Sepede Gianna, Di Iorio Giuseppe, Spano Maria Chiara, Lorusso Marco, Sarchione Fabiola, Santacroce Rita, Salerno Rosa Maria, Di Giannantonio Massimo
*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.
Clin Neuropharmacol. 2016 Nov/Dec;39(6):322-324. doi: 10.1097/WNF.0000000000000191.
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.
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.
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.
难治性精神分裂症（TRS）的特点是症状严重且对不同抗精神病药物反应不佳。TRS的首选治疗药物是氯氮平，但高/中剂量往往难以耐受。在低剂量氯氮平基础上加用口服抗精神病药物是治疗TRS的一种有前景的策略。相反，关于氯氮平与长效注射剂（LAI）联合用药的数据很少，关于氯氮平/LAI阿立哌唑联合用药则尚无相关数据。
一名21岁男性精神分裂症患者，对多种口服和LAI药物均耐药，在接受300mg/d氯氮平治疗后症状部分改善。不幸的是，他还出现了过度镇静和一次肌阵挛发作，因此氯氮平减至150mg/d，但未观察到额外益处。随后加用LAI阿立哌唑（最初200mg/月，之后400mg/月），随着时间推移患者病情显著改善。经过1年观察，症状减轻50%或更多，且无明显不良事件。
由于担心严重不良反应，TRS患者使用氯氮平常常减少或延迟。在低剂量氯氮平基础上加用LAI阿立哌唑可能是获得良好疗效/耐受性平衡的一种有效治疗选择。
