Moriarty Sydney E, Parhami Paria, Parikh Jay, Galicki Linda
HOLO Labs - Simulation and Educational Technology, Edward Via College of Osteopathic Medicine, Blacksburg, USA.
Psychiatry, Edward Via College of Osteopathic Medicine, Blacksburg, USA.
Cureus. 2025 Mar 7;17(3):e80204. doi: 10.7759/cureus.80204. eCollection 2025 Mar.
This case presents a male in his early 20s with schizoaffective disorder and cannabis use disorder presenting with treatment resistance demonstrated by inadequate control of psychotic symptoms despite multiple trials of antipsychotics. The patient was experiencing positive symptoms, including hyper-religiosity, hallucinations, mood lability, agitation, and aggression. The patient and next of kin were unable to provide consent for clozapine due to concerns for monitoring requirements. The patient continued paliperidone long-acting injectable (LAI) 234 milligrams (mg) every four weeks and divalproex 750 mg twice per day (BID) and was started on haloperidol with titration to 2 mg BID. Following the addition of a second antipsychotic agent, the patient exhibited marked improvement with reduced intensity of perceptual disturbances. This case underscores the potential benefits and challenges of antipsychotic polypharmacy in addressing residual psychosis and improving functional outcomes. We also provide an overview of available evidence for and against antipsychotic polypharmacy, defined as two or more antipsychotic medications used in a patient concurrently, as well as alternative non-antipsychotic agents for treatment-resistant schizophrenia.
该病例为一名20岁出头的男性，患有精神分裂症伴情感障碍和大麻使用障碍，尽管多次使用抗精神病药物治疗，但精神病症状控制不佳，表现出治疗抵抗。患者存在阳性症状，包括过度宗教信仰、幻觉、情绪不稳定、激越和攻击行为。由于担心监测要求，患者及其近亲无法同意使用氯氮平。患者继续每四周接受234毫克长效帕利哌酮注射剂治疗，并每天两次服用750毫克丙戊酸/divalproex，同时开始使用氟哌啶醇，滴定至每日两次、每次2毫克。在加用第二种抗精神病药物后，患者的感知障碍强度降低，病情有显著改善。该病例强调了联合使用抗精神病药物在解决残留精神病症状和改善功能结局方面的潜在益处和挑战。我们还概述了支持和反对联合使用抗精神病药物（定义为同时在一名患者中使用两种或更多种抗精神病药物）的现有证据，以及用于治疗难治性精神分裂症的替代性非抗精神病药物。
