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Modern standards of therapy for mental disorders, including bipolar disorder, provide important support in making therapeutic decisions. Bipolar disorder by its variability - mania, hypomania, depression — is a significant therapeutic challenge. At the same time, it is a disease that accompanies the patient for most of his or her adult life, forcing use of mood stabilizers, antimanic, antipsychotic and/or antidepressant drugs not only in the active phase of the disease, but above all during the period of euthymia, in order to prevent relapse of the disease. This article analyzes the standard of therapy of bipolar disorders presented by the Canadian Psychiatric Association in 2018 (CANMAT 2018). The reference drug is quetiapine, which is a drug that belongs to both group A of normothymic drugs (has an antimanic effect - A above), and to the group of normothymic drugs B (has an antidepressant effect - B below), and the comparator was aripiprazole, a frequently used second-generation antipsychotic drug, which finds its application as a normothymic drug. The authors of the CANMAT 2018 standard analyzed several hundred clinical papers covering different levels of effectiveness of drugs used in bipolar disorder. This allowed them to assess the level of effectiveness of broadly understood normothymic drugs. The most important conclusions from this study are: 1. With regard to the therapy of a manic episode, first-line drugs are mainly those antipsychotic drugs that can be administered to a muscular or inhaled form. In the group of drugs administered orally, the administration of quetiapine or risperidone is proposed here. 2. The therapy for a first-line depressive episode is precisely quetiapine or a combination of lurasidone with lithium or monotherapy. Of the strategies for the therapy of depressive episode listed here, only all the conditions of normothymic, and thus its effectiveness has been confirmed not only in relation to depression, but also in the therapy of a manic episode and maintenance treatment of both mania and depression meets only quetiapine. 3. The first-line therapy in maintenance treatment is considered to be: lithium, quetiapine, valproate, lamotrigine and a combination of quetiapine with valproate or lithium.4. The first-line therapy for bipolar disorder type II is considered to be quetiapine, lithium and lamotrigine. The CANMAT 2018 standard also provides possibilities but also limitations of bipolar disorder therapy in specific groups of patients, e.g. pregnant women, patients with bipolar disorder co-occurrence with other mental and somatic disorders. 5. Therapy of an episode of depression in patient with bipolar disorder in old age is based on quetiapine, maintenance treatment in geriatric patients is considered to be first-line lithium or valproate drugs. [ABSTRACT FROM AUTHOR]

Aripiprazole differs from other antipsychotics in its unique mechanism of action: as a partial D2 and 5-HT1A agonist and a 5-HT2A antagonist, it acts as a dopamine system stabiliser. The drug allows controlling positive, negative and cognitive symptoms of schizophrenia. The indications in the summary of product characteristics also include treatment of up to 12 weeks of mild-tosevere manic episodes in type 1 bipolar affective disorder in adults and adolescents aged ≥13 years as well as prevention of new manic episodes in adults who experienced predominantly manic episodes and responded to aripiprazole treatment. Clinical trials have shown that the drug is well-tolerated compared to other neuroleptics. Aripiprazole therapy involves a relatively low risk of extrapyramidal symptoms and does not increase the risk of metabolic syndrome. Case reports where combining aripiprazole with another neuroleptic reduced sedation, hypersomnia, drooling, weight gain, dyslipidaemia and sexual dysfunction may be found in literature. Since the drug is available in different forms, it may be also used in agitated, catatonic or persistently uncooperative patients as well as in patients with swallowing problems.

Delirium is a disorder of consciousness and it is caused by acute brain disfunction in the course of, e.g., severe somatic condition, intoxication or withdrawal syndrome. Delirium management is based on the treatment of the state that caused disturbance in central nervous system. Severe delirium syndromes such as agitation, disorganized behavior or hallucinations require additional pharmacological treatment with antypsychotics. Aripiprazole is used in treatment of schizophrenia, bipolar disorder and Tourette syndrome, but also off-label in delirium. A systematic review of databases was carried out and results were limited to case reports, clinical trials and randomized controlled trials. There is evidence that there is no difference in effectiveness of aripiprazole compared to haloperidol and other atypical neuroleptics. Aripirazole could be a better option in particular groups of patients due to its safer cardiological and metabolic profile as well as better tolerance of treatment. However, data from clinical findings are still insufficient to recommend a routine use of aripiprazole in the treatment of delirium. Therefore, further investigations are necessary to work out new strategy of managing delirium syndrome.

