title: The successful concurrent use of two long-acting depot antipsychotics in a patient with treatment-resistant schizophrenia and history of serious violence: a case report.
abstract: OBJECTIVE
  This case report describes a forensic psychiatric patient presenting with treatment-resistant schizophrenia and serious interpersonal violence complicated by poor adherence to oral medication who was treated successfully with two concurrent long-acting depot antipsychotics.
  
  
  METHODS
  Treatment response was measured for a 6-month period at 6-weekly intervals, post-initiation using the Positive and Negative Symptoms of Schizophrenia with Excited Component score (PANSS-EC), Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression Scale (CGI).
  
  
  RESULTS
  At 6 months, the presentation was found to have markedly improved. The overall PANSS-EC score was reduced by 43.9%, with reductions in Positive Symptom and Excited Component subscales most evident. BPRS Score was reduced from 81 at baseline to 47 at 18 weeks. There was improvement in the patient's level of cooperativeness, aggression and engagement in ward therapeutic activities.
  
  
  CONCLUSIONS
  Although concurrent use of two depot antipsychotics requires further exploration, there is potential benefit for patient groups presenting with treatment-resistant schizophrenia and poor compliance. Due to risk of serious adverse effects which are difficult to reverse with long-acting formulations, we recommend this option be reserved for this complex patient population and exclusively in care settings allowing close physical health monitoring.
authors.affiliation: Specialist Registrar, Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Lenardon
authors.affiliation: Specialist Registrar, Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK.
authors.forename: Mona
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Mental Health Nurse (Team Leader), Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK.
authors.forename: Katie-Lynn
authors.initials: KL
authors.lastname: Harfield
authors.affiliation: Consultant Forensic Psychiatrist, Broadmoor Hospital, West London Mental Health Trust, Berkshire, UK and; College Tutor, Oxford School of Psychiatry, Oxford, UK, and; Consultant Forensic Psychiatrist, Top End Mental Health Service, Parap, NT, Australia.
authors.forename: Mrigendra
authors.initials: M
authors.lastname: Das
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014754:Violence / Q000523:psychology*
chemical_list: D014150:Antipsychotic Agents
keywords: combination antipsychotics; depot antipsychotics; long-acting antipsychotics; treatment-resistant schizophrenia