Of the different phases of bipolar disorder, bipolar depression is more prevailing and is more difficult to treat. However, there is a deficit in systemic research on the pharmacological treatment of acute bipolar depression. Therefore, consensuses on the pharmacological treatment strategies of acute bipolar depression has yet to be made. Currently, there are only three drugs approved by the Food and Drug Administration for acute bipolar depression : quetiapine, olanzapine-fluoxetine complex, and lurasidone. In clinical practice, other drugs such as mood stabilizers (lamotrigine, lithium, valproate) and/or the other atypical antipsychotics (aripiprazole, risperidone, ziprasidone) are frequently prescribed. There remains controversy on the use of antidepressants in bipolar depression. Here, we summarized the evidence of current pharmacological treatment options and reviewed treatment guidelines of acute bipolar depression from recently published studies.
Antidepressive Agents ; Antipsychotic Agents ; Bipolar Disorder* ; Consensus ; Lithium ; Lurasidone Hydrochloride ; Quetiapine Fumarate ; Risperidone ; United States Food and Drug Administration

Objective: To investigate the clinical effects of aripiprazole on sexual dysfunction induced by amisulpride or risperidone in male patients with schizophrenia. METHODS: This study included 75 male patients with drug-induced secondary sexual dysfunction after treated with amisulpride or risperidone for first-episode schizophrenia between October 2014 and October 2016. We substituted aripiprazole for amisulpride or risperidone, gradually increased the dose from 10 to 30 mg/d within 2 weeks, and maintained 30 mg/d from the 3rd week. At 4 and 8 weeks after medication, we evaluated the sexual function of the patients, measured the levels of serum prolactin (PRL) and testosterone (T), obtained the scores of the Positive and Negative Symptoms Scale (PANSS), recorded adverse reactions, and compared the parameters with those before aripiprazole administration. RESULTS: Compared with pre-aripiprazole administration, the patients showed significant increases after 4 weeks of medication in the sexual function score (24.3 ± 2.1 vs 32.6 ± 3.6, P <0.05) and T level (［13.3 ± 2.7］ vs ［17.4±3.0］ mmol/L, P <0.05) but a decreased level of PRL (［38.5 ± 10.5］ vs ［27.9 ± 8.2］ ng/ml, P <0.05). At 8 weeks, the sexual function score and serum PRL were both restored to the baseline levels at admission, and the erectile function score, ejaculation score, total score, and serum T level even exceeded the baseline, though with no statistically significant differences (P >0.05). In comparison with pre-aripiprazole administration, the PANSS score was significantly decreased at 4 weeks after medication (62.1 ± 4.9 vs 57.2 ± 5.5, P <0.05) and even lower at 8 weeks (51.2 ± 5.2) (P <0.05). The incidence rates of medication-related excitation, dizziness, insomnia, and loss of appetite were 6.7%, 5.3%, 4.0% and 1.3% respectively, and no other serious adverse reactions were observed. CONCLUSIONS Aripiprazole is effective for the treatment of drug-induced sexual dysfunction in schizophrenic men by continuously alleviating their positive and negative symptoms and meanwhile improving their sexual function and restoring their sexual hormone levels.
Amisulpride ; Antipsychotic Agents ; administration & dosage ; adverse effects ; Aripiprazole ; administration & dosage ; Drug Administration Schedule ; Humans ; Male ; Prolactin ; blood ; Risperidone ; adverse effects ; Schizophrenia ; blood ; drug therapy ; Sexual Behavior ; Sexual Dysfunction, Physiological ; blood ; chemically induced ; drug therapy ; Sulpiride ; adverse effects ; analogs & derivatives ; Testosterone ; blood ; Treatment Outcome

Less than one third of patients who suffer from major depressive disorder (MDD) report remission following antidepressant treatments requiring more diverse treatment approaches. Augmentation of second generation antipsychotics (SGAs) has been increasingly recognized as an important treatment option. The authors have previously provided a comprehensive review of SGAs for the treatment of MDD in 2013. Since then, numerous additional clinical trials have been conducted to investigate diverse issues regarding the utility of SGAs in MDD. Moreover, a new SGA, brexpiprazole, was recently approved by the Food and Drug Administration in July 2015 for the treatment of MDD as an augmentation agent to antidepressants. Thus, the aim of this study was to provide a concise update of all the available SGAs for the treatment of MDD, in particular on the additional clinical trials which have been published since 2013.
Antidepressive Agents ; Antipsychotic Agents ; Depressive Disorder ; Depressive Disorder, Major ; Depressive Disorder, Treatment-Resistant ; Humans ; United States Food and Drug Administration

