PDF(Pubmed)
Abstract：
A 22-year-old male was admitted to an in-patient psychiatric unit for treatment, after a period of 2 years of increasing psychotic symptoms corresponding to a very severe case of schizophrenia across the entire scale of symptom disorder domains along with some drug abuse comorbidity. Previous treatments with olanzapine (OLA) and risperidone (RIS) had been at best partly successful toward his positive symptoms with no, or even worsening effects on the negative symptomatology. Given the gravity of the latter symptoms and functional impairment of our patient, he might thus have been a candidate for clozapine (CLZ) treatment. It was however decided to switch his antipsychotic treatment to cariprazine (CAR), an agent with a novel pharmacological and clinical profile, because of its favorable pharmacodynamic, pharmacokinetic, and tolerability/safety properties. In a follow-up on the patient 6 months after discharge he is not fully recovered, but the recovery attained reflects a marked functional improvement compared to before the RIS-to-CAR switch. The remarkable response to CAR observed may, speculatively, be in line with the suggestion that CAR could offer an alternative, safer, and more tolerable monotherapy approach (vs. CLZ) for patients with severe negative symptoms and functional deficiency resistant to standard antipsychotic treatment. He appears to occasionally still be taking drugs, but no worsening of positive symptoms has been noted. Whether or not he could reach full recovery if he would abstain entirely from drugs of abuse remains an open question.
摘要：
一名二十二岁男性入住精神病院接受治疗,在经历了2年的精神病性症状增加之后，在整个症状障碍领域范围内，与非常严重的精神分裂症病例以及一些药物滥用合并症相对应。以前使用奥氮平（OLA）和利培酮（RIS）的治疗充其量对他的阳性症状取得了部分成功，没有，甚至对负面症状的恶化影响。鉴于后一种症状的严重性和我们患者的功能损害，因此，他可能是氯氮平（CLZ）治疗的候选人。然而，决定将他的抗精神病药物治疗改为卡利拉嗪（CAR），一种具有新药理和临床特征的药物，由于其有利的药效学，药代动力学，和耐受性/安全特性。在患者出院后6个月的随访中，他没有完全康复，但是，与RIS转换为CAR之前相比，所获得的恢复反映出功能上的显着改善。观察到的对CAR的显着反应可能，投机性地，符合CAR可以提供替代方案的建议，更安全,和更耐受的单一疗法(vs.CLZ）适用于具有严重阴性症状和对标准抗精神病药物治疗具有抗性的功能缺陷的患者。他似乎偶尔还在吸毒，但没有发现阳性症状恶化。如果他完全放弃滥用药物，他是否能完全康复仍然是一个悬而未决的问题。
