Treatment of refractory catatonic schizophrenia with low dose aripiprazole

Tsuyoshi Sasaki,Tomihisa Niitsu,Nobuhisa Kanahara,Masaomi Iyo,Tasuku Hashimoto

doi:10.1186/1744-859x-11-12

Abstract

This case is of 54-year-old female with catatonic schizophrenia, characterized by treatment resistance to the pharmacotherapy with olanzapine, risperidone, flunitrazepam, and ECT. Olanzapine and risperidone and flunitrazepam did not improve her catatonic and psychotic symptoms, and induced the extrapyramidal symptoms. The effects of ECT did not continue even for a month. However, the treatment with low-dose aripiprazole dramatically improved the patient’s psychotic symptoms and extrapyramidal symptoms. The mechanisms underlying the effects of low-dose aripiprazole in this case remain unclear, but unlike other antipsychotics, aripiprazole is a dopamine D2 partial agonist. In this regard, our results suggest that aripiprazole has numerous advantages, especially in cases of stuporous catatonia and a defective general status.

Highlights

Catatonia, which is characterized by motoric immobility such as catalepsy or stupor, mutism, negativism, is shown in about 10-15% of patients with schizophrenia [1]
We present a patient of catatonic schizophrenia, which was markedly improved on low-dose aripiprazole, after failing to respond to olanzapine, risperidone, and electroconvulsive therapy (ECT)
Case presentation A 54-year-old woman began to experience auditory hallucinations, including a voice admonishing her to deny herself, and delusions of persecution and reference, and to withdraw socially. She gradually entered a catatonic stupor with insomnia and anorexia

Summary

Background

Catatonia, which is characterized by motoric immobility such as catalepsy or stupor, mutism, negativism, is shown in about 10-15% of patients with schizophrenia [1]. Case presentation A 54-year-old woman began to experience auditory hallucinations, including a voice admonishing her to deny herself, and delusions of persecution and reference, and to withdraw socially. She gradually entered a catatonic stupor with insomnia and anorexia. She is 59 years old and has been treated with only 3 mg/day aripiprazole for 48 months. She has no recrudescence of psychotic symptoms or extrapyramidal symptoms, and continues to help her mother with the housework

Discussion

Conclusion