Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
Int Clin Psychopharmacol. 2022 Nov 1;37(6):263-275. doi: 10.1097/YIC.0000000000000417. Epub 2022 Jul 12.
Antipsychotic polypharmacy in psychotic disorders is widespread despite international guidelines favoring monotherapy. Previous evidence indicates the utility of low-dose partial dopamine agonist (PDAs) add-ons to mitigate antipsychotic-induced metabolic adverse effects or hyperprolactinemia. However, clinicians are often concerned about using PDAs combined with high-potency, full dopaminergic antagonists (FDAs) due to the risk of psychosis relapse. We, therefore, conducted a literature review to find studies investigating the effects of combined treatment with PDAs (i.e. aripiprazole, cariprazine and brexpiprazole) and FDAs having a strong D 2 receptor binding affinity. Twenty studies examining the combination aripiprazole - high-potency FDAs were included, while no study was available on combinations with cariprazine or brexpiprazole. Studies reporting clinical improvement suggested that this may require a relatively long time (11 weeks), while studies that found symptom worsening observed this happening in a shorter timeframe (3 weeks). Patients with longer illness duration who received add-on aripiprazole on ongoing FDA monotherapy may be at greater risk for symptomatologic worsening. Especially in these cases, close clinical monitoring is therefore recommended during the first few weeks of combined treatment. These indications may be beneficial to psychiatrists who consider using this treatment strategy. Well-powered randomized clinical trials are needed to derive more solid clinical recommendations.
抗精神病药联合治疗在精神障碍中广泛存在,尽管国际指南倾向于单药治疗。先前的证据表明,低剂量部分多巴胺激动剂(PDAs)的添加物可用于减轻抗精神病药引起的代谢不良影响或高催乳素血症。然而,由于担心精神病复发的风险,临床医生通常不愿将 PDAs 与高效能、全多巴胺拮抗剂(FDAs)联合使用。因此,我们进行了文献综述,以寻找研究 PDAs(即阿立哌唑、卡利培嗪和布瑞哌唑)与具有强 D2 受体结合亲和力的 FDAs 联合治疗效果的研究。共纳入了 20 项研究阿立哌唑与高效能 FDAs 联合治疗的研究,而卡利培嗪或布瑞哌唑联合治疗的研究则没有。报告临床改善的研究表明,这可能需要相对较长的时间(约 11 周),而发现症状恶化的研究则表明这种情况发生在较短的时间内(约 3 周)。正在接受 FDA 单药治疗的患者,若在此基础上添加阿立哌唑治疗,其症状恶化的风险可能更高。因此,在联合治疗的最初几周内,尤其需要密切的临床监测。这些发现可能对考虑使用这种治疗策略的精神科医生有益。需要进行更多的、强有力的随机临床试验,以获得更可靠的临床建议。