aripiprazole. The label information of aripiprazole in Japan states that according to one case report "there is a report of miscarriage in clinical trial". The aim of this study was to evaluate the relationship between aripiprazole and miscarriage by conducting a disproportionality analysis of an adverse drug event report database. We conducted a disproportionality analysis of second-generation antipsychotic exposure during pregnancy using the Japanese Adverse Drug Event Report database, which is a spontaneous reporting database in Japan. We investigated aripiprazole and other approved second-generation antipsychotics in Japan. In accordance with the previous report, we created a data set for analysis consisting of pregnancy-related reports. A potential signal for miscarriage was detected for aripiprazole [proportional reporting ratio: 2.39, χ 2: 13.77, reporting odds ratio (95% confidence interval): 2.76 (1.62-4.69); n=18]. In contrast, no potential signal for miscarriage was detected for other second-generation antipsychotics. Through our analysis of the Japanese Adverse Drug Event Report database, we found a potential signal for miscarriage for aripiprazole. Safety information on the use of aripiprazole during pregnancy is very limited. Therefore, we suggest that the potential signal detected in our analysis be explored further.

ARIPIPRAZOLE AUGMENTATION IN PROFOUND, SRI-REFRACTORY OBSESSIVE-COMPULSIVE DISORDER

Background The National Inpatient service for Obsessive-Compulsive Disorder (OCD) And Body Dysmorphic Disorders (BDD), funded by NHS England, is the only 24-hour staffed dedicated inpatient facility for profound, refractory OCD in the UK. Although OCD is a common and frequently disabling condition, often responds well to treatment with either Cognitive Behavioural Therapy or SRI. Pharmacological strategies utilized in SRI non-responders include, amongst the others, the use of first or second-generation antipsychotics. David Veale et al (2014) highlighted in A recent Meta-analysis that two studies found Aripiprazole to be effective in the short term. The aim of this study was to look at the use of Aripiprazole compared to other antipsychotics in the National OCD Service for all the patients admitted between March 2006 and September 2011. Method data were gathered from case records, electronic records system. We used the Yale Brown Obsessive-Compulsive Rating Scale (YBOCS) to measure severity. Results our sample consisted of 89 patients (45 males and 44 females) with an initial YBOCS average score of 23.5± 2.9 SD, indicating profound OCD. Overall, the highest number of patients (n=30) patients were treated with Aripiprazole when discharged from the National Service. Patients whose treatment was augmented with Aripiprazole, displayed an average YBOCS reduction of 14. Conclusions Aripiprazole was widely used in our population of inpatients with profound, treatment-refractory OCD, producing a reduction in the YBOCS scores

Dose Trends of Aripiprazole from 2004 to 2014 in Psychiatric Inpatients in Korea.

ObjectiveAlthough aripiprazole has been widely used to treat various psychiatric disorders, little is known about the adequate dosage for Asian patients in clinical practice. Hence, we evaluated the initial and maximum doses of aripiprazole from 2004 to 2014 to estimate the appropriate dosage for Korean psychiatric inpatients in clinical practice.MethodsIn this retrospective study, we reviewed the medical records of patients who were hospitalized in five university hospitals in Korea from March 2004 to December 2014. The psychiatric diagnosis according to the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition during index hospitalization and the initial and maximum doses of aripiprazole were evaluated.ResultsThere were 74 patients in Wave 1 (2004–2006), 201 patients in Wave 2 (2007–2010), and 353 patients in Wave 3 (2011–2014). The initial doses of aripiprazole in all diagnostic groups were significantly lower in Wave 3 than in Wave 2. The maximum doses of aripiprazole in each diagnostic group were not significantly different among Waves 1, 2, and 3.ConclusionThe relatively low initial doses of aripiprazole documented in our study may reflect a strategy by clinicians to minimize the side effects associated with aripiprazole use, such as akathisia.

What antipsychotic is more effective? Pafip three years longitudinal study comparing haloperidol, risperidone, olanzapine, quetiapine, ziprasidone and aripiprazole

IntroductionEarly stages after a first psychotic episode (FEP) are crucial for the prognosis of the disease. Those patients who drop out of treatment after a FEP show a significant increase in their vulnerability to relapse. Relapses associated a greater risk of neurotoxicity, chronicity, hospitalization, decrease of response to the treatment, increase of burden and functional decline.ObjectivesTo determine what antipsychotic is more effective in the prevention of relapse after a first psychotic episode.Material and methodsPAFIP is an assistance program focused on early intervention in psychosis. Between January 2001 and January 2011, 255 patients were recruited and randomly assigned to treatment with haloperidol (n = 48), olanzapine (n = 41), risperidone (n = 44), quetiapine (n = 34), ziprasidone (n = 38) and aripiprazole (n = 50). We compared the rates of relapse and remission reached by haloperidol, olanzapine, risperidone, aripiprazole, ziprasidone and quetiapine during a 3-year follow-up. All of the patients were antipsychotic naives at the beginning of the treatment.ResultsThere were no statistically significant differences in regard to the rate of clinical remission. Patients assigned to the groups of aripiprazole, olanzapine and risperidone presented a solid trend to a significantly inferior rate of discontinuation for any reason since the beginning of the treatment.ConclusionsThese data point to a greater protection against relapse and a likely better prognosis related to the use of aripiprazole, Olanzapine and risperidone.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Using Routine Hemoglobin A1c Testing to Determine the Glycemic Status in Psychiatric Inpatients.

