Combination of clozapine and aripiprazole once-monthly in resistant schizophrenia. A review of a clinical case

Introduction We report the successful management of a 49-year-old woman with an initial diagnosis of schizoaffective disorder transitioned to resistant schizophrenia. First contact with our psychiatrist service in 2000; referring problems with treatment adherence and occasional toxic abuse, she underwent 15 admissions in acute adult psychiatric hospitalisation units since then (last discharge March, 2015), and a one-year stay (2012–2013) in an adult mid-term mental health unit. She is currently followed-up throughout the major mental-health outpatient visits program. Aims The patient was prescribed paliperidone 6 mg 2-0-0, oxcarbazepine 600 mg 1-0-1 and clonazepam 0.5 mg 1-0-1 during the last 2 months. Methods Due to lack of treatment adherence and toxic abuse she suffered a psychotic decompensation in May 2015. She was then prescribed clozapine 200 mg 1-0-2, boosted with aripiprazole 400 mg once monthly. The adjunction of aripiprazole once monthly (AOM) was intended to improve treatment adherence, and to supplement the psychotic control of clozapine without entailing a worsening of therapy tolerability. The patient was monitored during 5 months in our unit. Results We observed a positive psychopathological evolution of the patient, which allowed us to re-evaluate the initial diagnostic, ascribing the previous mood fluctuations to toxic consumption. Conclusion Previous works have been published about the combination of clozapine and oral aripiprazole for the treatment of resistant schizophrenia, but, as far as we know, this is the first repost of the combined use of clozapine and AOM. Based on our results, this antipsychotic combination resulted in a psychopathological improvement of the patient, with good tolerability.