Focus on aripiprazole: a review of its use in child and adolescent psychiatry.

OBJECTIVE

To review published literature regarding aripiprazole in child and adolescent psychiatry.

METHODS

A literature review was conducted using the medline search term: 'aripiprazole' with limits: Human trials, English language, All Child (aged 0-18 years). Additional articles were identified from reference information and poster presentation data.

RESULTS

Aripiprazole is an atypical antipsychotic which was recently approved for use in Canada, but has been available for several years in the United States. Pharmacologically, aripiprazole is a partial agonist at D(2) and 5-HT(1A) receptors and an antagonist at 5-HT(2A) receptors. Randomized controlled trial data is available showing efficacy for aripiprazole in the treatment of children and adolescents with schizophrenia, bipolar disorder and behavioural problems associated with autism. Open-label evidence is also available for use of aripiprazole in other disorders such as tic disorders, aggression and disruptive behavior disorders. Unlike some other available atypical antipsychotics, there does not appear to be any effect on QTc interval on the electrocardiogram. Adverse effects including extrapyramidal symptoms (EPS), akathisia, sedation, headache, nausea were significant in clinical trials in children and adolescents. The possibility of aripiprazole causing tardive dyskinesia cannot be excluded. In this population, aripiprazole appears to have minimal impact on the metabolic profile compared to most other atypical antipsychotics, with minimal changes in weight or body mass index, no significant changes in glucose or lipid metabolism, and a decrease in serum prolactin.

CONCLUSIONS

Aripiprazole may represent an important alternative for some children and adolescents who have experienced poor efficacy or significant metabolic adverse effects with their current antipsychotic treatment regimen.