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Atypical antipsychotic switching versus atypical antipsychotic combination in schizoaffective disorder – A clinical case

Published online by Cambridge University Press:  23 March 2020

A. Ballesteros*
Affiliation:
Red de Salud Mental Gobierno de Navarra, CSM Estella, Estella, Spain
B. Cortés
Affiliation:
Consulta Dr. B. Cortés, Psychiatry, Salamanca, Spain
A. Petcu
Affiliation:
Greater Manchester West Mental Health NHS Foundation Trust, Psychiatry, Manchester, United Kingdom
L. Montes
Affiliation:
Red de Salud Mental Gobierno de Navarra, Complejo Hospitalario de Navarra, Pamplona, Spain
W. Jaimes
Affiliation:
Hospital de Donostia Osakidetza, Psychiatry, Donostia, Spain
F. Inchausti
Affiliation:
Proyecto Hombre de Navarra, Comunidad terapéutica Proyecto Hombre de Estella, Estella, Spain
*
*Corresponding author.

Abstract

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Introduction

Recent studies suggest that aripiprazole (ARP) shows a better profile in terms of mental state and extrapyramidal symptoms (EPS) in psychosis. However, other studies consider that a combination of atypical antipsychotics (AAP) may also be an option for some refractory patients. We present a case of a schizoaffective disorder, manic type (SAFM) (F25.0, ICD-10 criteria) that improved in terms of EPS adverse effects after switching from long-term fluphenazine (LTF) to Long-acting injectable aripiprazole (LAIA) but showed relapse symptoms.

Objective

We present a clinical case of SAFM that improved clinically in our outpatient clinic after 1 month of bi-therapy with low doses of oral risperidone and standard dose of LAIA. We study oral AAP-LAIA drug combination utility in this clinical setting.

Aims

To study “oral AAP-LAIA combo” benefits in refractory SAFM cases.

Methods

Our patient is a 68-year-old female diagnosed of SAFM clinically stable with a combination of lithium and LTF. She presented severe cogwheel stiffness in the upper limbs and postural tremor. We switched from long-term fluphenazine to LAIA and 4 weeks later, she showed discrete cogwheel stiffness but also persecutory delusions and dysphoria.

Results

We maintained LAIA (400 mg/28 days) and lithium (800 mg/day) doses and added-on risperidone 1 mg/day. She presented clinical relapse 1 month later. She kept her better EPS tolerance as she only had discrete cogwheel in upper limbs only by using attention distraction techniques.

Conclusions

Oral risperidone-LAIA drug combination appears as an effective and well-tolerated treatment in refractory SAFM cases.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
EV1000
Copyright
Copyright © European Psychiatric Association 2016
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