Department of Psychiatry and Behavioral Health.
Department of Psychiatry and Behavioral Health, Stony Brook University Renaissance School of Medicine, Stony Brook, New York.
Int Clin Psychopharmacol. 2022 May 1;37(3):122-128. doi: 10.1097/YIC.0000000000000391.
A potential link between switching to aripiprazole and worsening of psychosis was first reported in the early 2000s. There have since been numerous published case reports describing this phenomenon, but only recently has the concept of a theoretical aripiprazole-induced dopamine supersensitivity psychosis (DSP) caused by D2 receptor activation in patients undergoing a switch to aripiprazole appeared in the literature. There is less awareness in clinical practice of the possibility of inducing DSP with aripiprazole, which may be particularly severe in some patients. The objective of this article is to present four cases demonstrating rapid and dramatic onset of DSP during switching to aripiprazole. In each case, a patient with a Diagnostic and statistical manual of mental disorders (5th ed.) diagnosis of schizophrenia experienced severe worsening of psychosis within 4-5 days of abrupt switching to aripiprazole from a full D2 antagonist. To our knowledge, this is the first case series characterizing the previously well-documented worsening of psychosis during switching to aripiprazole specifically as aripiprazole-induced DSP. We discuss clinical relevance, prevention and future directions. Careful cross-titration per clinical practice guidelines may reduce occurrence of DSP during aripiprazole switching or augmentation treatment.
早在 21 世纪初就首次报道了切换到阿立哌唑与精神病恶化之间存在潜在联系。此后，有许多已发表的病例报告描述了这种现象，但直到最近，文献中才出现了一种理论概念，即由于切换到阿立哌唑后 D2 受体激活，可能会引起阿立哌唑诱导的多巴胺超敏性精神病（DSP）。在临床实践中，人们对阿立哌唑引起 DSP 的可能性的认识较少，而在某些患者中，这种可能性可能更为严重。本文的目的是介绍四个病例，这些病例表明在切换到阿立哌唑时，DSP 会迅速而明显地发作。在每种情况下，一名被诊断为精神分裂症的患者（DSM-5）在从完全的 D2 拮抗剂突然切换到阿立哌唑后 4-5 天内，精神病恶化严重。据我们所知，这是首次将之前文献中记录的切换到阿立哌唑时精神病恶化具体描述为阿立哌唑诱导的 DSP 的病例系列。我们讨论了临床相关性、预防措施和未来方向。根据临床实践指南进行仔细的交叉滴定可能会减少在阿立哌唑切换或增效治疗期间发生 DSP 的可能性。