Aripiprazole is an antipsychotic drug with unique pharmacological properties showing ago-antagonistic effects against the D2 receptor and is classified as a III generation antipsychotic. Clinical and preclinical studies indicate efficacy and safety of high doses of aripiprazole in selected patients, supporting the decision to use the drug at a maximum dose of 30 mg/day. This paper presents the mechanism of action of high doses of aripiprazole and discusses clinical situations when it is appropriate to use the drug at the maximum dose. The second part of the study presents arguments for beneficial effects of the combination of aripiprazole with olanzapine and other antipsychotic drugs of II generation. [ABSTRACT FROM AUTHOR]

This theoretical and practical article discusses the results of studies on aripiprazole in terms of its anti-maniac, antipsychotic effectiveness, its efficacy in relapse and re-hospitalisation prevention, and its effects on cognition. Study results indicate that aripiprazole may not only be a valuable component of combination therapy, but also, and perhaps above all, is an effective drug when used in monotherapy. The use of aripiprazole in too low doses does not allow for its full clinical effect. The use of high doses of the drug, exceeding 20 mg/day, translates into a high degree of dopaminergic receptor involvement. When excess dopamine is present, aripiprazole competes with dopamine for receptor binding, thereby acting as a D2 receptor antagonist. Therefore, the use of too low doses of the drug often has the opposite effect to the intended one, with aripiprazole acting as a dopaminergic receptor agonist, which results in additional activation instead of anti-manic and antipsychotic effects. Understanding the mechanism of action of this drug is therefore the key to successful treatment with aripiprazole. Data from scientific studies are presented and discussed below, explaining why and in which situations the 30 mg/day dose has an advantage over the 15 mg/day dose. The article answers the most common questions and explains doubts expressed by doctors, along with scientific background and a reference to the literature. Presenting data from the literature, the author also presents their clinical implications and refers to practical experience with the use of aripiprazole both in the hospital and in outpatient practice. [ABSTRACT FROM AUTHOR]

Polypharmacy, meaning combining two or more antipsychotic agents, is frequently used not only in Poland, but across the world. It is estimated, that even 2/3 of patients receive polypharmacy. It may be justified in the acute phase of illness and/or in the treatment resistant patients, or during the switching period from one drug to another. However, it should not be treated as a routine practice because of the increased risk of the adverse events. The analysis of the long-term adverse events of polypharmacy is essential, since those events may increase over the time. Amongst them the weight increase, glucose intolerance, hyperlipidemia, extrapyramidal symptoms, hyperprolactinemia, QTc prolongation and sedation are observed. Aripiprazole is one of the atypical or II generation antipsychotics known for several years. Many clinical trials and everyday practice confirm its clinical efficacy in schizophrenia and bipolar disorder. It is frequently used in the combination with the other antipsychotics. This paper reviews data about aripiprazole application in monotherapy, which should become a routine practice in the mental diseases treatment. [ABSTRACT FROM AUTHOR]

Aripiprazole differs from other antipsychotics in its unique mechanism of action: as a partial D2 and 5-HT1A agonist and a 5-HT2A antagonist, it acts as a dopamine system stabiliser. The drug allows controlling positive, negative and cognitive symptoms of schizophrenia. The indications in the summary of product characteristics also include treatment of up to 12 weeks of mild-tosevere manic episodes in type 1 bipolar affective disorder in adults and adolescents aged =13 years as well as prevention of new manic episodes in adults who experienced predominantly manic episodes and responded to aripiprazole treatment. Clinical trials have shown that the drug is well-tolerated compared to other neuroleptics. Aripiprazole therapy involves a relatively low risk of extrapyramidal symptoms and does not increase the risk of metabolic syndrome. Case reports where combining aripiprazole with another neuroleptic reduced sedation, hypersomnia, drooling, weight gain, dyslipidaemia and sexual dysfunction may be found in literature. Since the drug is available in different forms, it may be also used in agitated, catatonic or persistently uncooperative patients as well as in patients with swallowing problems. [ABSTRACT FROM AUTHOR]

