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Interactive Report: Aripiprazole LAI Effective in Treating Schizophrenia in Adolescent
As you read the case, keep in mind this question for our interactive poll: In your experience treating adolescents with schizophrenia, what is the top reason patients stop taking their oral medication?
A 2-injection start regimen of aripiprazole long-acting injectable (LAI) showed good efficacy and tolerability in a 16-year-old adolescent with schizophrenia, according to a recent case report published in Neuropsychopharmacology Reports.
Currently, the literature on the use of LAI antipsychotics in treatment for adolescents is limited. “The only published study reported similar efficacy for aripiprazole, paliperidone, and risperidone LAI in a small group of thirty 16-year-old adolescents with schizophrenia after 2-3 weeks of open-label treatment,” wrote lead author Virginio Salvi, Associate Professor of Psychiatry, Università Politecnica delle Marche, Ancona, Italy, and co-authors. “Being lack of insight and noncompliance to treatment a major issue in adolescents with schizophrenia, this dearth of studies is problematic.”
The case
A 14-year-old adolescent was admitted to the Child and Adolescent Psychiatry inpatient unit at the local children’s hospital following an aggressive episode and history of social withdrawal. He was administered aripiprazole 5 mg/d. Socially, he remained withdrawn, but his tantrums settled so without medical advice to do so, he stopped taking the aripiprazole after 1 month. His aggressive tantrums returned, so he was readmitted and treated with lithium and olanzapine. He then gained 10 kg (22 lbs) in 3 months and discontinued medications, which led to treatment interruption.
After this treatment interruption, he went through a brief period of “good functioning”; however his aggressive behavior returned and he was admitted to the general psychiatry inpatient unit. His positive and negative syndrome scale (PANSS) total score was 136 with a clinical global impression (CGI) score of 7. Clinicians administered the structured clinical interview for DSM-5 (SCID-5), which led to a schizophrenia diagnosis.
After starting aripiprazole uptitrated to 30 mg/d, positive symptoms were significantly reduced. “The patient appeared more in contact with doctors and nurses, being able to sustain brief conversations, and his auditory hallucinations significantly reduced. On the flipside, he showed minimal to absent speech, no interactions with others, and a remarkably flat affect.”
The patient’s PANNS total score decreased to 81 and the patient was deemed “stable,” but his parents expressed concern that the now 16-year-old would stop taking his medication when he returned home. Clinicians opted for a 2-injection LAI of aripiprazole in conjunction with outreach community treatment consisting of professional educators working with the patient on problem solving, social skills, and performing monthly psychiatric consultations.
After 1 month, the patient’s PANSS total score was 43 and CGI score 2, and positive symptoms were no longer present.
Conclusions and implications
Typically, during the first 2 weeks of treatment, aripiprazole LAI requires oral supplementation, but given the success of this case, the 2-injection start regimen “may be an interesting option.” This method of treatment could help reduce the length of hospital stays and allows for earlier discharge, according to the written report.
“Further research on the efficacy and safety of LAI antipsychotics in adolescence is very much needed. Plus, the putative protective effect of continuous treatment with LAI antipsychotics on the adolescent brain should be explored in future studies,” researchers concluded in the report.
