Improvement of psychotic symptoms in a schizophrenic subject after cariprazine add-on to clozapine

Management options for patients with schizophrenia remain sub-optimal, as indicated by insufficient symptom control and low response rates in a sizable subgroup of patients, frequently leading to persistent functional impairment. More knowledge is needed about augmentation strategies, especially with the most recent antipsychotic medications. For this reason, we present data on the efficacy and safety profile of cariprazine, in the treatment of schizophrenia in a 34-year-old Caucasian man, in augmentation to clozapine (400 mg). Cariprazine was started at the dose of 1.5 mg/day and titrated up to 4.5 mg over a 2-week period. After 3 months of therapy at a dose of 4.5 mg, it was administered a dose of 6 mg/day, which is still ongoing. Primary efficacy variables were the changes in the Positive and Negative Syndrome Scale (PANSS) subscales scores and total score from baseline. The Global Assessment of Functioning (GAF) Scale and Specific Level of Functioning (SLOF) Scale were used to assessed global functioning. Cognitive function was valued with the WAIS IV (Wechsler Adult Intelligence Scale). Reduction of all PANSS subscales scores and total score and improvement of functioning at GAF and SLOF scores were more evident with cariprazine 6 mg/day. A slight improvement in the overall WAIS score, a slight worsening in working memory and an improvement in processing speed were found. Safety assessment variables included assessment of treatment emergent adverse events, clinical laboratory test, vital sign measurements, ECG; these variables were all monitored for changes from baseline, without relief of side effects.