Article No 4

Home , Dopamine antagonist, Lahore General Hospital

20 National Journal of Health Sciences, 2018, 3, 20-22

non adherence to drugs with other problems including was 3 and 4 which correspond to moderate to marked level of treatment of neuroleptic-induced akathisia. J Clin Psychophar- try 2009; 70(5): 627-43. DOI: 10.4088/JCP.08r04210 self-harm behaviors and worsening of psychosis [7]. akathesia respectively. One patient (3.34%) in the group macol 1990; 10(1): 12-21. Propranolol and low dose mirtazapine have been found useful receiving Risperidone 2 mg presented with akathesia of the DOI: 10.1097/00004714-199002000-00003 [7] Poyurovsky M, Pashinian A, Weizman R, Fuchs C, Weizman in treatment of Akathisia [8, 9]. 7th post treatment day having a score of 3 on BARS A. Low-dose mirtazapine: A new option in the treatment of corresponding to moderate level akathesia. Furthermore, no [4] Stern TA, Fava M, Wilens TE, Rosenbaum JF. Massachusetts antipsychotic-induced akathisia. A randomized, double-blind, Concerns regarding Aripiprazole having greater tendencies to patients in either of the sub-groups had Akathesia when General Hospital Psychopharmacology and Neurotherapeu- placebo-and propranolol-controlled trial. Biol Psychiatry cause Akathisia has come to surface but there’s lack of assessed on 21st post treatment day. tics. 1st ed. US: Elsevier Health Sciences 2015. 2006;59(11): 1071-7. DOI: 10.1016/j.biopsych.2005.12.007 substantial evidence [9]. Agitation and Akathisia being noted in patients on aripiprazole [9] by clincians has moved authors DISCUSSION/CONCLUSION [5] Cohen ST, Rulf D, Pies R: Extrapyramidal side effects associ- [8] Schatzberg AF, DeBattista C, Eds. Manual of clinical psycho- to run a clinical trial in Lahore General Hospital , to primarily The results of the study depict a nearly comparable frequency ated with aripiprazole coprescription in 2 patients. J Clin pharmacology. USA: American Psychiatric Association 2015. establish the incidence of Akathisia in Aripiprazole in of Akathesia between Aripiprazole and Risperidone when Psychiatry 2005; 66(1):135-6. DOI: 10.4088/JCP.v66n0118c DOI: 10.1176/appi.books.9781615370047 comparison to risperidone. seen in context of the relatively small sample size. The AIM OF STUDY frequency of akathesia with Aripiprazole found in this study is [6] Kane JM, Fleischhacker WW, Hansen L, Perlis R, Pikalov 3rd [9] Cruz MP. Aripiprazole lauroxil (Aristada): An extended-re- 6.67% which is consistent with results of previous studies on A, Assunção-Talbott S. Akathisia: An updated review lease, long-acting injection for the treatment of schizophrenia. This is a comparative study which is aimed at determining that the subject which have found the incidence to be equal or focusing on second-generation antipsychotics. J Clin Psychia- PT 2016; 41(9): 556-9. whether Aripiprazole does or does not has a higher incidence greater than 5% [9] . In a 12-week, placebo-controlled, of Akathisia than that of Risperidone, so that, the raised fixed-dose schizophrenia trial, 2 out of 415 patients concern of clinicians regarding Aripiprazole induced discontinued Aripiprazole due to akathesia [9]. The incidence Akathisia could have a more scientific (evidence based) of Akathesia with Aripiprazole is not found to be dose related ground, which is somewhat challenged because of the lack of [9] . The frequency of Akathesia with Risperidone (3.34%) in existing literature on the subject. less than the incidence found in the plethora of previous HYPOTHESIS studies on the subject. Some studies have found the incidence of Akathesia with Risperidone to be as high as 10%. The “Aripiprazole induced Akathisia has a lower incidence than smaller frequency in our study could be a result of small Risperidone induced Akathisia”. sample size and/or the low dosage of 2mg of Risperidone METHOD used. A total of 60 patients were included in the study. The patients Despite the nearly comparable frequency of Akathesia with fulfilled the DSM-V criteria for acute