Aripiprazole belongs to atypical antipsychotic medication of the so-called third generation, with a mechanism of action different from most antipsychotic drugs available. Its receptor action profile contributes to relatively good tolerance and low risk of metabolic complications. The high level of safety of aripiprazole was described in multiple groups of patients - the elderly and patients suffering from diabetes as well as kidney, liver and heart diseases. Furthermore, an increasing number of studies show that the drug used in the population of pregnant women was not linked to a clinically significant risk of major birth defects. At present, aripiprazole is mainly used in the treatment of schizophrenia, bipolar disorder and recurrent treatment-resistant depression and occupies a significant position in the recommendations for the treatment regimens for these diseases. In persons with mental illness, somatic diseases frequently coexist (among them, the metabolic syndrome and diabetes) and the inclusion of aripiprazole therapy may result in an additional improvement in metabolic parameters. The literature data suggest that polytherapy with the use of aripiprazole (especially in combination with such atypical drugs as olanzapine, clozapine or risperidone) can bring tangible benefits for patients with schizophrenia. Its clinical utility is significant in the context of the difficulties encountered in the treatment of schizophrenia and bipolar disorder - the lack of cooperation on the part of the patients with respect to drug consumption and the coexistence of numerous somatic ailments in both diseases. [ABSTRACT FROM AUTHOR]

Aripiprazole is an atypical neuroleptic of proven effectiveness for the treatment of schizophrenia and bipolar I disorder. Despite its many years' availability on the market, it tends not to be as popular as it deserves among psychiatrists. Aripiprazole is often used as an adjunctive treatment, added in a small dose to another neuroleptic, not as the primary antipsychotic treatment or prevention of manic episodes. Hence, its full benefits and optimal clinical effect cannot be achieved. This is due to the lack of knowledge concerning the full medical potential associated with the pharmacological profile of this neuroleptic and lack of awareness regarding its efficiency. Aripiprazole is characterised by better tolerability than some other antipsychotics, e.g. in terms of inducing symptomatic hyperprolactinemia, QTc prolongation, impaired glucose tolerance or significant weight gain. It is also associated with a low risk of extrapyramidal symptoms. Its good safety profile facilitates its use in patients with somatic burden, older than 65 years old and obese patients. The article briefly presents the current state of knowledge concerning the effect of aripiprazole in bipolar affective disorder and schizophrenia, focusing on the practical aspects. The following questions have been addressed: • Who is most likely to benefit from aripiprazole treatment, and how to adjust the dosage to the patient's symptom profile? • When to consider a change of therapy to aripiprazole? • When is it appropriate to use aripiprazole as monotherapy and when as an element of combination therapy? Several case reports have been included in the study to best illustrate the drug's therapeutic potential. [ABSTRACT FROM AUTHOR]

Long-acting injectable antipsychotics constitute a valuable alternative for the treatment of psychotic disorders, mainly schizophrenia. They assure a more stable drug level, improve treatment compliance, and increase the chances for favorable and long-lasting improvement. Additionally, the long-acting second-generation antipsychotics combine the values of long-acting injectable drugs with the values of atypical antipsychotics. Four second generation long-acting antipsychotics have been described: risperidone, olanzapine, aripiprazole and paliperidone. The indications for their use, treatment strategy, tolerance, and potential interactions are discussed.

Aripiprazole is a new drug applied in schizophrenia treatment. There are not strict indications for aripiprazole therapeutic drug monitoring. Despite, serum aripiprazole measuring would help control the drug doses effectiveness. The drug monitoring can eliminate overdosing, adverse effects and let control proper drug ingestion. The aim of the paper was to develop a simple method for aripiprazole determination in serum for therapeutic drug monitoring. High performance liquid chromatography with spectrophotometric detection (HPLC-UV) was used. Resolution was performed on LC-8 column; moving phase was solution 0,025M trimethylammonium buffer: acetonitrile (62:38). Isocratic flow was 1,2 ml/min; internal standard (IS) was promazine; monitored wavelength was lambda=214 nm. The validation parameters were: limits of linearity (LOL) 100-800 ng/ml, limit of detection (LOD) 10 ng/ml, limit of quantity (LOQ) 100 ng/ml. Coefficient of variation (CV) describing accuracy and precision didn't cross 10%. The method was useful for therapeutic drug monitoring in serum of patients treated with aripiprazole.