From the Research
The antipsychotic of choice for delusional disorder is aripiprazole, given its effectiveness and good tolerability as shown in recent studies. According to a systematic review published in 2020 1, aripiprazole has been found to be effective in treating delusional disorders, with an average dose of 11.1 mg/day and an average time to achieve clinical response of 5.7 weeks. The review also noted that aripiprazole had few adverse effects, including asthenia, extrapyramidal symptoms, hyperprolactinemia, and insomnia.
Key Considerations
- Aripiprazole can be initiated at 5-10 mg daily and adjusted up to 15-30 mg daily as needed.
- Treatment should continue for at least 6-12 months after symptom resolution, with some patients requiring longer maintenance therapy.
- Regular monitoring for metabolic side effects (weight gain, diabetes, dyslipidemia) and movement disorders is essential.
- Psychotherapy, particularly cognitive behavioral therapy, should be considered as an adjunct to medication for comprehensive treatment.
Comparison with Other Antipsychotics
- While other second-generation antipsychotics like risperidone and olanzapine may also be effective, aripiprazole's favorable side effect profile makes it a preferred choice 1.
- First-generation antipsychotics may have a slight superiority in terms of response rates, but their use is limited by their side effect profile 2.
Clinical Implications
- Clinicians should consider aripiprazole as a first-line treatment option for delusional disorder, given its efficacy and tolerability.
- Regular monitoring and adjustments to treatment should be made as needed to minimize side effects and optimize treatment outcomes.