title: A Case of Resistant Schizophrenia Successfully Treated With Clozapine/Long-acting Injectable Aripiprazole Combination.
abstract: BACKGROUND
  Treatment-resistant schizophrenia (TRS) is a condition characterized by intense symptom severity and poor response to different antipsychotic agents. The first therapeutic option in TRS is clozapine, but often high/medium doses are not tolerated. Adding an oral antipsychotic to low doses of clozapine is a promising strategy in the management of TRS. On the contrary, there are few data on combined clozapine/long-acting injectable (LAI) medications, and none on clozapine/LAI-aripiprazole.
  
  
  METHODS
  A 21-year-old male schizophrenic patient, resistant to several oral and LAI medications, partially improved after clozapine 300 mg/d treatment. Unfortunately, he also reported excessive sedation and an episode of myoclonus, so clozapine was reduced to 150 mg/d, but no additional benefits were observed. Subsequently, LAI-aripiprazole (first 200 mg/mo, then 400 mg/mo) was added, and the patient's conditions dramatically improved over time. After 1 year of observation, symptoms reduction was 50% or greater, without significant adverse events.
  
  
  CONCLUSIONS
  Clozapine use in TRS is often reduced or delayed due to the fear of serious adverse effects. Adding LAI-aripiprazole to low doses of clozapine may be a useful therapeutic option to obtain a good efficacy/tolerability balance.
authors.affiliation: *Department of Basic Medical Sciences, Neurosciences and Sense Organs, "A. Moro" University of Bari, Bari; †Department of Neuroscience, Imaging and Clinical Science, "G. d' Annunzio" University of Chieti; and ‡National Health Trust, Department of Mental Health, Chieti, Italy.
authors.forename: Gianna
authors.initials: G
authors.lastname: Sepede
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Iorio
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Spano
authors.forename: Marco
authors.initials: M
authors.lastname: Lorusso
authors.forename: Fabiola
authors.initials: F
authors.lastname: Sarchione
authors.forename: Rita
authors.initials: R
authors.lastname: Santacroce
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Salerno
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Giannantonio
mesh_terms: D000068180:Aripiprazole / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D012559:Schizophrenia / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000068180:Aripiprazole; D003024:Clozapine