psychotic episode, both drugs, the question remains that why clinicians' schizophreniform disorder or schizophrenia with the illness suspicion or fear index for Aripiprazole is much higher for being a first episode in all the cases and the patients were Aripiprazole than Risperidone. We hypothesized that one either anti-psychotic naive or had taken any antipsychotic in explanation for this dilemma could be the presence of the past three months. There was no demarcation of age, sex numerous case reports on severe Akathesia being reported or duration of illness in the inclusion criteria. Patients with Aripiprazole. Many of these reports came around the fulfilling the inclusion criteria were then randomly assigned time of launch of Aripiprazole in the market which may have into 2 groups of 30 patients each. One group is given put a bias in the heads of doctors who were still just Aripiprazole (10 mg) and the other is prescribed Risperidone familiarizing themselves with the drug. INTRODUCTION properties. Adverse effects of Risperidone include significant (2mg). Both groups were directed to take the medicine in weight gain and metabolic problems such as diabetes mellitus CONFLICT OF INTEREST Risperidone (1993) and Aripiprazole (2002) are second tablet form and at night time. Both groups were not receiving type 2 as well as extra-pyramidal symptoms and neuroleptic generation of anti-psychotics, Risperidone with a mean dose any other medication for their psychiatric disorder except Declared none. malignant syndrome [3]. clonzepam 2mg or less. Patients of both groups were re-called of 3.9mg/day was established as a well-tolerated drug in ACKNOWLEDGEMENTS Clinical Anti Psychotic Trials of Intervention Effectiveness Aripiprazole has partial D2 and 5HT1A agonistic rather than on the 7th day after the start of the medication and were (CATIE) 1998 [1]. Risperidone and Aripiprazole, have been antagonist, it also has affinity for presynaptic D2 auto receptor screened and calibrated for Akathisia using the Barnes Declared none. Akathisia Rating Scale (BARS) with a cut off value of 2 or chosen as a monotherapies for first episode of psychosis in agonist as well, so it is believed to have lesser neurological REFERENCES schizophreniform and schizophrenia treatment of in this side effects but its impact on effectiveness is unclear as it was more on global assessment indicating the presence of clinical trial [2]. Risperidone and Aripiprazole are best not tested in CATIE trial [4]. Weight gain and metabolic Akathisia. The patients not having akathesia of the 7th day [1] Manschreck TC, Boshes RA. The CATIE schizophrenia trial: choices in oral form in acute psychotic episodes in which disturbances are not associated with Aripiprazole, it is were put in a sub-group and were re-assessed for presence of Results, impact, controversy. Harv Rev Psychiatry 2007; rapid titration is required [3]. believed to cause less EPS but Akathisia has been reported akathesia on the 21st day following start of anti-psychotic. 15(5): 245-58. DOI: 10.1080/10673220701679838 from this drug [5]. Intra muscular second generation Risperidone is administered both in the form of oral tablets or RESULTS anti-psychotics are associated with Akathisia in patients who [2] Jenkins JA, Kontos N. The Maudsley prescribing guidelines in in solution from. It is a dopamine antagonist possessing are clearly at risk of Dystonia or Parkinsonism [6]. The Akathesia assessment done on the 7th day revealed the psychiatry. J Clin Psychiatry 2016; 77(4): 469-73. DOI: anti-serotonergic, anti-adrenergic and anti-histaminergic presence of Akathesia in two (6.67%) patients getting 10.4088/JCP.16bk10716 Anti-psychotics can cause ‘unpleasant sensation of motor Aripiprazole 10 mg. The score of both patients as caliberated restlessness’ in lower extremities known as Akathisia causing on Barnes Akathisia Rating Scale (BARS) global assessment [3] Fleischhacker WW, Roth SD, Kane JM. The pharmacologic 22 National Journal of Health Sciences, 2018, Vol. 