Aripiprazole and Risperidone for Treatment of Methamphetamine-Associated Psychosis in Chinese Patients

• The aripiprazole group had a significantly lower retention due to medication related adverse effects.
• The risperidone group reported significantly greater methamphetamine craving reductions.
• Patients who tolerated their medications and completed the entire study achieved comparable reductions of psychotic symptoms.

We evaluated tolerability and efficacy of aripiprazole and risperidone for treatment of methamphetamine (METH) associated psychotic symptoms in China. Patients with acute METH-associated psychotic symptoms (N = 42) and with Positive and Negative Syndrome Scale (PANSS) total score between 60 and 120 were randomized to aripiprazole (initial dose 5–10 mg per day followed by flexible doses 5–15 mg per day) or risperidone (initial dose 2–4 mg per day followed by flexible doses 4–6 mg per day) from day 3 to 25 of inpatient hospital stay. Outcome measures included PANSS and Clinical Global Impressions-Severity of Illness scale (CGI-S), METH craving Visual Analogue Scale (VAS), Simpson Angus Scale (SAS), Barnes Assessments Akathasia Rating Scale (BARS), and self-reported adverse effects evaluated during treatment. Retention was evaluated using Kaplan-Meier survival analysis and the MIXED models procedure was used to compare the groups on measures of psychotic and extra-pyramidal symptoms. Patients in both aripiprazole and risperidone groups showed statistically significant reductions in psychotic symptomatology from baseline during treatment (p < 0.001) with no statistically significant differences between the treatment groups (p = 0.73 and p = 0.15, respectively). Risperidone-treated patients reported significantly greater METH craving reductions (p < 0.001). Overall, 71% of patients completed the entire study, but the aripiprazole group had a significantly lower retention than the risperidone group (p = 0.007), primarily due to medication related adverse effects. Aripiprazole-treated patients also had significantly more akathisia (p = 0.03) and agitation (p = 0.02) than risperidone-treated patients. Patients in both groups who tolerated their medications and completed the entire study achieved comparable reductions of psychotic symptoms.

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