Using routine hemoglobin A1c (HbA1c) testing to describe the prevalence, characteristics, and length of stay (LOS) of psychiatry inpatients with type 2 diabetes compared to those with pre-diabetes and those without diabetes. In this prospective observational study, all inpatients aged greater than 30 years admitted to the Austin Health Psychiatry Unit, a major tertiary hospital, affiliated with the University of Melbourne, between February 2014 and April 2015 had routine HbA1c testing as part of the Diabetes Discovery Initiative. Patients were divided into three groups: diabetes (HbA1c ≥ 6.5%, 48 mmol/mol), pre-diabetes (HbA1c 5.7-6.4%, 39-46 mmol/mol), or no diabetes (HbA1c ≤ 5.6%, 38 mmol/mol). Baseline characteristics, co-morbidities, psychiatric illnesses, and treatment were recorded. There were a total of 335 psychiatry inpatients (median age 41 years). The most prevalent diagnoses were schizophrenia, depression, and substance abuse. Of the 335 psychiatric inpatients, 14% (n = 46) had diabetes and 19% (n = 63) had pre-diabetes, a prevalence threefold greater than in the aged matched general population. Compared to inpatients with pre-diabetes and no diabetes, those with diabetes were older and were at least twice as likely to have hypertension, obesity, and hyperlipidemia (all p ≤ 0.002). In multivariable analyses, diabetes was associated with increasing age (p = 0.02), substance abuse (p = 0.04), dyslipidaemia (p = 0.03), and aripiprazole use (p = 0.01). Patients with diabetes also had a 70% longer expected LOS (95% CI: 20-130%; p = 0.001), compared to those with pre-diabetes and no diabetes. Despite relative youth, one-third of all psychiatric inpatients above the age of 30 have diabetes or pre-diabetes. Presence of diabetes in psychiatric inpatients is associated with older age, substance abuse, and longer LOS. Routine inpatient HbA1c testing provides an opportunity for early detection and optimization of diabetes care.

Delirium in hospitalized patients: Risks and benefits of antipsychotics.

Consensus panel guidelines advocate for the judicious use of antipsychotic drugs to manage delirium in hospitalized patients when nonpharmacologic measures fail and the patient is in significant distress from symptoms, poses a safety risk to self or others, or is impeding essential aspects of his or her medical care. Here, we review the use of haloperidol, olanzapine, quetiapine, risperidone, and aripiprazole for this purpose.

Risk of extrapyramidal reactions with aripiprazole

Aripiprazole is a third‐generation antipsychotic with a distinct pharmacological profile. It is a partial agonist at the dopamine D2 receptor, and as such has comparatively fewer D2 receptor‐related adverse effects, such as extrapyramidal reactions. Despite this unique receptor activity, case reports have provided evidence that aripiprazole use could be associated with an increased risk of extrapyramidal reactions, primarily in antipsychotic‐naïve patients.

Aripiprazole associated with adverse effects in pediatric population

Citing the scarcity of evidence regarding the use of aripiprazole in children and adolescents, researchers undertook a study of adverse drug reaction (ADR) reports in children and adolescents. Although aripiprazole is considered safe and well‐tolerated in children, there have been severe adverse events.

Antipsychotic Medications and Risk of Acute Coronary Syndrome in Schizophrenia: A Nested Case-Control Study.

BackgroundThis study assessed the risk of developing acute coronary syndrome requiring hospitalization in association with the use of certain antipsychotic medications in schizophrenia patients.MethodsA nationwide cohort of 31,177 inpatients with schizophrenia between the ages of 18 and 65 years whose records were enrolled in the National Health Insurance Research Database in Taiwan from 2000 to 2008 and were studied after encrypting the identifications. Cases (n = 147) were patients with subsequent acute coronary syndrome requiring hospitalization after their first psychiatric admission. Based on a nested case-control design, each case was matched with 20 controls for age, sex and the year of first psychiatric admission using risk-set sampling. The effects of antipsychotic agents on the development of acute coronary syndrome were assessed using multiple conditional logistic regression and sensitivity analyses to confirm any association.ResultsWe found that current use of aripiprazole (adjusted risk ratio [RR] = 3.68, 95% CI: 1.27–10.64, p<0.05) and chlorpromazine (adjusted RR = 2.96, 95% CI: 1.40–6.24, p<0.001) were associated with a dose-dependent increase in the risk of developing acute coronary syndrome. Although haloperidol was associated with an increased risk (adjusted RR = 2.03, 95% CI: 1.20–3.44, p<0.01), there was no clear dose-dependent relationship. These three antipsychotic agents were also associated with an increased risk in the first 30 days of use, and the risk decreased as the duration of therapy increased. Sensitivity analyses using propensity score-adjusted modeling showed that the results were similar to those of multiple regression analysis.ConclusionsPatients with schizophrenia who received aripiprazole, chlorpromazine, or haloperidol could have a potentially elevated risk of developing acute coronary syndrome, particularly at the start of therapy.

Clinical Usefulness of Aripiprazole and Lamotrigine in Schizoaffective Presentation of Tuberous Sclerosis

Tuberous sclerosis is not as rare as once thought and has high psychiatric comorbidities. However, bipolar or psychotic features associated with tuberous sclerosis have been rarely reported. This report first presents a tuberous sclerosis patient, resembling a schizoaffective disorder of bipolar type. A patient with known tuberous sclerosis displayed mood fluctuation and psychotic features. Her symptoms did not remit along with several psychiatric medications. After hospitalization, the patient responded well with lamotrigine and aripiprazole without exacerbation. As demonstrated in this case, tuberous sclerosis may also encompass bipolar affective or psychotic features. We would like to point out the necessity to consider bipolarity in evaluating and treating tuberous sclerosis.