Aripiprazole led to shorter hospital stays than risperidone for teens with cannabis-related psychosis | Research

The takeaway

In a chart review of 110 hospitalized adolescents with cannabis use disorder and psychosis, those prescribed aripiprazole had significantly shorter hospital stays than those on risperidone.

Child psychiatrists, emergency medicine providers, and inpatient clinicians treating adolescent cannabis-related psychosis.

Aripiprazole: 5.8 days vs. risperidone: 9.7 days hospital stay (p=0.002)

What the researchers found

Adolescents prescribed aripiprazole had a mean length of stay of 5.8 days compared to 9.7 days for risperidone (p=0.002). The length of stay index was also significantly lower for aripiprazole (0.79 vs. 1.4, p=0.004).

Why it matters

Co-occurring cannabis use and psychosis in adolescents is increasing, and clinicians lack evidence to guide antipsychotic choice for this specific population. These preliminary data suggest aripiprazole may resolve acute symptoms faster.

The numbers in context

110 adolescents. Aripiprazole: mean stay 5.8 days, index 0.79. Risperidone: mean stay 9.7 days, index 1.4. Both differences significant (p=0.002 and p=0.004 respectively).

How the study worked

Retrospective chart review of 110 adolescents (ages 13-21) hospitalized for psychosis with co-occurring cannabis use disorder. Compared outcomes between those prescribed risperidone versus aripiprazole. Nonrandomized quality improvement project.

What this study cannot tell us

Nonrandomized design with potential selection bias in medication choice. Retrospective chart review. Cannot control for illness severity, cannabis use patterns, or other medications. Single-center data.

How to read the evidence

Nonrandomized retrospective comparison. Useful signal but prone to selection bias and confounding.

When this study was published

Published 2023.

The bigger picture

The pharmacology may matter here: aripiprazole is a partial dopamine agonist while risperidone is a full antagonist. Cannabis-induced psychosis may respond differently to these mechanisms than primary psychotic disorders.

Questions still open

Would a randomized trial confirm aripiprazole superiority in this population? Does the mechanism of cannabis-induced psychosis make it more responsive to partial dopamine agonism?

Common questions

Which antipsychotic is better for cannabis-induced psychosis in teens?

This preliminary study suggests aripiprazole may resolve symptoms faster than risperidone, based on shorter hospital stays. However, this was not a randomized trial, and the medication choice was made by treating clinicians who may have selected differently based on patient characteristics.

Why might aripiprazole work differently than risperidone for cannabis psychosis?

Aripiprazole is a partial dopamine agonist, meaning it modulates rather than fully blocks dopamine signaling. Since cannabis affects dopamine pathways, this partial agonism may be better suited to cannabis-related psychosis than the full dopamine blockade of risperidone. This is speculative and needs further study.

Read the original research

Program Evaluation to Aid Choice of Aripiprazole or Risperidone for Hospitalized Adolescents with Cannabis Use Disorder and Psychosis.

Journal of child and adolescent psychopharmacology, 33(8), 332-336

View on PubMed ↗Publisher’s paper ↗

Citation

Thurstone, Christian; Loh, Ryan; Foreman, Kristina; Thurstone, Christian A; Wolf, Chelsea. (2023). Program Evaluation to Aid Choice of Aripiprazole or Risperidone for Hospitalized Adolescents with Cannabis Use Disorder and Psychosis.. Journal of child and adolescent psychopharmacology, 33(8), 332-336. https://doi.org/10.1089/cap.2023.0053