title: The effectiveness of aripiprazole in the management of problem behaviour in people with intellectual disabilities, developmental disabilities and/or autistic spectrum disorder--a systematic review.
abstract: The management of problem behaviours (PB) in individuals with intellectual disabilities (ID), developmental disabilities (DD) and/or autistic spectrum disorders (ASD) can be challenging. Antipsychotic medications are commonly prescribed where other strategies have failed. A systematic review (SR) was conducted to establish the research evidence for the efficacy of aripiprazole in the management of PB in adults and children with ID, DD and/or ASD. Although included studies supported the efficacy of aripiprazole for this indication, the overall quality of studies was poor. Of the 20 studies included in this systematic review there were only two randomised controlled trials (RCTs) on children with ASD and/or ID/DD, both of which were conducted by the pharmaceutical company that manufactures aripiprazole, and it is not clear whether a number of same participants were included in both RCTs. One of the RCTs was extended into an open label long term follow up, which showed that aripiprazole's efficacy lasted over 52 weeks and the adverse effects were tolerable. Four studies were open label prospective studies, 11 were retrospective case reports which included four single case reports, and two were prospective case series. Most studies reported adverse effects from aripiprazole in the form of weight gain, increased appetite, sedation, tiredness, drooling and tremor. However, aripiprazole improved serum prolactin level in some participants and overall did not show any adverse effect on QTc interval. There is a need for more carefully designed RCTs into the use of aripiprazole in the management of PB in people with ID/DD and/or ASD, which should be carried out independent of pharmaceutical companies.
authors.affiliation: Imperial College, London, UK.
authors.forename: Shoumitro
authors.initials: S
authors.lastname: Deb
authors.affiliation: School of Psychiatry, West Midlands Deanery, Birmingham, UK.
authors.forename: Baldeep K
authors.initials: BK
authors.lastname: Farmah
authors.affiliation: University of Birmingham, UK.
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Arshad
authors.affiliation: Imperial College, London, UK.
authors.forename: Tanya
authors.initials: T
authors.lastname: Deb
authors.affiliation: Birmingham Community Healthcare NHS Trust, UK. Electronic address: meera.roy@nhs.net.
authors.forename: Meera
authors.initials: M
authors.lastname: Roy
authors.affiliation: School of Psychology, University of Birmingham, UK.
authors.forename: Gemma L
authors.initials: GL
authors.lastname: Unwin
mesh_terms: D000374:Aggression; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole; D002659:Child Development Disorders, Pervasive / Q000150:complications / Q000188:drug therapy*; D002658:Developmental Disabilities / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008607:Intellectual Disability / Q000150:complications / Q000188:drug therapy*; D001523:Mental Disorders / Q000150:complications / Q000188:drug therapy; D010879:Piperazines / Q000627:therapeutic use*; D015363:Quinolones / Q000627:therapeutic use*; D016728:Self-Injurious Behavior / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D000068180:Aripiprazole
keywords: ASD; Aggression; Aripiprazole; Developmental disabilities; Intellectual disabilities; Problem behaviour; Self-injurious behaviour