engleski

The patient with schizophrenia taking aripiprazole: case report

INTRODUCTION Atypical antipsychotics generally have a lower propensity for extrapyramidal side-effects (EPSE), hyperprolactinaemia and tardive dyskinesia than that associated with typical antipsychotics but may still produce troublesome side-effects, such as weight gain, cardiac rhythm changes and impaired glucose tolerance (Folnegovic-Smalc et al. 2003). Aripiprazole is a third-generation antipsychotic agent indicated for use in the treatment of schizophrenia (Uzun et al. 2005a, Uzun et al. 2005b). Unlike other antipsychotics, aripiprazole demonstrates mixed D2 and serotonin (5-HT1A) receptor agonist-antagonist activity that is hypothesized to improve schizophrenia's positive and negative symptoms ; the drug has been referred to as a dopamine-serotonin stabilizer (Lawler et al. 1999). The efficacy of aripiprazole was investigated in the treatment of schizophrenia, in the treatment of acute manic episode associated with Bipolar I Disorder, and in the treatment of psychosis associated with Alzheimer's dementia. Aripiprazole has demonstrated superiority to placebo in clinical studies of the treatment of both schizophrenia and acute bipolar mania (Lawler et al. 1999). Aripiprazole appears to be well tolerated, with most studies suggesting a frequency of adverse effects similar to placebo (Taylor 2003). CASE REPORT A-V, 27 years old, married, engineer from Zagreb, started therapy with aripiprazole during January 2004. Since aripiprazole is not on the positive list of Croatian department for health insurance, the patient was buying aripiprazole during this period of time. The patient was diagnosed with schizophrenia (F20.0), according to ICD X, in March 2003, and the therapy with flufenazine (10 mg daily) and promazine (200 mg daily) was started. The dominant symptoms were delusions and auditory hallucinations. The improvement of symptoms of schizophrenia emerged during the treatment, but also the extrapyramidal symptoms that incapacitated the patient's working and social capacities. Because of that we were considering the option of changing the therapy. The patient found the data regarding aripiprazole on the internet and was inquiring on this subject. We informed him about the fact that aripiprazole was not on the positive list in Croatia, but the patient and his father insisted on buying the medication. The treatment with aripiprazole (20 mg daily) was initiated during February 2004. The daily dosage was decreased to 15 mg during March 2004. This was the maintenance dose, and the patient continued taking this dose until today. No side effects occurred during the treatment. In the meantime, the patient finished his education, found a job, and got married. He is undergoing the outpatient treatment and is very satisfied. CONCLUSION We can conclude that the therapy with aripiprazole was beneficial for this patient. No data about side effects were obtained during treatment. The therapy provided improvement of symptoms of schizophrenia, but also improvement in quality of life and social functioning of this patient. The improvement in quality of life and better social functioning are the most important benefit of therapy with aripiprazole in this patient.

schizophrenia; aripiprazole

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