Elderly patients affected with dementia frequently accompany delusions, hallucinations and other psychotic symptoms. As such, these patients are commonly prescribed antipsychotic medications for the treatment of psychosis. However, in recent years, the use of antipsychotics has been widely debated for reasons concerning their efficacy and safety in these patients. Conventional antipsychotics have been widely used for behavioral psychological symptoms in dementia (BPSD) in the past. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, the Food and Drug Administration alert the possible increase in cerebrovascular adverse events after using antipsychotics and consequent studies reported various adverse (including fatalities) events. Notwithstanding controversial data, antipsychotics are probably the best option for short-term treatment of severe BPSD. However, due to possible serious adverse events, long-term therapy is not recommended and clinician should decrease the dosage and discontinue treatment wherever a sufficient control of behavioral symptoms has been obtained. Before prescribing an antipsychotic drug, the possible risk factor should be structurally reviewed and monitored. The aim of this review is to asses systematically the efficacy and safety concern of antipsychotics in treating elderly patients with BPSD. And we also review how and what we should prescribe and monitor, if once antipsychotic medication is decided.
Aged* ; Antipsychotic Agents* ; Behavioral Symptoms ; Delusions ; Dementia* ; Equidae ; Hallucinations ; Humans ; Psychotic Disorders ; Risk Factors ; United States Food and Drug Administration

INTRODUCTIONA bibliometric study was carried out to ascertain the volume and impact of scientific literature published on second-generation antipsychotic drugs (SGAs) in Singapore from 1997 to 2011.

METHODSA search of the EMBASE and MEDLINE databases was performed to identify articles originating from Singapore that included the descriptors 'atypic* antipsychotic*', 'second-generation antipsychotic*', 'clozapine', 'risperidone', 'olanzapine', 'ziprasidone', 'quetiapine', 'sertindole', 'aripiprazole', 'paliperidone', 'amisulpride', 'zotepine', 'asenapine', 'iloperidone', 'lurasidone', 'perospirone' and 'blonanserin' in the article titles. Certain bibliometric indicators of production and dispersion (e.g. Price's Law on the increase of scientific literature, and Bradford's Law) were applied, and the participation index of various countries was calculated. The bibliometric data was also correlated with some social and health data from Singapore, such as the total per capita expenditure on health and gross domestic expenditure on research and development.

RESULTSFrom 1997 to 2011, a total of 51 articles on SGAs in Singapore were published. Our results suggested non-fulfilment of Price's Law (r = 0.0648 after exponential adjustment vs. r = 0.2140 after linear adjustment). The most widely studied drugs were clozapine (21 articles), risperidone (16 articles) and olanzapine (8 articles). Division into Bradford zones yielded a nucleus occupied by the Journal of Clinical Psychopharmacology (6 articles) and the Singapore Medical Journal(4 articles). The analysed material was published in a total of 30 journals, with the majority from six journals. Four of these six journals have an impact factor greater than 2.

CONCLUSIONPublications on SGAs in Singapore are still too few to confirm an exponential growth of scientific literature.

Antipsychotic Agents ; therapeutic use ; Benzodiazepines ; administration & dosage ; Bibliometrics ; Biomedical Research ; methods ; Clozapine ; administration & dosage ; Humans ; Journal Impact Factor ; Publications ; Risperidone ; administration & dosage ; Singapore

OBJECTIVETo observe the therapeutic efficacy of Dangfei Liganning Tablet (DLT) in the treatment of antipsychotics induced mild hepatic damage.

