Early psychosis treated with cariprazine: a case study
This article by D. De Berardis et al. summarizes a case report of early schizophrenia treated successfully with cariprazine monotherapy. This is the summary of the first case report, where cariprazine helped the patient achieve remission from an early acute psychosis, following a discontinuation of olanzapine due to inefficacy and adverse effects.
Descripción del caso
Antecedentes de la paciente / Diagnóstico y síntomas
21-year-old woman, unemployed, with a family history of psychiatric illness, practically having no friends, described by her parents as always “shy”, “awkward” and “introverted, of few words”.
The patient displayed gradual, increasingly sever social withdrawal and refused to go to school. Bizarre ideations included being watched by cameras in the street and at school, an inability to study because of radiation given off by the computer screen and believing that her classmates think she is the devil. She had attention and concentration deficits, blunted affect, abulia, self-neglect, dysmorphophobic-type symptoms (“the evil eye making me change the shape of my face”) and auditory hallucinations (“…the neighbours’ voices talking about me and making fun of the way I look…”, “…my teachers’ voices giving me orders about what I should do…”).
Tratamiento
At her last visit (on a dose of 4.5 mg/day cariprazine), she reported that she has “…finally woken up as if from a long mental dream…”, and that “…it’s a long time since my thoughts were so clear…”
First, the patient went to a private psychiatrist who prescribed olanzapine at up to 5 mg/day, which she took for 3 months. Her symptoms did not improve, and she had issues with sedation and increased appetite, leading her to stop taking the medication by her own will.
Six months after seeing the private psychiatrist, she went with her highly concerned parents to the outpatient consultation at a Psychiatric Diagnosis and Care Unit in central Italy. She was observed to have a PANSS (Positive and Negative Syndrome Scale) score of 130 (POS=31, NEG=28, GEN=71). There was no history of substance abuse. She refused hospitalization and was prescribed home therapy starting with 1.5 mg/day cariprazine which was increased to 3 mg/day three days later.
After one month of therapy her PANSS score was 99 (POS=20, NEG=24, GEN=55) and cariprazine was increased to 4.5 mg/day. No side effects were reported or detected. One month later, her PANSS score was 59 (POS=11, NEG=15, GEN=33). Furthermore, the patient agreed to participate in a course of psychotherapy with rehabilitation. At her last visit (on a dose of 4.5 mg/day cariprazine), she reported that she has “…finally woken up as if from a long mental dream…”, and that “…it’s a long time since my thoughts were so clear…”.
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” in the above case. 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 negative side effects such as sedation, dizziness or feeling “dazed” or “lightheaded”, which often leads to the withdrawal of antipsychotic drugs. Additionally, there were no sexual side effects reported.
COD. 300020/R41. Submitted to AIFA on 12 October 2020.
Clinical Experiences with Cariprazine in Patients with Early Psychosis
„…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 