Aripiprazole and Other Third-Generation Antipsychotics as a Risk Factor for Impulse Control Disorders: A Systematic...

Area of Science:

• Psychiatry and Pharmacology
• Neuroscience
• Clinical Therapeutics

Background:

• Third-generation antipsychotics (TGAs) are increasingly associated with impulse control disorders (ICDs), potentially due to dopamine receptor partial agonism.
• However, the precise risks of ICDs with TGA use remain unclear.
• This systematic review and meta-analysis aims to quantify the association between TGAs and ICDs.

Approach:

• A comprehensive electronic literature search was conducted across major databases (Medline, PsychINFO, EMBASE, Cochrane) from database inception to November 2022.
• Eligible studies were identified through a rigorous screening process by three independent reviewers.
• A random-effects meta-analysis was performed on the included studies to synthesize the findings.

Key Points:

• All 8 included studies reported an increased probability of ICDs with TGA use.
• Pooled analysis revealed a significantly increased risk of ICDs (OR=5.54) when comparing TGAs to other antipsychotics.
• Cariprazine and brexpiprazole showed significant associations with ICDs, while aripiprazole indicated a trend towards increased risk.

Conclusions:

• Third-generation antipsychotics (TGAs) are associated with an elevated risk of impulse control disorders (ICDs).
• Despite consistent findings across studies, the overall quality of evidence is very low.
• High risk of bias and wide confidence intervals necessitate cautious clinical interpretation of these findings.