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Aripiprazole in the treatment of acute manic or mixed episodes in patients with bipolar I disorder: • Dosing could be reduced to 15 mg/day for Tolerability • Aripiprazole : no significant difference from placebo in change in mean body weight • not associated with elevated prolactin or QTc prolongation • fasting glucose, • fasting insulin • insulin resistance index • cholesterol • triglycerides • low-density lipoprotein (LDL) • LDL/HDL, • Chol/HDL treatment of an acute manic episode for up to 12 weeks Aripiprazole showed superior levels of response and tolerability to haloperidol • Aripiprazole showed similar efficacy to olanzapine for longterm treatment of acutely psychotic and chronic, stable schizophrenia patients, • lower liability for weight gain or increased lipid levels Aripiprazole: initial clinical experience with 142 hospitalized psychiatric patients. • daily dose, 16.1 +/- 6.2 mg • body weight: 0.20 +/- 0.09 mg/kg • aripiprazole is likely to be onsidered for obese patients • weight should be considered short-term treatment of schizophrenia 1. aripiprazole 15-30 mg is as effective 2. haloperidol 10 mg/day 3. risperidone 6 mg/day Aripiprazole • quinolinone derivative • high affinity for D2 , D3 receptors • partial agonist action on 5-HT (1A) receptors • 5-HT (2A) receptors antagonist • active metabolite: dehydroaripiprazole, = parent compound dopamine D2 receptors • peak plasma concentration=3 hours • Steady-state plasma concentrations are achieved by 14 days • CYP3A4 and CYP2D6 transform it to dehydroaripiprazole • genetic polymorphism • The drug is effective as early as the first or second week of treatment. • No additional therapeutic benefit at the higher-than-recommended dosages induce weight gain • • • • clozapine and olanzapine. TCA, mirtazapine come next majority of the mood stabilizers. The old antipsychotics seem to involve less gain of weight. • SSRI make lose weight in the first weeks, but induce a moderate weight gain on the long term.