Abstract
This case report describes a 30-year old male diagnosed with schizophrenia at the age of 23, and with a long history of drug abuse. He had previously received a wide range of antipsychotic drug treatment regimens, all with some degree of effect, but never with complete symptom relief. He was also suffering from persistent cognitive and negative symptoms. At the time of admission in our clinic, he was on Quetiapine (QUE) and Haloperidol (HAL). It was therefore decided to substitute HAL for Cariprazine (CAR)—an agent with a novel pharmacological and clinical profile—in the hope of gaining increased efficacy, particularly in the cognitive and negative symptom domains. Within 3 weeks of the switch from HAL to CAR the patient clearly improved, and notably so in the aforementioned symptom areas. A number of subsequent adjustments of antipsychotic dosages and adjunct medications during the ensuing months resulted in an apparently more stable alleviation of positive as well as negative and cognitive symptoms, including markedly improved personal and social capabilities. Interestingly, some time after initiating CAR treatment the patient also reported that from being a heavy smoker (60 cig/d) he had cut down and eventually ceased smoking entirely; furthermore, he has remained clean of other substance abuse since his first admission in 2020. The joint treatment with CAR in combination with QUE thus seems to have improved the patient's cognitive functioning as well as possibly his susceptibility to substance abuse.
Highlights
Schizophrenia is a chronic disorder with variable clinical features and changes in numerous aspects of mental processing
We present a case of a patient with concomitant schizophrenia and substance abuse disorder admitted to an in-patient psychiatric unit due to increasing psychotic symptoms
We believe that besides the obvious and independent positive symptoms of schizophrenia, the overall profile in this case should be interpreted as a combination of schizophrenia with its premorbid symptoms and negative symptoms, as well as superimposed harmful effects of substance abuse
Summary
Schizophrenia is a chronic disorder with variable clinical features and changes in numerous aspects of mental processing. Substance abuse is common in individuals with schizophrenia, the association of which links to symptom exacerbation, poorer medication compliance, deterioration of functioning, higher risk of hospitalization and overall increased costs to the individual and society [1,2,3]. In this regard, very frequent drug comorbidities are marijuana, and psychostimulant agents like amphetamine and cocaine [1, 4]. We present a case of a patient with concomitant schizophrenia and substance abuse disorder admitted to an in-patient psychiatric unit due to increasing psychotic symptoms He had previously been treated with a wide range of antipsychotic drugs. The months prior to the hospitalization there was a slow decline in function [described in detail under section Current episode (overview in Table 2), below] and increase in psychotic symptoms seen correlating with social stressors, and with drug intake
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