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The advantage of using 3-week data to predict response to aripiprazole at week 6 in first-episode psychosis

Park, Jong-Ila; Cho, Dong-Hwanc; Hahn, Sang Wood; Jeong, Bumseoke; Kim, Jong-Hoonf; Kim, Sung-Wang; Koo, Min-Seongh; Lee, Seung Hwani; Lee, Seung Jaej; Lee, Yo Hank; Park, Jong-Ikl; Rho, Seung Hom; Chung, Young-Chula,b

International Clinical Psychopharmacology: March 2014 - Volume 29 - Issue 2 - p 77–85
doi: 10.1097/YIC.0000000000000005
Original Articles

We investigated the efficacy and safety of aripiprazole in first-episode psychosis and explored the association between early response and later response to this medication. This was a 6-week, open-label, multicenter trial. The study population consisted of 59 patients with a DSM-IV diagnosis of a schizophreniform disorder, schizoaffective disorder, schizophrenia, or psychotic disorder not otherwise specified. The primary outcome measures were the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression-Severity scale. To assess the safety, we measured the drug-related adverse events, weight, and lipid-related variables. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the response status at weeks 2 and 3 to predict the subsequent response at week 6. Among the 59 participants, 38 were able to complete the 6-week trial. Treatment with aripiprazole resulted in significant improvement in the PANSS and Clinical Global Impression scores over time. The response rate (defined as a ≥30% decrease in the PANSS total score from baseline to the last observation) was 69.1%. The most accurate prediction of later response in terms of negative predictive value and specificity was a reduction in the PANSS total score from baseline to week 3 of at least 20%. Aripiprazole had a modest side effect burden and was characterized by a safe profile with respect to weight and metabolic side effects. These results indicate that aripiprazole is effective and safe in the treatment of first-episode psychosis. The response at week 3, rather than week 2, predicted the later response more accurately.

aDepartment of Psychiatry, Chonbuk National University Medical School

bResearch Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju

cDr Cho’s Neuropsychiatry Clinic and Research Center, Busan

dDepartment of Psychiatry, Soonchunhyang University of College of Medicine, Seoul

eGraduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon

fDepartment of Psychiatry, Gil Medical Center, Gachon University, Incheon

gDepartment of Psychiatry, Chonnam National University Medical School, Gwangju

hDepartment of Psychiatry, Myongji Hospital, Kwandong University College of Medicine, Koyang

iDepartment of Psychiatry, Inje University College of Medicine, Ilsan Paik Hospital, Goyang

jDepartment of Psychiatry, Kyungpook National University School of Medicine, Daegu

kSt. John of God Hospital, Kwangju

lDepartment of Psychiatry, Kangwon National University College of Medicine, Chunchon

mDepartment of Psychiatry, Wonkwang University, School of Medicine, Iksan, Republic of Korea

Correspondence to Young-Chul Chung, MD, PhD, Department of Psychiatry, Chonbuk National University Medical School, Keumam Dong 634-18, Jeonju 561 712, Korea Tel: +82 63 250 2185; fax: +82 63 275 3157; e-mail: chungyc@jbnu.ac.kr

Received January 20, 2013

Accepted July 23, 2013

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