METHODSTotally 80 mental inpatients with antipsychotics induced mild liver injury were randomly assigned to two groups, the treatment group (40 cases) and the control group (40 cases). Patients in the treatment group took DLT, two tablets each time, three times per day, while those in the control group took Liver-protecting Tablet (LT), four tablets each time, three times per day. The treatment course was 4 weeks for all. Changes of glutamic-pyruvic transaminase (ALT) and glutamic-oxalacetic transaminase (AST) were observed before treatment, week 1, 2, and 4 after treatment. The therapeutic efficacy was compared between the two groups.

RESULTSCompared with the former time point, ALT and AST gradually decreased in the two groups at week 1, 2, and 4 (P <0. 05). The cured rate was 72. 5% and the total effective rate was 97. 5% in the treatment group. They were 62. 5% and 90. 0% respectively in the control group. There was no statistical difference in the two indices between the two group (P >0.05). No obvious adverse reaction occurred in the two groups.

CONCLUSIONDLT could treat antipsychotics induced mild hepatic damage in a safe and effective way.

Alanine Transaminase ; metabolism ; Antipsychotic Agents ; adverse effects ; Chemical and Drug Induced Liver Injury ; drug therapy ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Humans ; Liver ; metabolism ; Protective Agents ; administration & dosage ; therapeutic use ; Tablets ; therapeutic use

OBJECTIVETo assess the efficacy and safety of Wuji Powder (WP) and a small dose aripiprazole in treatment of antipsychotic drug-induced phlegm dampness type amenorrhea.

METHODSSeventy female schizophrenic patients with antipsychotic drug-induced galactorrhea-amenorrhea syndrome (GAS) were recruited and randomly assigned to the treatment group and the control group, 35 in each group. All patients received antipsychotic drug therapy. Patients in the treatment group additionally took WP, while those in the control group took aripiprazole (at the daily dose of 5 mg, once daily). The therapeutic course for all was 4 weeks. Prolactin levels and obesity indices[body weight, waist aircumstance, body mass index (BMI) and waist-hit ratio (WHR)] were determined before and after treatment. The efficacy was evaluated.

RESULTSThe treatment course was completed in 95.71% of patients. The total effective rate of the 33 patients of the treatment group was 93.94% (31/33), while it was 91.18% (31/34) in the 34 patients of the control group. There was no difference in the total effective rate between the two groups (P > 0.05). Prolactin levels in both group after treatment were significantly lower than those of the baseline (P < 0.01). There was no significant difference in prolactin levels between the two groups after treatment (P > 0.05). Compared with before treatment, body weight, BMI, waist circumstance, and waist-hip ratio obviously decreased after treatment, showing significant difference when compared with the control group (P < 0.05). There was no significant difference in body weight, BMI, waist circumstance, and waist-hip ratio in the control group between before and after treatment (P > 0.05).

CONCLUSIONSBoth WP and aripiprazole could lower high prolactin levels of schizophrenics with phlegm dampness type amenorrhea. They showed equivalent efficacy. But WP showed more obvious effect in reducing obesity indices.

Aged ; Amenorrhea ; drug therapy ; Antipsychotic Agents ; administration & dosage ; adverse effects ; therapeutic use ; Aripiprazole ; Body Mass Index ; Body Weight ; Drug Therapy, Combination ; methods ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Galactorrhea ; drug therapy ; Humans ; Obesity ; Piperazines ; administration & dosage ; adverse effects ; therapeutic use ; Quinolones ; administration & dosage ; adverse effects ; therapeutic use ; Waist-Hip Ratio

