Ivanova Elena, Maslinkova Desislava, Polnareva Nadia, Milanova Vihra
Clinic of Child Psychiatry "St. Nicholas", University Hospital "Alexandrovska", Sofia, Bulgaria.
Department of Psychiatry and Medical Psychology, Medical University - Sofia, Sofia, Bulgaria.
Front Psychiatry. 2023 Apr 14;14:1155518. doi: 10.3389/fpsyt.2023.1155518. eCollection 2023.
Negative symptoms are part of the clinical manifestations of schizophrenia and their presence is associated with a poorer prognosis, significantly limited vocational opportunities, impaired quality of life and social functioning. In the clinical practice, treatment of negative symptoms in patients with schizophrenia, is a challenge. Cariprazine is a novel partial agonist of D3 and D2 receptors, and shows a high affinity for D3, with good tolerability, good response to schizophrenic symptoms and limited side effects. We present two cases of young patients with predominantly negative symptoms during treatment with an atypical antipsychotic, administered in a stable dose and therapeutic range, and for at least 4 weeks prior to the Cariprazine switch.
Two patients (men aged 21 and 22) with schizophrenia, exhibiting predominantly negative symptoms, are presented. Their diagnosis was based on, DSM-5 criteria (295.10).Patients were treated with Cariprazine at a daily dose of 4.5 mg. They were followed for a period of 18 months and assessed with Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and Clinical Global Impression-Severity (CGI-S), at the fourth week of initiation of treatment with Cariprazine, at 6 months, at 12 months and at 18 months. Their mean initial value was 75.5 on PANSS, 4.0 on CGI-S, and 52.5 on GAF. Both patients were treated with stable doses of atypical antipsychotic-Risperidone at a daily dose of 4,5 mg. Cross-titration to Cariprazine was initiated, from 1.5 mg daily dose up to 4,5 mg daily dose, during a period of 2 weeks.
After 18 months of treatment with Cariprazine at a daily dose of 4.5 mg, the following results were reported: mean value was 57.5 on PANSS, 3.0 on CGI-S, and 74.5 on GAF. The overall PANSS mean score decreased by 23.8%, the CGI-S mean score improved by 25% and the mean GAF score increased by 29.5%. The positive PANSS subscale score decreased minimally, from 20 to 16, while for the negative subscale the improvement was 29.8%.Cariprazine was well tolerated by patients and no side effects were observed from it during therapy.
After 18 months Cariprazine succeeded in improving negative symptoms, global functioning, and global clinical impression. In young schizophrenic patients with a predominance of negative symptoms, the cariprazine may be a successful alternative.
阴性症状是精神分裂症临床表现的一部分，其存在与较差的预后、显著受限的职业机会、受损的生活质量和社会功能相关。在临床实践中，精神分裂症患者阴性症状的治疗是一项挑战。卡立哌嗪是一种新型的D3和D2受体部分激动剂，对D3显示出高亲和力，耐受性良好，对精神分裂症症状反应良好且副作用有限。我们报告两例年轻患者，在以稳定剂量和治疗范围内使用非典型抗精神病药物治疗期间主要表现为阴性症状，且在换用卡立哌嗪前至少已治疗4周。
报告两名患有精神分裂症且主要表现为阴性症状的患者（分别为21岁和22岁男性）。他们的诊断基于《精神疾病诊断与统计手册》第5版（DSM-5）标准（295.10）。患者接受每日剂量4.5毫克的卡立哌嗪治疗。在开始使用卡立哌嗪治疗的第4周、6个月、12个月和18个月时对他们进行随访，并使用阳性与阴性症状量表（PANSS）、功能总体评定量表（GAF）和临床总体印象-严重程度量表（CGI-S）进行评估。他们在PANSS上的初始平均值为75.5，在CGI-S上为4.0，在GAF上为52.5。两名患者均接受每日剂量4.5毫克的稳定剂量非典型抗精神病药物利培酮治疗。在2周内开始从每日剂量1.5毫克交叉滴定至卡立哌嗪每日剂量4.5毫克。
在每日剂量4.5毫克的卡立哌嗪治疗18个月后，报告了以下结果：PANSS平均值为57.5，CGI-S为3.0，GAF为74.5。PANSS总体平均得分下降了23.8%，CGI-S平均得分提高了25%，GAF平均得分提高了29.5%。PANSS阳性分量表得分从20略微降至16，而阴性分量表的改善为29.8%。患者对卡立哌嗪耐受性良好，治疗期间未观察到副作用。
18个月后，卡立哌嗪成功改善了阴性症状、整体功能和总体临床印象。对于以阴性症状为主的年轻精神分裂症患者，卡立哌嗪可能是一种成功的替代药物。
