Open AccessSuccessful rechallenge with paliperidone after clozapine treatment for a patient with dopamine supersensitivity psychosis
Author(s) -
Remiko Kobayashi,
Yasunori Oda,
Ryunosuke Hayatsu,
Nozomi Ohki,
Misa Akutsu,
Takahiro Oiwa,
Hideki Kobara,
Tomihisa Niitsu,
Tsuyoshi Sasaki,
Masaomi Iyo
Publication year - 2020
Publication title -
sage open medical case reports
Language(s) - English
Resource type - Journals
ISSN - 2050-313X
DOI - 10.1177/2050313x20929561
Subject(s) - medicine , clozapine , paliperidone , psychosis , dopamine , schizophrenia (object oriented programming) , paliperidone palmitate , psychiatry , dopamine receptor d2 , pharmacology , oncology , antipsychotic
We describe the case of a 49-year-old Japanese male patient successfully treated with a paliperidone rechallenge following 2-year treatment with clozapine for treatment-resistant schizophrenia. He had responded well to conventional antipsychotic treatment for the initial psychotic episode but gradually developed dopamine supersensitivity; even treatment with paliperidone and another antipsychotic medication (a total up to 1700 mg in chlorpromazine-equivalent dose) had not improved his psychotic symptoms. Clozapine treatment produced temporary symptomatic relief, but the clozapine dose could not be increased to > 150 mg due to the patient’s intolerance. Following low-dose clozapine treatment for 2 years, a rechallenge with paliperidone monotherapy ameliorated his psychotic symptoms. This suggests that clozapine may have the potential to release the dopamine supersensitivity state. Our patient’s case indicates that for patients with dopamine supersensitivity psychosis, a rechallenge with a previously ineffective antipsychotic after clozapine treatment may be successful.