A clinical case of patient with early psychosis treated with cariprazine
This article by D. De Berardis et al. summarizes a case report of early schizophrenia treated successfully with cariprazine monotherapy.
Descripción del caso
Antecedentes de la paciente / Diagnóstico y síntomas
19-year-old man, with a history of “separation anxiety” diagnosed at age 13 with no therapeutic follow-up, a family history of psychosis, and occasional cannabis and MDMA use. He left school at age 17 in his third year of high school (due to poor performance). He had very few friends and never had a romantic relationship.
At age 16, the patient experienced “what was probably his first episode”; symptoms included persecutory ideation, delusions of influence, and unspecified auditory hallucinations.
Tratamiento
The GP prescribed low-dose haloperidol (1 mg/day) for several months, which the patient eventually withdrew from, apparently due to the remission of symptoms.
At age 19, in the present episode, the patient went to an emergency department, reporting “anxiety” and that “…a terrorist attack is about to happen in my town, and I might be suspected of being one of the terrorists…”. He also had auditory (thought broadcasting and conversing voices) and somatic hallucinations, social withdrawal, blunted affect, overwhelming suspiciousness, insomnia with night waking and nightmares, intense anguish, disconnected thinking, and episodes of impulse control loss (compulsive masturbation). During observation, PANSS score was 156 (POS=33, NEG=25, GEN=98).
Haloperidol therapy was suggested but refused by the patient with no reason given. The patient preferred not to be hospitalized but accepted therapy “… as long as it doesn’t make me put on weight or turn me impotent…”. He was started on 1.5 mg/day cariprazine (along with low-dose alprazolam 1 mg/day), which was increased to 3 mg/day a few days later. About two weeks later, cariprazine was increased to 4.5 mg/day and then to 6 mg/day.
After a month and a half on 6 mg/day, the patient showed a significant response, reporting a considerable reduction in symptoms (“… I feel more alive …”), which were also scored objectively on the PANSS total score 98 (POS=17, NEG=13, GEN=68).
At the last visit the patient was on cariprazine 6 mg/day and reported no side effects, and his PANSS score was 73 (POS=16, NEG=12, GEN=45). It is noteworthy that the patient’s impulse control loss ceased by this point. Furthermore, he agreed take a specific course of psychotherapy.
Discusión
The onset of schizophrenia is often unrecognized or inadequately treated, therefore early diagnosis and treatment are important for preventing chronic consequences and the development of serious disability and drug resistance. Cariprazine therapy was extremely effective and very well tolerated. Cariprazine’s “efficacy and tolerability profiles make it an ideal drug in early-stage schizophrenia, when the choice of first-line treatment can determine the course of the illness and treatment adherence”. The patient reported “not feeling” the therapy, referring to disturbing side effects such as sedation, dizziness or feeling “dazed” or “lightheaded”, which often leads to the withdrawal of antipsychotic drugs.
COD. 300020/R41. Submitted to AIFA on 12 October 2020.
Clinical Experiences with Cariprazine in Patients with Early Psychosis
| „In the case described, cariprazine therapy was extremely effective and very well tolerated. Indeed, cariprazine’s efficacy and tolerability profiles make it an ideal drug in early-stage schizophrenia, when the choice of first-line treatment can determine the course of the illness and treatment adherence.” |
Sí, acepto 
No, quiero ir a los ajustes 