Review

Treatment of psychotic symptoms in bipolar disorder with aripiprazole monotherapy: a meta-analysis

Konstantinos N Fountoulakis¹ , Xenia Gonda² , Eduard Vieta³ and Frank Schmidt⁴

¹  Third Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, Greece

²  Department of Pharmacology and Pharmacotherapy and Department of Psychiatry Kutvolgyi Klinikai Tömb, Semmelweis University, Budapest, Hungary

³  Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain

⁴  Tippie College of Business, University of Iowa, Iowa City, IA, USA

author email corresponding author email

Annals of General Psychiatry 2009, 8:27doi:10.1186/1744-859X-8-27

Published:	31 December 2009

Abstract

Background

We present a systematic review and meta-analysis of the available clinical trials concerning the usefulness of aripiprazole in the treatment of the psychotic symptoms in bipolar disorder.

Methods

A systematic MEDLINE and repository search concerning clinical trials for aripiprazole in bipolar disorder was conducted.

Results

The meta-analysis of four randomised controlled trials (RCTs) on acute mania suggests that the effect size of aripiprazole versus placebo was equal to 0.14 but a more reliable and accurate estimation is 0.18 for the total Positive and Negative Syndrome Scale (PANSS) score. The effect was higher for the PANSS-positive subscale (0.28), PANSS-hostility subscale (0.24) and PANSS-cognitive subscale (0.20), and lower for the PANSS-negative subscale (0.12). No data on the depressive phase of bipolar illness exist, while there are some data in favour of aripiprazole concerning the maintenance phase, where at week 26 all except the total PANSS score showed a significant superiority of aripiprazole over placebo (d = 0.28 for positive, d = 0.38 for the cognitive and d = 0.71 for the hostility subscales) and at week 100 the results were similar (d = 0.42, 0.63 and 0.48, respectively).

Conclusion

The data analysed for the current study support the usefulness of aripiprazole against psychotic symptoms during the acute manic and maintenance phases of bipolar illness.