Patient profiles to consider*
The following are hypothetical patients with bipolar I disorder
*Establish tolerability to oral aripiprazole. Following first injection administer
Meet our Patient. Diagnosed 3 years ago. She currently lives in a dorm with roommates while attending a 4-year college.
HISTORY She was initially diagnosed with ADHD. At age 18, her diagnosis was changed to bipolar I disorder when she experienced a 2-week manic episode that coincided with final exams. Her symptoms included distractibility, hyperactivity, and decreased need for sleep.
TREATMENT HISTORY She was hospitalized and discharged with a prescription for quetiapine. She was rehospitalized 3 months ago and stabilized on oral aripiprazole during an inpatient stay.
CURRENT SITUATION She is stable on oral aripiprazole, but does not want to take a daily dose. She’s self-conscious about her roommates seeing her pill bottles. Her parents are concerned about her willingness to keep them informed about her treatment. Her psychiatrist mentioned that she may be a good candidate for an LAI. She can receive injections at the school’s health center, which accepts her parents’ insurance, and can receive injections at her doctor’s office when she is home.
ADHD=attention deficit hyperactivity disorder; LAI=long-acting injectable.
In a private practice
Meet our Patient. Diagnosed 3 years ago. She works as an IT specialist. She lives with her husband and their kids.
HISTORY She was diagnosed with MDD in her early 20s. At age 24, her diagnosis was changed to bipolar I disorder after she was hospitalized for a manic episode. Her symptoms have included inflated self-esteem, pressured speech, an increase in goal-directed activities, fatigue, and inappropriate guilt.
TREATMENT HISTORY Her physician confirmed her tolerability to oral aripiprazole. She's also been prescribed mood stabilizers, antidepressants, and 2-week, long-acting risperidone injections. However, she did not want to receive injections every 2 weeks. Her physician reinitiated oral risperidone and she is currently stable but wishes to avoid taking a daily oral antipsychotic.
CURRENT SITUATION Her husband states that his wife's work schedule causes her to skip her daily oral antipsychotic. Based on the husband’s feedback, her psychiatrist has suggested once-monthly
MDD=major depressive disorder.
In a community mental health center
Meet our Patient. Diagnosed 17 years ago. He lives with his aunt and works part-time at a grocery store.
HISTORY He was diagnosed with bipolar I disorder at 20 years of age, when he experienced a period of mania. His symptoms have included racing thoughts, elevated mood, risky behaviors, and grandiosity. He has been hospitalized twice in the past 3 years.
TREATMENT HISTORY He has been prescribed mood stabilizers and antipsychotics. He was prescribed risperidone, then switched to quetiapine. He has previously expressed concern with remembering to take his daily oral antipsychotic.
CURRENT SITUATION He is currently stable on oral aripiprazole which he receives through Medicaid. He wants to avoid a daily oral antipsychotic. His psychiatrist reminds him that he has the option to receive once-monthly
Important Warning and Precaution Regarding Metabolic Changes:
Atypical antipsychotic drugs have caused metabolic changes including:
- Hyperglycemia/Diabetes Mellitus: Hyperglycemia, in some cases extreme and associated with ketoacidosis, hyperosmolar coma, or death, has been reported in patients treated with atypical antipsychotics including aripiprazole. Patients with diabetes mellitus should be regularly monitored for worsening of glucose control; those with risk factors for diabetes (e.g., obesity, family history of diabetes), should undergo baseline and periodic fasting blood glucose testing. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia should also undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the suspect drug.
- Dyslipidemia: Undesirable alterations in lipids have been observed in patients treated with atypical antipsychotics.
- Weight Gain: Weight gain has been observed with atypical antipsychotic use. Clinical monitoring of weight is recommended.