Clinical Utility of Cariprazine in the Management of Acute Schizophrenia: Current Evidence and Practical Recommendations

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Abstract
Background: The management of schizophrenia in acute care units presents significant challenges, particularly in addressing negative symptoms and functional impairment. Cariprazine, a dopamine D3/D2 receptor partial agonist, offers a unique pharmacological profile in this setting. This review aims to provide an expert consensus on the clinical utility of cariprazine in acute settings and establish practical recommendations for its use. Methods: A comprehensive literature review was conducted across specialized databases, including PubMed/MEDLINE, EMBASE, PsycINFO, and the Cochrane Library, ensuring a robust evidence base. The consensus was developed by a panel of six senior experts during a formal consensus meeting held in Madrid. Following a structured discussion and evidence synthesis, a modified Delphi-like process was employed to refine the recommendations. The quality of evidence and the strength of the recommendations were assessed using the grading of recommendations assessment, development, and evaluation (GRADE) approach. Results: The evidence confirms cariprazine’s efficacy in acute exacerbations, with a distinct advantage in treating predominant negative symptoms and hostility compared to other second-generation antipsychotics (SGAs). Its metabolic-neutral profile and D3-mediated impact on craving also make it a strategic option for patients with dual diagnosis. Conclusions: Cariprazine is a valuable tool for the stabilization and long-term functional recovery of patients in acute psychiatric units. The consensus provides a practical framework to optimize its clinical application based on high-quality evidence.