Efficacy of aripiprazole versus cariprazine in controlling manic symptoms in three cases of psychosis

ABSTRACT Cariprazine is a new antipsychotic with partial agonism at D3/D2 dopamine receptors, along-with a multitude of actions at serotonin receptors. Aripiprazole and brexpiprazole are the other dopamine receptor partial agonist antipsychotics. The D3-preferring pharmacology makes cariprazine unique and relatively free from the adverse effects. All second-generation antipsychotics are known to have mood-stabilizing effects, with both cariprazine and aripiprazole reported to have antimanic efficacy. Here, we report three obese, middle-aged females, diagnosed with schizophrenia or schizoaffective disorder, with comorbid diabetes mellitus, dyslipidemia, or hyperprolactinemia, previously stabilized with combinations of amisulpride and aripiprazole, who stopped medications and relapsed. When antipsychotics were to be restarted, cariprazine had already become available and was approved for treating both schizophrenia and manic symptoms, while being free of metabolic side effects or hyperprolactinemia. Thus, Cariprazine was started along-with amisulpride, following which the symptoms of schizophrenia related to positive domain were significantly reduced but manic/hypomanic symptoms persisted. Cariprazine had to be stopped, and aripiprazole was added, leading to effective reduction of manic symptoms in each case. Thus, aripiprazole appears to have a better mood-stabilizing and antimanic property as compared to cariprazine in the sub-population of patients reported here, that is in middle-aged females suffering from psychosis, with comorbid metabolic syndrome/hyperprolactinemia.