Aripiprazole: from unique mechanism of action to widespread clinical applications
Tomasz Sobów

Effective treatment of schizophrenia and bipolar disorder, the aim of which is complete symptomatic and functional improvement, still remains a challenge. Comprehensive approach to patient’s problems is thought to be crucial, and the usage of an adequate antipsychotic drug is believed to support this process effectively. Currently common modern antipsychotics exhibit similar efficacy in treating positive symptoms of schizophrenic psychosis and mania. However, they vary considerably in terms of their influence on other symptoms as well as tolerance, treatment acceptance and broadly understood doctor–patient cooperation. Aripiprazole is unique due to its mechanism of action. By contrast with other antipsychotics, it is a partial antagonist of D2/D3 (and certain serotonin receptors). Such a pharmacological profile not only grants it considerable efficacy in psychosis treatment, comparable to other second-generation antipsychotics, but also makes it beneficial in treating affective, cognitive and negative symptoms of schizophrenia. Other benefits granted by the pharmacological profile of this drug include: low risk of parkinsonism, beneficial profile in terms of its influence on metabolism (practically no influence on body weight) and the fact that it does not induce hyperprolactinaemia. Due to these positive pharmacological features, aripiprazole can be used not only in preferred monotherapy, but also in combined treatment, including for improved tolerance of other drugs. More recent studies suggest the extension of its indications to, among others, depression refractory to standard pharmacotherapy and behavioural disorders in patients with dementia.