Impulse control symptoms associated with aripiprazole long-acting injectable: A prospective cohort study

Abstract

Impulse control disorders (ICDs) have been described in association with dopamine partial agonists, particularly aripiprazole. However, data regarding the risk of ICDs with long-acting injectable (LAI) formulations remain limited. To prospectively examine the presence and course of impulse control symptoms in psychiatric patients treated with intramuscular aripiprazole, compared with paliperidone and risperidone, over six months of follow-up. Prospective cohort study. We conducted a prospective cohort study in a naturalistic clinical setting to evaluate the emergence of impulse control symptoms in patients treated with aripiprazole LAI. 27 patients initiating intramuscular treatment with aripiprazole (n=17), paliperidone (n=6), or risperidone (n=4) were systematically assessed monthly for pathological gambling, compulsive buying, hypersexuality, alcohol use, and other substance use. Repeated-measures ANOVA and linear mixed-effects models were applied. Clinically significant impulse control symptoms emerged in a proportion of patients treated with aripiprazole LAI, particularly compulsive buying. Symptom presentation was heterogeneous. While most monitored behaviours followed comparable longitudinal trajectories across treatment groups, compulsive buying showed a significant group-by-time interaction, characterized by a peak at month 3 among patients receiving aripiprazole. These findings suggest that aripiprazole LAI may be associated with the emergence of impulse control symptoms in a subset of patients. Although preliminary, this study highlights the importance of systematic monitoring of behavioral side effects in patients receiving LAI formulations of dopamine partial agonists. Further research with larger samples is warranted to better characterize this association.