3, No. 1 Ali et al. non adherence to drugs with other problems including was 3 and 4 which correspond to moderate to marked level of treatment of neuroleptic-induced akathisia. J Clin Psychophar- try 2009; 70(5): 627-43. DOI: 10.4088/JCP.08r04210 self-harm behaviors and worsening of psychosis [7]. akathesia respectively. One patient (3.34%) in the group macol 1990; 10(1): 12-21. Propranolol and low dose mirtazapine have been found useful receiving Risperidone 2 mg presented with akathesia of the DOI: 10.1097/00004714-199002000-00003 [7] Poyurovsky M, Pashinian A, Weizman R, Fuchs C, Weizman in treatment of Akathisia [8, 9]. 7th post treatment day having a score of 3 on BARS A. Low-dose mirtazapine: A new option in the treatment of corresponding to moderate level akathesia. Furthermore, no [4] Stern TA, Fava M, Wilens TE, Rosenbaum JF. Massachusetts antipsychotic-induced akathisia. A randomized, double-blind, Concerns regarding Aripiprazole having greater tendencies to patients in either of the sub-groups had Akathesia when General Hospital Psychopharmacology and Neurotherapeu- placebo-and propranolol-controlled trial. Biol Psychiatry cause Akathisia has come to surface but there’s lack of assessed on 21st post treatment day. tics. 1st ed. US: Elsevier Health Sciences 2015. 2006;59(11): 1071-7. DOI: 10.1016/j.biopsych.2005.12.007 substantial evidence [9]. Agitation and Akathisia being noted in patients on aripiprazole [9] by clincians has moved authors DISCUSSION/CONCLUSION [5] Cohen ST, Rulf D, Pies R: Extrapyramidal side effects associ- [8] Schatzberg AF, DeBattista C, Eds. Manual of clinical psycho- to run a clinical trial in Lahore General Hospital , to primarily The results of the study depict a nearly comparable frequency ated with aripiprazole coprescription in 2 patients. J Clin pharmacology. USA: American Psychiatric Association 2015. establish the incidence of Akathisia in Aripiprazole in of Akathesia between Aripiprazole and Risperidone when Psychiatry 2005; 66(1):135-6. DOI: 10.4088/JCP.v66n0118c DOI: 10.1176/appi.books.9781615370047 comparison to risperidone. seen in context of the relatively small sample size. The AIM OF STUDY frequency of akathesia with Aripiprazole found in this study is [6] Kane JM, Fleischhacker WW, Hansen L, Perlis R, Pikalov 3rd [9] Cruz MP. Aripiprazole lauroxil (Aristada): An extended-re- 6.67% which is consistent with results of previous studies on A, Assunção-Talbott S. Akathisia: An updated review lease, long-acting injection for the treatment of schizophrenia. This is a comparative study which is aimed at determining that the subject which have found the incidence to be equal or focusing on second-generation antipsychotics. J Clin Psychia- PT 2016; 41(9): 556-9. whether Aripiprazole does or does not has a higher incidence greater than 5% [9] . In a 12-week, placebo-controlled, of Akathisia than that of Risperidone, so that, the raised fixed-dose schizophrenia trial, 2 out of 415 patients Received: January 5, 2018 Revised: February 11, 2018 Accepted: February 12, 2018 concern of clinicians regarding Aripiprazole induced discontinued Aripiprazole due to akathesia [9]. The incidence Akathisia could have a more scientific (evidence based) © 2018 National Journal of Health Sciences. of Akathesia with Aripiprazole is not found to be dose related ground, which is somewhat challenged because of the lack of This is an open-access article. [9] . The frequency of Akathesia with Risperidone (3.34%) in existing literature on the subject. less than the incidence found in the plethora of previous HYPOTHESIS studies on the subject. Some studies have found the incidence of Akathesia with Risperidone to be as high as 10%. The “Aripiprazole induced Akathisia has a lower incidence than smaller frequency in our study could be a result of small Risperidone induced Akathisia”. sample size and/or the low dosage of 2mg of Risperidone METHOD used. A total of 60 patients were included in the study. The patients Despite the nearly comparable frequency of