Brown adipose tissue is specialized to burn lipids for thermogenesis and energy expenditure. Second-generation antipsychotics (SGA) are the most commonly used drugs for schizophrenia with several advantages over first-line drugs, however, it can cause clinically-significant weight gain. To reveal the involvement of brown adipocytes in SGA-induced weight gain, we compared the effect of clozapine, quetiapine, and ziprasidone, SGA with different propensities to induce weight gain, on the differentiation and the expression of brown fat-specific markers, lipogenic genes and adipokines in a mouse brown preadipocyte cell line. On Oil Red-O staining, the differentiation was inhibited almost completely by clozapine (40 microM) and partially by quetiapine (30 microM). Clozapine significantly down-regulated the brown adipogenesis markers PRDM16, C/EBPbeta, PPARgamma2, UCP-1, PGC-1alpha, and Cidea in dose- and time-dependent manners, whereas quetiapine suppressed PRDM16, PPARgamma2, and UCP-1 much weakly than clozapine. Clozapine also significantly inhibited the mRNA expressions of lipogenic genes ACC, SCD1, GLUT4, aP2, and CD36 as well as adipokines such as resistin, leptin, and adiponectin. In contrast, quetiapine suppressed only resistin and leptin but not those of lipogenic genes and adiponectin. Ziprasidone (10 microM) did not alter the differentiation as well as the gene expression patterns. Our results suggest for the first time that the inhibition of brown adipogenesis may be a possible mechanism to explain weight gain induced by clozapine and quetiapine.
Adipocytes, Brown/drug effects ; Adipogenesis/drug effects ; Adipokines/metabolism ; Animals ; *Antipsychotic Agents/administration & dosage/adverse effects ; Cell Differentiation/drug effects ; Cell Line ; Cell Survival/drug effects ; *Clozapine/administration & dosage/adverse effects ; *Dibenzothiazepines/administration & dosage/adverse effects ; Gene Expression Regulation/drug effects ; Humans ; Mice ; *Piperazines/administration & dosage/adverse effects ; Schizophrenia/drug therapy ; *Thiazoles/administration & dosage/adverse effects ; Weight Gain/*drug effects

OBJECTIVETo explore the clinical efficacy and safety of three-step acupuncture (TSA) combined with small dosage antipsychotic in treating incipient schizophrenia (IS).

METHODSSixty IS patients were randomly assigned to the test group and the control group equally. Patients in the test group received the combined therapy of TSA and antipsychotic, while patients in the control group were treated by full-dose antipsychotic, all for 8 weeks. The clinical efficacy was assessed by the positive and negative syndrome scale (PANSS), and the adverse reaction was evaluated by treatment emergent symptom scale (TESS).

RESULTSThe clinical efficacy in the two groups showed insignificant difference at the end of the 8-week treatment (P > 0.05), but the total scores of PANSS evaluated at the end of the 2nd and 4th week in the test group (74.26 +/- 9.54, 56.33 +/- 10.12) were significantly higher than those in the control group (85.56 +/- 9.73, 70.57 +/- 9.62), respectively (P < 0.05), furthermore, TESS analysis showed that the incidence of adverse reactions in nervous system and autonomic nervous system in the test group were also lesser than in the control group (P < 0.05).

CONCLUSIONThe combined therapy of TSA and small dose antipsychotic shows an efficacy equivalent to that of full-dose antipsychotic, but with shorter initiation time and less side effects.

Acupuncture Therapy ; methods ; Adolescent ; Adult ; Antipsychotic Agents ; administration & dosage ; Combined Modality Therapy ; Female ; Humans ; Male ; Psychiatric Status Rating Scales ; Schizotypal Personality Disorder ; therapy ; Young Adult

This study aimed to investigate the transport characteristics of aripiprazole. A human intestinal epithelial cell model Caco-2 cell in vitro cultured had been applied to study the transport of aripiprazole. The effects of time, concentration of donor solutions, pH, temperature and P-glycoprotein inhibitor on the transport of aripiprazole were investigated. The determination of aripiprazole was performed by HPLC. It is concluded that aripiprazole is transported through the intestinal mucosa via a passive diffusion mechanism primarily, coexisting with a carrier-mediated transport. The transport of aripiprazole is positively correlated to transport time, pH, and temperature. Papp increased with donor concentrations up to 10 microg x mL(-1), and then decreased for higher concentrations. The P-glycoprotein inhibitor cyclosporine A significantly enhanced the transport amount of aripiprazole.
ATP-Binding Cassette, Sub-Family B, Member 1 ; antagonists & inhibitors ; Antipsychotic Agents ; administration & dosage ; pharmacokinetics ; Aripiprazole ; Biological Transport ; drug effects ; Caco-2 Cells ; Cyclosporine ; pharmacology ; Dose-Response Relationship, Drug ; Humans ; Hydrogen-Ion Concentration ; Piperazines ; administration & dosage ; pharmacokinetics ; Quinolones ; administration & dosage ; pharmacokinetics ; Temperature ; Time Factors