title: Favourable results in treatment-resistant schizophrenic patients under combination of aripiprazole with clozapine.
abstract: Clozapine is still the gold standard in treatment-resistant schizophrenia. However, a substantial amount of patients do not fully recover on clozapine monotherapy. Though there is still a lack of randomised controlled studies of combination strategies in treatment-resistant schizophrenia, they are widely used. Aripiprazole is a relatively new therapeutic option due to its partial D2 agonism. Both clozapine and aripiprazole, though having a generally favourable side-effect profile, may lead to insufficient response and might provoke side effects in monotherapy. We report the case of four patients in whom we observed a distinct clinical improvement with respect to positive and negative symptoms without major side effects under a combination of clozapine and aripiprazole. The combination of clozapine action and aripiprazole-mediated D(2) receptor regulation could be responsible for the described favourable effects and for the increase of D(2) receptor blockade after adding aripiprazole to clozapine observed in one patient. A combination of clozapine and aripiprazole may be an effective therapeutic strategy for some schizophrenic patients, leading to a good response with respect to positive and negative symptoms without the occurrence of major side effects.
authors.affiliation: Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria. nilufar.mossaheb@meduniwien.ac.at
authors.forename: Nilufar
authors.initials: N
authors.lastname: Mossaheb
authors.forename: Christoph
authors.initials: C
authors.lastname: Spindelegger
authors.forename: Susanne
authors.initials: S
authors.lastname: Asenbaum
authors.forename: Peter
authors.initials: P
authors.lastname: Fischer
authors.forename: Christian
authors.initials: C
authors.lastname: Barnas
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000068180:Aripiprazole; D003024:Clozapine / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage / Q000627:therapeutic use*; D015363:Quinolones / Q000008:administration & dosage / Q000627:therapeutic use*; D012559:Schizophrenia / Q000188:drug therapy*; D012563:Schizophrenia, Paranoid / Q000188:drug therapy; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D000068180:Aripiprazole; D003024:Clozapine