Department of Clinical Neurosciences/DIMSC, Università Politecnica delle Marche, Ancona, Italy.
Neuropsychopharmacol Rep. 2022 Jun;42(2):241-244. doi: 10.1002/npr2.12240. Epub 2022 Feb 19.
Aripiprazole long-acting injection (LAI) is approved for the treatment of schizophrenia in adults. Recently, Europe and Canada approved the use of the two-injection start regimen: two separate injections of 400-mg long-acting aripiprazole along with a single 20-mg dose of oral aripiprazole. Aripiprazole showed efficacy in the treatment of adolescents with acute schizophrenia in several controlled trials, leading to its approval for 13- to 17-year-old adolescents with schizophrenia by the EMA. However, the LAI formulation still remains off-label in adolescents.
The patient was admitted to the General Psychiatry inpatient unit with a Positive and Negative Syndrome Scale (PANSS) total score of 136 and the Clinical Global Impression (CGI) score of 7. Aripiprazole was started and up-titrated to 30 mg/d. After 3 weeks, the positive symptoms were significantly reduced; however, he still showed prominent negative symptoms. Clozapine 100 mg/d was added, and in the following 2 weeks, the patient appeared slightly more communicative and generally more aware of himself and the others. The PANSS total score decreased to 81. Due to poor insight, the patient was at-risk not to take medications upon returning home; therefore, aripiprazole LAI was proposed. Since he urged to be discharged from the hospital, we opted for the two-injection start. The medication was optimally tolerated, with no evidence of akathisia or other side effects. One month later, global functioning and illness insight improved; Positive and Negative Syndrome Scale score was 43 and CGI score 2.
Aripiprazole LAI showed good efficacy and tolerability in an adolescent with schizophrenia. The two-injection start regimen was a safe and effective option.
阿立哌唑长效注射剂（LAI）已获批准用于治疗成人精神分裂症。最近，欧洲和加拿大批准了两针起始方案的使用：两针分别给予 400mg 长效阿立哌唑，同时给予单次 20mg 阿立哌唑口服剂量。几项对照试验表明阿立哌唑治疗青少年急性精神分裂症有效，这促使 EMA 批准该药用于 13-17 岁精神分裂症青少年。然而，LAI 制剂在青少年中仍属超适应证使用。
患者因阳性和阴性综合征量表（PANSS）总分 136 和临床总体印象量表（CGI）评分为 7 分而被收入综合精神病学住院病房。给予阿立哌唑起始治疗并滴定至 30mg/d。3 周后，阳性症状显著减轻；然而，他仍表现出明显的阴性症状。加用氯氮平 100mg/d，在接下来的 2 周内，患者表现出稍微更具交流性，且对自身和他人的意识总体上有所增强。PANSS 总分降至 81。由于缺乏洞察力，患者在出院后存在不遵医嘱服药的风险；因此，建议使用阿立哌唑 LAI。由于患者强烈要求出院，我们选择了两针起始方案。药物得到了很好的耐受，没有出现静坐不能或其他不良反应的证据。一个月后，整体功能和疾病洞察力得到改善；阳性和阴性综合征量表评分为 43，CGI 评分为 2。
阿立哌唑 LAI 对患有精神分裂症的青少年显示出良好的疗效和耐受性。两针起始方案是一种安全有效的选择。
