Once-year experience with aripiprazole in acute care units. Recommendations for use

Abstract

Background:

In the last year, a new antipsychotic (AP) was approved in Spain for treatment of schizophrenia: ariprazole. Objetives: 23 clinical psychiatrists of Acute Units throughout Spain have constituted a regular work group (PSIQ-A) for the purpose of sharing clinical experiences and examining topics of interest to our daily clinical practice.

Methods:

In periodic meetings, members of PSIQ-A have made a compilation of different approaches to distinct clinical situations that hospitalized schizophrenic patients may present: approach in Emergency Room to try to reach a consensus, specifically with respect to ariprazole use in each situations.

Results:

Usually recommended dosage with predominance of positive symptoms: 25-30 mg/day (generally more than 15 mg/day) and with predominance of negative symptoms: smaller doses are sufficient and effective. Because of the demands of Acute Care rapid changes are chosen (about 1 week), except with clozapine and depot preparations (2 weeks) with full doses of ariprazole in 1-3 days and tapering off of previous AP. The initial, temporary association of drugs with a more sedative profile is frequent (BZD, levomepromazine, quetiapine). Some benefits have been: Reduction of psychotic anxiety; possibility of improving insight; excellent tolerance, even at high doses; response in negative-residual patients: more activity, more eagerness to do things, “evident improvement in the most chronic patients”.

Conclusion:

Ariprazole is a new and interesting drug in the approach to the phase of decompensation and admission of patients with schizophrenia, with good tolerability in major areas of patient concern and feeling well-being and improving insight.