Aripiprazole in Treatment-refractory Schizophrenia

Clozapine is the first choice antipsychotic medication for treatment-refractory schizophrenia; however, there are some disadvantages in using clozapine. A few reports have appeared concerning switching from clozapine to other antipsychotics for treatment-refractory schizophrenia. This report describes the case of a 58-year-old female patient with treatment-refractory schizophrenia who was successfully switched from clozapine 300 mg/day to aripiprazole 20 mg/day because of changes in consciousness. After the switch to aripiprazole, the patient's psychotic condition improved. As expected, we identified few successful cases of switches from clozapine in our search of the literature. Although controlled clinical trial data support use of clozapine in treatment-refractory schizophrenia, some patients cannot tolerate this agent or it may increase the risk of physical problems for some patients. In such situations, clinicians may want to consider prescribing a different antipsychotic or adding another antipsychotic and decreasing the dosage of clozapine.