Physical illness in schizophrenia and the role of tolerability in antipsychotic selection: an expert consensus with a focus on cariprazine.

Journal: Annals of general psychiatry

Volume: 24

Issue: 1

Year of Publication: 

Affiliated Institutions:  Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy. Electrophysiology and Cardiac Pacing, University of Milano Ospedale Sacco, Milan, Italy. Manar clinic, Tunis , Tunisia. Blakstad Psychiatric Hospital, Vestre Viken Hospital Trust, Drammen, Norway. Nursing School, University of Salamanca, Av. Donantes de Sangre SN, Salamanca, , Spain. University of Coimbra School of Medicine, Coimbra, Portugal. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain. Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa, Greece. FACT-team, Leeuwarden, GGZ Friesland, The Netherlands. Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nürnberg, Germany. Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy. andreafagiolini@gmail.com.

Abstract summary 

Schizophrenia is a highly heterogeneous disease, and a high percentage of patients are at high risk of developing somatic comorbidities, which must be taken into account in disease management and treatment selection.Antipsychotics are often associated with side effects that worsen the somatic comorbidities. Among the different options, cariprazine is generally safe and usually well tolerated in both acute and long-term treatment and is often a good choice when balancing clinical benefits and side effects. Given the lack of consensus on the priority of symptoms to treat and the reasons for switching therapy based on the balance between side effects and symptom resolution, twelve psychiatrists met for an expert meeting to discuss the most common and worrisome antipsychotic side effects leading to switching, the most important somatic comorbidities, and the best way to address specific symptoms in both the acute and maintenance phases of treatment in schizophrenia. Special attention was given to metabolic comorbidities, sexual dysfunction, and cardiovascular disease. This paper aims to examine the relationship between schizophrenia and specific somatic comorbidities, to discuss how the balance between efficacy and tolerability influences treatment choice in the acute and maintenance treatment of schizophrenia, and how these two variables may have different priorities at different stages of treatment.The choice of treatment is based primarily on efficacy and tolerability. Cariprazine is beneficial in patients with positive and negative symptoms, and it has a side-effect profile with low rates of metabolic side effects, sedation, and sexual dysfunction.

Authors & Co-authors:  Cuomo Alessandro A Forleo Giovanni B GB Ghodhbane Taieb T Johnsen Jon J Montejo Angel L AL Oliveira Cristina Vilares CV Pillinger Toby T Ramos-Quiroga Jose Antonio JA Samara Myrto M Seerden Paul H B PHB Thomas Stoeckl Thomas T Fagiolini Andrea A

Study Outcome 

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Statistics
Citations :  Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: overview and treatment options. P T. 2014;39:638–45.
Authors :  12
Identifiers
Doi : 13
SSN : 1744-859X
Study Population
Male,Female
Mesh Terms
Other Terms
Antipsychotics;Cardiovascular diseases;Cariprazine;Metabolic comorbidities;Schizophrenia;Sexual dysfunctions;Somatic comorbidities;Switch therapy
Study Design
Study Approach
Country of Study
Publication Country
England