Augmentation of Clozapine with Aripiprazole in Treatment-Resistent Schizophrenia: A Case Report

摘要

Clozapine is the treatment of choice for non-responder schizophrenic patients, with beneficial effects in terms of mental state and suicide mortality. Nevertheless, approximately 30%-50% of patients with treatment-resistant schizophrenia are only partially responsive to clozapine. The prescription of two antipsychotic drugs in combination is one of the most common treatment strategies for those patients who have demonstrated a suboptimal response to clozapine. Here we present a patient with schizophrenia, who has got potential benefits of adding aripiprazole on clozapine. A 34-year-old woman, was admitted to emergency ward after exhibiting hostile behaviors and extreme anger. She had a 15 years history of paranoid schizophrenia with several hospitalizations. She has been taking 500 mg of clozapine daily for 9 years. She was hospitalized because of exacerbation of positive symptoms. Psychiatric examination revealed diminished abstract thinking and negativistic manner including rejection of the treatment. Aripiprazole 5 mg daily was added for antipsychotic augmentation on the third day of her hospitalization. On the 10th day of admission, her overall condition started to improve. Her negativistic manner decreased and she was able to communicate appropriately. This was considered as response to the treatment and aripiprazole dose was increased to 10 mg/daily. During the third week of her hospitalization, she was euthymic without psychotic symptoms. Her anger towards her family disappeared. She was discharged with the combination of clozapine 500 mg/daily and aripiprazole 10 mg/daily. This report indicates that the addition of aripiprazole to ongoing clozapine treatment showed a beneficial effect in a patient with treatment-resistant schizophrenia, who failed to respond to clozapine.This combination of drugs was well tolerated without any adverse effects. Placebo-controlled trials are required in order to test and confirm this observation.