A Case Study: Treatment of Refractory Schizoaffective Disorder with Aripiprazole

Abstract

Objective: To report the use of aripiprazole in the treatment of refractory schizoaffective disorder. Case Summary: A 42-year-old African American male with a 10-year history of schizoaffective disorder decompensated while being treated with haloperidol decanoate 200 mg intramuscularly per month and valproic acid 500 mg twice daily. Upon admission, his Global Assessment of Function scale (GAF) score was 10 and his Mini-Mental State Examination (MMSE) score was 2. He was treated with an initial injection of haloperidol decanoate 100 mg and, thereafter, with haloperidol 5 mg orally twice a day. He remained refractory to haloperidol and, on day 14, chlorpromazine 150 mg/day was added. The patient continued to show no response. On day 20, oral aripiprazole 15 mg was substituted for haloperidol and chlorpromazine. Forty-eight hours later, the GAF score was 30 and the MMSE score was 18. Ninety-six hours after receiving aripiprazole, the GAF and MMSE scores were 40 and 26, respectively. Discussion: Aripiprazole has been approved for the treatment of schizophrenia and bipolar disorder; however, it has not been approved for treatment of schizoaffective disorder. Aripiprazole is a novel drug representing a new class of agents used for the treatment of psychosis. Aripiprazole is a partial agonist at the dopamine D2 and serotonin 5-HT1A receptors, but an antagonist at the serotonin 5-HT2A receptors. Conclusions: Aripiprazole may be useful in treatment of refractory schizoaffective disorder.