A Case Report of Chronic Schizophrenia: From Combined Treatment to Monotherapy and Decrease in Positive Symptoms with Decreasing Dose of Clozapine

摘要

Clozapine is one of the most effective drugs in treatment resistant schizophrenia, schizoaffective and bipolar disorder. There is limited evidence to support the combination of multiple antipsychotics in treatment resistant schizophrenia, in the literature. Any monotherapy should be given at the maximum tolerated dose and at least three antipsychotics with different actions, including clozapine, should be given before a combination is considered.In this report, a case whose positive symptoms decrease with the decrease of the clozapine dose is discussed. 37 years old, primary school graduate, single, male patient has been followed with schizophrenia diagnosis for 25 years in different clinics. Because of persistent symptoms and results, under treatment of clozapine 900 mg/day, aripiprazole 30 mg/day, valproate 500 mg/day the patient has been hospitalized. It was investigated that the seizures of the patient were caused by clozapine. For this reason clozapine doses were decreased and discontinuation of aripiprazole was planned. Psychotic symptoms decreased with the doses of clozapine 625 mg/day. In a case-control study of Multiple versus single antipsychotic agents for hospitalized psychiatric patients, ?nitial doses were closely similar at admission for both treatment groups, but the median total final antipsychotic dose was 78% higher for those receiving antipsychotic polytherapy versus monotherapy. Also, median length of stay in the hospital was longer, and risk of adverse effects was higher with polytherapy, whereas clinical improvement scores were similar for both treatments. The clinicians should pay attention about seizure risk of clozapine.