A Case of Aripiprazole-induced Mania

Introduction

Aripiprazole is a novel atypical neuroleptic. It acts as a partial agonist at the dopamine D₂ receptor, as a partial agonist at the 5-HT_1A receptor, and as an antagonist at the 5-HT_2A receptor. Clinical trials have established its clinical efficacy and favorable tolerability profile [5] [16]. Nevertheless, infrequent undesirable adverse events are often encountered during wide-scale everyday clinical use. Induction of mania, described for almost all second-generation neuroleptics [2] [3] [11] [15] [17], may be one of the rare adverse events of aripiprazole therapy.

We present a case of an induction of mania after initiation of aripiprazole treatment in a male patient with chronic schizophrenia who had never presented affective symptoms and had been without continuous medication for several years.

References

• 1 American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington DC: American Psychiatric Association 1994
• 2 Aubry JM, Simon AE, Bertschy G. Possible induction of mania and hypomania by olanzapine or risperidone: a critical review of reported cases.  J Clin Psychiatry. 2000;  61 649-654
• 3 Baldassano CF, Ballas C, Datto SM, Kim D, Littman L, O'Reardon J, Rynn MA. Ziprasidone-associated mania: a case series and review of the mechanism.  Bipol Disorder. 2003;  5 72-75
• 4 Burris KD, Molski TF, Xu C, Ryan El, Tottori K, Kikiuchi T. et al . Aripiprazole, a novel antipsychotic, is a high-affinity partial agonist at human dopamine D₂ receptors.  J Pharmacol Exp Ther. 2002;  302 381-389
• 5 Carson WH, McQuade RD, Ali M, Saha AR, Dunbar GC, Ingenito G. A double-blind, placebo-controlled trial of aripiprazole and haloperidol.  Schizophr Res. 2001;  49 ((Suppl 1)) 221-222
• 6 Hugenholtz GWK, Herrdink ER, Meijer WE, Stolker JJ, Egberts ACG, Nolen WA. Reasons for switching between antipsychotics in daily clinical practice.  Pharmacopsychiatry. 2005;  38 122-124
• 7 Hirose T, Uwahodo Y, Yamada S, Miwa T, Kikuchi T, Kitagawa H. et al . Mechanism of action of aripiprazole predicts clinical efficacy and a favourable side-effect profile.  J Psychopharmacol. 2004;  18 375-383
• 8 Jordan S, Koprivica V, Chen R, Tottori K, Kickuchi T, Altar CA. The antipsychotic aripiprazole is a potent, partial agonist at the human 5-HT_1A receptor.  Eur J Pharmacol. 2002;  441 137-140
• 9 Keck PE, Marcus R, Tourkodimitris S, Ali M, Liebeskind A, Saha A, Ingenito G. A placebo-controlled, double-blind study of the efficacy and safety of aripiprazole in patients with acute bipolar mania.  Am J Psychiatry. 2003;  160 1651-1658
• 10 Kelland MD, Freeman AS, Chiodo LA. Serotonergic afferent regulation of the basic physiology and pharmacological responsiveness of nigrostriatal dopamine neurons.  J Pharmacol Exp Ther. 1990;  253 803-811
• 11 Lane HY, Lin YC, Chang WH. Mania induced by risperidone: dose related?.  J Clin Psychiatry. 1998;  59 85-86
• 12 Marder SR, McQuade RD, Stock E, Kaplita S, Marcus R, Safferman AZ. et al . Aripiprazole in the treatment of schizophrenia: safety and tolerability in short-term, placebo-controlled trials.  Schizophr Res. 2003;  61 123-136
• 13 McDaniel JS, Ninan PT, Magnuson JV. Possible induction of mania by buspirone.  Am J Psychiatry. 1990;  147 125-126
• 14 Millan MJ. Improving the treatment of schizophrenia: focus on serotonin (5-HT)_1A receptors.  J Pharmacol Exp Ther. 2000;  295 853-861
• 15 Murphy BP. Amisulpride-induced mania in a patient with schizophrenia.  Br J Psychiatry. 2003;  183 172
• 16 Potkin SG, Saha AR, Kujawa MJ, Carson WH, Ali M, Stock E. et al . Aripiprazole, an antipsychotic with a novel mechanism of action, and risperidone vs placebo in patients with schizophrenia and schizoaffective disorder.  Arch Gen Psychiatry. 2003;  60 681-690
• 17 Rachid R, Bertschy G, Bondolfi G, Aubry JM. Possible induction of mania or hypomania by atypical antipsychotics: an updated review of reported cases.  J Clin Psychiatry. 2004;  65 1537-1545
• 18 Shapiro DA, Renock S, Arrington E, Chiodo LA, Liu LX, Sibley DR. et al . Aripiprazole, a novel atypical antipsychotic drug with a unique and robust pharmacology.  Neuropsychopharmacology. 2003;  28 1400-1411
• 19 Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reliability, validity, sensitivity.  Br J Psychiatry. 1978;  133 423-435

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