Consortium PSYCHIATRICUMConsortium PSYCHIATRICUMConsortium PSYCHIATRICUM2712-76722713-2919Eco-Vector4010.17650/2712-7672-2020-1-2-43-51REVIEWОБЗОРReview ArticleNegative Symptoms of Schizophrenia: New Prospects of Cariprazine TreatmentНегативные симптомы шизофрении: новые перспективы лечения карипразиномhttps://orcid.org/0000-0002-7076-59014955-8297ReznikAleksandr M.РезникАлександр Михайлович
Russian Federation

MD, PhD, assistant-professor, doctor-psychiatrist, Medical Institute of Continuing Education of «Moscow National University of Food Production»

к.м.н., доцент, заведующий кафедрой психиатрии ФГБОУ ВО «Московский государственный университет пищевых производств»

a.m.reznik1969@gmail.comhttps://orcid.org/0000-0001-8940-9299ArbuzovAleksandr L.АрбузовАлександр Леонидович
Russian Federation

MD, PhD, assistant-professor, doctor-psychiatrist, Medical Institute of Continuing Education of «Moscow National University of Food Production»

к.м.н., доцент кафедры психиатрии ФГБОУ ВО «Московский государственный университет пищевых производств»

arbuzov_dr@rambler.ruhttps://orcid.org/0000-0001-5770-8956MurinSergey P.МуринСергей Павлович
Russian Federation

MD, PhD, assistant-professor, doctor-psychiatrist, Medical Institute of Continuing Education of «Moscow National University of Food Production»

преподаватель кафедры психиатрии ФГБОУ ВО «Московский государственный университет пищевых производств»

Sergejmurin@yandex.ruMedical Institute of Continuing Education of «Moscow National University of Food Production»Федеральное государственное бюджетное учреждение высшего образования «Московский государственный университет пищевых производств»Mental-health Clinic No. 1 named after N.A. AlexeevГосударственное бюджетное учреждение здравоохранения «Психиатрическая клиническая больница №1 им. Н.А. Алексеева Департамента здравоохранения города Москвы»Mental Health Clinic No. 5Государственное бюджетное учреждение здравоохранения Московской области «Психиатрическая больница №5»041220201243510710202021102020Copyright ©; 2020, Reznik A.M., Arbuzov A.L., Murin S.P., Pavlichenko A.V.Copyright ©; 2020, Резник А.М., Арбузов А.Л., Мурин С.П., Павличенко А.В.2020Reznik A.M., Arbuzov A.L., Murin S.P., Pavlichenko A.V.Резник А.М., Арбузов А.Л., Мурин С.П., Павличенко А.В.https://creativecommons.org/licenses/by/4.0https://consortium-psy.com/jour/article/view/40

Background. Cariprazine is a new piperazine derivative atypical antipsychotic, like aripiprazole and brexpiprazole. It has been approved for treating schizophrenia in many countries and has recently been included on the List of Essential Medicines in Russia. Unlike most other atypical antipsychotics, it shows high in vivo occupancy of dopamine D2 and D3 receptors at clinically relevant doses. In animal models, cariprazine has demonstrated dopamine D3 receptor- dependent pro-cognitive and anti-anhedonic effects, suggesting its potential for treating negative symptoms. This review summarizes the efficacy of cariprazine in the treatment of negative symptoms of schizophrenia.

Methods. A literature search of databases covering international and Russian journals, for articles published between 1st January 2010 and 1st June 2020.

Results. Cariprazine demonstrated at least comparable efficacy in the treatment of schizophrenia symptoms to active comparators including risperidone, olanzapine or aripiprazole. The drug has a good safety profile. It appeared to be associated with a lower risk of metabolic syndromes and most extrapyramidal symptoms. The positive effect of cariprazine on the negative symptoms of schizophrenia may be associated with the elimination of secondary negative symptoms. However, of all the atypical antipsychotics to date, only cariprazine has a convincingly, methodologically robust proven advantage over risperidone in eliminating the predominant negative symptoms of schizophrenia. Yet only four studies have investigated the effect of cariprazine on the negative symptoms of schizophrenia. There is a lack of research into its direct impact on emotional-volitional disorders, anhedonia, cognitive symptoms and personality changes. However, there is evidence to suggest cariprazine is effective in treatment-resistant cases, but this requires further confirmation.

Conclusion. Cariprazine is an effective and well-tolerated agent for the treatment of schizophrenia and may be effective in cases where other antipsychotics have failed. Cariprazine has been shown to have a positive effect on negative symptoms. Further studies are needed to collect more data on long-term treatment of schizophrenia and especially negative symptoms.

Карипразин, новый атипичный антипсихотик, подобно арипипразолу и брекспипразолу, представляющий собой производное пиперазина, был одобрен для лечения шизофрении во многих странах, и в 2019 году – в России. В отличие от большинства других атипичных антипсихотиков, карипразин in vivo в клинически значимых дозах проявляет высокую активность в отношении как дофаминовых D2-рецепторов, так и D3-рецепторов. В моделях на животных карипразин продемонстрировал зависимые от D3 рецептора дофамина прокогнитивные и антиангедонические эффекты, предполагая возможность лечения негативных симптомов. Данный обзор нацелен на выяснение данных об эффективности карипразина при лечении негативных симптомов шизофрении. Был проведен поиск литературы по базам данных международных и российских журналов, опубликованных с 1 января 2010 г. по 1 июня 2020 г. Карипразин продемонстрировал, по крайней мере, сопоставимую эффективность в лечении симптомов шизофрении с активными препаратами сравнения, включая рисперидон и арипипразол. Установлен хороший профиль безопасности. В частности, при использовании карипразина отмечен низкий риск развития метаболического синдрома и появления большинства экстрапирамидных симптомов. Положительное влияние карипразина на негативные симптомы шизофрении может быть связано с устранением вторичных негативных симптомов. Однако из всех атипичных нейролептиков на сегодняшний день только карипразин имеет убедительно, методологически обоснованное преимущество перед рисперидоном в устранении негативных и когнитивных симптомов шизофрении. В то же время изучению влияния карипразина на негативные симптомы шизофрении было посвящено всего 4 исследования. Остается неизученным непосредственное действие на эмоциональные, волевые расстройства, проявления ангедонии, когнитивные симптомы и изменения личности, происходящие у пациентов. Имеются данные, позволяющие предложить наличие лечебного эффекта у карипразина в резистентных случаях. Однако это требует дальнейшей проверки.

Вывод. Карипразин - эффективное и безопасное средство лечения шизофрении, которое может быть эффективным в тех случаях, когда применение других антипсихотиков оказались недостаточно результативным. Карипразин показал доказал свое лечебное действие в отношении негативной симптоматики. Однако для сбора дополнительных данных о долгосрочном лечении шизофрении и особенно негативных симптомов необходимы дальнейшие исследования.

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