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Aripiprazole is a dopamine partial agonist with a low risk of movement disorder and metabolic adverse effects.
Method:
We identified 228 patients consecutively prescribed aripiprazole in our unit and established outcome (continuation with treatment) six months after initiation.
Results:
The study cohort consisted of subjects of mean age 36.2 years (17-86) of whom 53.1% were male. Two thirds had a diagnosis of schizophrenia. Overall, 112 (49%) patients completed 6 months' treatment. Reasons for discontinuation were adverse events (n = 61, 53% of those who stopped), lack of effectiveness (n = 45, 39%) and a variety of unconnected reasons (n = 10, 9%). The majority of discontinuations (n = 76, 66%) occurred in the first 60 days of treatment, largely because of adverse effects. Most common adverse events reported were anxiety/agitation (n = 57, 25% of total cohort), insomnia (n = 43, 19%) and movement disorder (n = 24, 11%).
Treatment discontinuation was more likely for in-patients than out-patients (61% vs 42%, p = 0.005) and in those previously prescribed clozapine (p = 0.01). Modal initiation dose was 15mg for patients starting in the first year of the study and 10mg for those starting later. Initiation dose was not associated with outcome.
Conclusion:
Aripiprazole showed a degree of effectiveness similar to that shown by other antipsychotics. Early-appearing, trivial adverse events are a major factor in treatment discontinuation. Outcome is best in out-patients and those not formerly treated with clozapine.
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