Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos, IdISSC, CIBERSAM, School of Medicine (UCM), Madrid, Spain.
Department of Psychiatry, Santa Creu and Sant Pau Hospital, Barcelona, Spain.
Int J Psychiatry Clin Pract. 2023 Mar;27(1):82-91. doi: 10.1080/13651501.2022.2064308. Epub 2022 Jul 6.
Aripiprazole is an antipsychotic with a partial agonism of dopamine D and D receptors. This differential mechanism implies a rigorous appraisal of the appropriate therapeutic strategies in certain situations. To answer currently unsolved clinical questions about the use of oral and long-acting injectable (LAI) aripiprazole, we present here an expert consensus from 12 Spanish psychiatrists and a pharmacologist with extensive experience in the use of this antipsychotic.
Through one face-to-face session and online collaboration, we reached consensus and established practical recommendations based on scientific evidence and clinical experience. We classified the available scientific literature according to SIGN system and attributed a level of evidence to each reviewed article.
The recommendations were divided according to (i) chronological dimension (based on previous treatments, including patients naïve or not to antipsychotic treatment and maintenance regimen), and (ii) dimension related to therapeutic options, comprising switches to aripiprazole and the most used combinations with this antipsychotic.
We recommend considering aripiprazole as first treatment option in the early stages of schizophrenia and in patients with affective symptoms and contemplating a switch to aripiprazole LAI in all candidate patients. Importantly, switches from other antipsychotics should consider previous antipsychotic history and exposure to aripiprazole. KEYPOINTSAripiprazole can be considered as first treatment option in early stages of schizophrenia and in patients with significant affective symptoms.Aripiprazole LAI shows better adherence than oral aripiprazole and could be considered in all candidate patients.Before switching to aripiprazole, detailed information about previous antipsychotic history should be gathered.Switch to aripiprazole should be managed differently for aripiprazole naïve and non-naïve patients.Rigorous and controlled studies on antipsychotics in real clinical practice should be carried out.
阿立哌唑是一种具有多巴胺 D 和 D 受体部分激动作用的抗精神病药物。这种差异化的作用机制意味着需要严格评估在某些情况下的适当治疗策略。为了回答目前关于口服和长效注射（LAI）阿立哌唑使用的未解决的临床问题，我们邀请了 12 位西班牙精神科医生和一位在使用这种抗精神病药物方面经验丰富的药理学家，共同制定了一份专家共识。
通过一次面对面的会议和在线合作，我们根据科学证据和临床经验达成了共识，并制定了实用建议。我们根据 SIGN 系统对现有文献进行了分类，并为每篇综述文章赋予了证据级别。
建议根据（i）时间维度（基于之前的治疗，包括对抗精神病药物治疗和维持方案是否有经验的患者）和（ii）治疗选择维度进行分类，包括转换为阿立哌唑和最常用的与该抗精神病药物联合用药。
我们建议在精神分裂症早期和有明显情感症状的患者中，将阿立哌唑作为首选治疗方案，并考虑所有候选患者转换为阿立哌唑 LAI。重要的是，从其他抗精神病药物转换时，应考虑之前的抗精神病药物史和阿立哌唑的暴露情况。
在精神分裂症早期和有明显情感症状的患者中，阿立哌唑可作为首选治疗方案。
阿立哌唑 LAI 的依从性优于口服阿立哌唑，可考虑用于所有候选患者。
在转换为阿立哌唑之前，应详细了解之前的抗精神病药物史。
对于阿立哌唑初治和非初治患者，应分别管理转换为阿立哌唑的策略。
应在真实临床实践中开展对抗精神病药物的严格和对照研究。
