Department of Psychiatry, Clermont-Ferrand University Hospital, Clermont Auvergne University, Clermont-Ferrand, France.
Psychiatry and Medical Psychology Department, Saint-Antoine Hospital, Paris Sorbonne University, Paris, France.
BMC Psychiatry. 2022 May 28;22(1):364. doi: 10.1186/s12888-022-04008-9.
Aripiprazole is a second-generation antipsychotic, efficacious in patients with schizophrenia during acute episodes. Due to its pharmacological profile, aripiprazole may be of interest in patients with specific clinical profiles who have not been studied extensively in randomised clinical trials.
To capture experience with aripiprazole in everyday psychiatric practice using the Delphi method in order to inform decision-making on the use of aripiprazole for the treatment of patients with schizophrenia in clinical situations where robust evidence from clinical trials is lacking.
The scope of the survey was defined as the management of schizophrenia in adults. A systematic literature review was performed to identify the different clinical situations in which aripiprazole has been studied, and to describe the level of clinical evidence. Clinical profiles to include in the Delphi survey were selected if there was a clear interest in terms of medical need but uncertainty over the efficacy of aripiprazole. For each clinical profile retained, five to seven specific statements were generated and included in a questionnaire. The final 41-item questionnaire was proposed to a panel of 406 French psychiatrists with experience in the treatment of schizophrenia. Panellists rated their level of agreement using a Likert scale. A second round of voting on eleven items was organised to clarify points for which a consensus was not obtained in the first round.
Five clinical profiles were identified in the literature review (persistent negative symptoms, pregnancy, cognitive dysfunction, addictive comorbidity and clozapine resistance). Sixty-two psychiatrists participated in the first round of the Delphi survey and 33 in the second round. A consensus was obtained for 11 out of 41 items in the first round and for 9/11 items in the second round. According to the panellists' clinical experience, aripiprazole can be used as maintenance treatment for pregnant women, is relevant to preserve cognitive function and can be considered an option in patients with a comorbid addictive disorder or with persistent negative symptoms.
These findings may help physicians in choosing relevant ways to use aripiprazole and highlight areas where more research is needed to widen the evidence base.
阿立哌唑是一种第二代抗精神病药，在精神分裂症急性发作期间对患者有效。由于其药理学特性，阿立哌唑可能对特定临床特征的患者有兴趣，这些患者在随机临床试验中尚未得到广泛研究。
使用德尔菲法在日常精神病学实践中收集阿立哌唑的经验，以便为缺乏临床试验强有力证据的情况下治疗精神分裂症患者的阿立哌唑使用决策提供信息。
调查范围定义为成人精神分裂症的管理。进行了系统的文献回顾，以确定阿立哌唑研究过的不同临床情况，并描述临床证据水平。如果存在明确的医疗需求但对阿立哌唑疗效存在不确定性，则选择纳入德尔菲调查的临床特征。对于保留的每个临床特征，生成了五到七个具体的陈述，并包含在问卷中。最终的 41 项问卷被提供给 406 名有精神分裂症治疗经验的法国精神科医生小组。小组成员使用李克特量表对其同意程度进行评分。对十一项未能在第一轮达成共识的项目进行了第二轮投票。
在文献综述中确定了五个临床特征（持续阴性症状、妊娠、认知功能障碍、成瘾共病和氯氮平耐药）。62 名精神科医生参加了第一轮德尔菲调查，33 名参加了第二轮。在第一轮中，有 11 项中的 11 项达成共识，在第二轮中，有 9/11 项达成共识。根据小组成员的临床经验，阿立哌唑可用于孕妇的维持治疗，与保留认知功能有关，可考虑用于合并成瘾障碍或持续存在阴性症状的患者。
这些发现可能有助于医生选择使用阿立哌唑的相关方法，并强调需要进一步研究以扩大证据基础的领域。
