Use of Aripiprazole in Adolescents with a History of Lupus-Associated Psychosis and Refractory Psychiatric Manifestations

Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
Journal of psychiatric practice 05/2011; 17(3):212-6. DOI: 10.1097/01.pra.0000398416.89986.c3
Source: PubMed


Neurologic and psychiatric manifestations are prevalent in children and adults with lupus (labeled by convention neuropsychiatric systemic lupus erythematosus or NPSLE). However, there is a paucity of data on the evaluation and management of NPSLE in youth, with only a few publications describing the use of atypical antipsychotics in children and adolescents with lupus. In children, aripiprazole, a D2/5-HT1A partial agonist, appears to cause less prominent metabolic derangements than other second-generation antipsychotics. This agent may be an important tool in the treatment of pediatric patients with lupus who are at risk for weight gain and dyslipidemia due to disease and corticosteroid effects. The authors present two cases in which psychiatric symptoms associated with treatment-refractory lupus responded to aripiprazole pharmacotherapy.

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    • "Psychosis alone required antipsychotic therapy for 2–3 months. In our series, haloperidol was used in most cases but risperidone, aripiprazole, olanzapine and quetiapine also have been reported with satisfactory results [23] [30] [31]. All depressive psychotic episodes were successfully treated with a combination of antidepressant and antipsychotic for a longer period of treatment than in pure psychosis. "
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    ABSTRACT: Objectives: To study the clinical characteristics and outcomes of psychosis and its clinical correlation with disease activity in Thai systemic lupus erythematosus (SLE) patients. Methods: From 750 SLE patients, 36 episodes of psychosis or psychotic depression in SLE patients were retrospectively identified between June 1999 and June 2009 at Srinagarind Hospital, Khon Kaen University. The clinical characteristics, laboratory analyses, disease activity, treatments and outcomes were studied. Results: A total of 35 SLE patients had 36 psychotic episodes that consisted of 29 psychotic episodes and 7 psychotic depressive episodes. Eleven episodes (30.6%) occurred during the first manifestation of lupus. Psychotic symptoms included persecutory delusion (50%), bizarre delusion (44.4%), third person auditory hallucinations (44.4%) and visual hallucinations (36.1%). Twenty four episodes (67%) were associated with active lupus in CNS and other organs. All patients received immunotherapy and psychotropic treatments. Psychosis and depressive psychosis were treated with antipsychotics and antidepressants for a mean duration of 71 and 410 days. One death resulted from suicide, and one of thirty four cases (2.9%) had a reoccurrence within a mean follow-up period of 44 months. Conclusion: About one-third of the psychotic episodes occurred during the first manifestation of lupus. Persecutory delusion, bizarre delusion, third person auditory hallucination, and visual hallucination were common. During psychotic episodes, lupus activity was active in other parts of CNS and organs in 67% of patients. Depressive psychosis required psychotropic treatment longer than psychosis alone. The psychiatric outcome was very favorable. Most of psychotic episodes (97.1%) were fully remitted and rarely showing recurrences.
    Full-text · Article · Dec 2012 · Journal of psychosomatic research
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    ABSTRACT: Treatments for neuropsychiatric complications of systemic lupus erythematosus are reviewed, including psychiatric medications, corticosteroids (which may also cause psychiatric complications), and emerging non-steroidal immune modulators.
    No preview · Article · May 2011
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    ABSTRACT: This paper describes the use of aripiprazole for the management of cognitive deficits and behavioral disorders in a young female patient suffering from systemic lupus erythematosus (SLE). Cognitive impairment, although often transient, is reported up to 75% of patients with SLE. The behavioral changes and, more generally, clear psychotic episodes have an incidence of 5% but they lead to considerable difficulties in clinical and therapeutic management. In cases with psychiatric manifestations of SLE, it is often necessary to introduce psychopharmacological therapy. The choice of aripiprazole has been made especially in light of low liability to cause weight gain and metabolic side effects. In fact aripiprazole is characterized by an original mechanism of action: it combines partial agonist activity on D2, D3 and 5-HT1A receptor with antagonistic activity on 5-HT2A and D2. Aripiprazole has demonstrated efficacy in the management of behavioral disturbances and has improved some of impaired cognitive functions. Aripiprazole, therefore, could be a great tool in young patients with SLE. Clin Ter 2012; 163(5):e319-323.
    Full-text · Article · Sep 2012 · La Clinica terapeutica
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