Akathesia with fulfilled the DSM-V criteria for acute psychotic episode, both drugs, the question remains that why clinicians' schizophreniform disorder or schizophrenia with the illness suspicion or fear index for Aripiprazole is much higher for being a first episode in all the cases and the patients were Aripiprazole than Risperidone. We hypothesized that one either anti-psychotic naive or had taken any antipsychotic in explanation for this dilemma could be the presence of the past three months. There was no demarcation of age, sex numerous case reports on severe Akathesia being reported or duration of illness in the inclusion criteria. Patients with Aripiprazole. Many of these reports came around the fulfilling the inclusion criteria were then randomly assigned time of launch of Aripiprazole in the market which may have into 2 groups of 30 patients each. One group is given put a bias in the heads of doctors who were still just Aripiprazole (10 mg) and the other is prescribed Risperidone familiarizing themselves with the drug. INTRODUCTION properties. Adverse effects of Risperidone include significant (2mg). Both groups were directed to take the medicine in weight gain and metabolic problems such as diabetes mellitus CONFLICT OF INTEREST Risperidone (1993) and Aripiprazole (2002) are second tablet form and at night time. Both groups were not receiving type 2 as well as extra-pyramidal symptoms and neuroleptic generation of anti-psychotics, Risperidone with a mean dose any other medication for their psychiatric disorder except Declared none. malignant syndrome [3]. clonzepam 2mg or less. Patients of both groups were re-called of 3.9mg/day was established as a well-tolerated drug in ACKNOWLEDGEMENTS Clinical Anti Psychotic Trials of Intervention Effectiveness Aripiprazole has partial D2 and 5HT1A agonistic rather than on the 7th day after the start of the medication and were (CATIE) 1998 [1]. Risperidone and Aripiprazole, have been antagonist, it also has affinity for presynaptic D2 auto receptor screened and calibrated for Akathisia using the Barnes Declared none. Akathisia Rating Scale (BARS) with a cut off value of 2 or chosen as a monotherapies for first episode of psychosis in agonist as well, so it is believed to have lesser neurological REFERENCES schizophreniform and schizophrenia treatment of in this side effects but its impact on effectiveness is unclear as it was more on global assessment indicating the presence of clinical trial [2]. Risperidone and Aripiprazole are best not tested in CATIE trial [4]. Weight gain and metabolic Akathisia. The patients not having akathesia of the 7th day [1] Manschreck TC, Boshes RA. The CATIE schizophrenia trial: choices in oral form in acute psychotic episodes in which disturbances are not associated with Aripiprazole, it is were put in a sub-group and were re-assessed for presence of Results, impact, controversy. Harv Rev Psychiatry 2007; rapid titration is required [3]. believed to cause less EPS but Akathisia has been reported akathesia on the 21st day following start of anti-psychotic. 15(5): 245-58. DOI: 10.1080/10673220701679838 from this drug [5]. Intra muscular second generation Risperidone is administered both in the form of oral tablets or RESULTS anti-psychotics are associated with Akathisia in patients who [2] Jenkins JA, Kontos N. The Maudsley prescribing guidelines in in solution from. It is a dopamine antagonist possessing are clearly at risk of Dystonia or Parkinsonism [6]. The Akathesia assessment done on the 7th day revealed the psychiatry. J Clin Psychiatry 2016; 77(4): 469-73. DOI: anti-serotonergic, anti-adrenergic and anti-histaminergic presence of Akathesia in two (6.67%) patients getting 10.4088/JCP.16bk10716 Anti-psychotics can cause ‘unpleasant sensation of motor Aripiprazole 10 mg. The score of both patients as caliberated restlessness’ in lower extremities known as Akathisia causing on Barnes Akathisia Rating Scale (BARS) global assessment [3] Fleischhacker WW, Roth SD, Kane JM. The pharmacologic