Case Report: Cariprazine in a Patient With Schizophrenia, Substance Abuse, and Cognitive Dysfunction

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.

Real-Life Clinical Experience With Cariprazine: A Systematic Review of Case Studies

“…Importantly, there were five patients ( cases 5, 6, 7, 17, 18 ) ( 36 , 37 , 44 , 45 ) with comorbid substance use disorder, who had several antipsychotic failures previously either due to ineffectiveness in reducing symptoms of schizophrenia and addiction, or due to severe side-effects. The patients had severely impaired psychosocial functioning and quality of life.…”

“…Cariprazine yielded significant improvements in positive, negative, cognitive, and affective symptoms, it contributed to substance abstinence and had positive effects on sleep regulation, psychomotor symptoms, weight decrease and metabolic symptoms. Although cariprazine induced extrapyramidal symptoms in two cases ( case 6 and 7 ) ( 36 , 37 ), they were well managed by the reduction of dose (from 6 to 4.5 m g/day in case 7 ) ( 37 ) and by using concomitant medication ( cases 6 and 7 ) ( 36 , 37 ).…”

Remission of Persistent Negative Symptoms and Psychosocial Consequences by Combined Clozapine and Cariprazine Treatment in a Patient With Long-Standing Treatment-Resistant Schizoaffective Disorder

“…We decided to introduce CAR in the treatment of our patient based on the consideration that it would furnish a complementary neuroreceptor profile to that of CLZ, with net potential benefits both regarding efficacy and adverse event readouts ( 15 – 17 ). Thus, CAR (monotherapy) has been shown to greatly improve predominant primary negative symptoms in patients with schizophrenia ( 9 , 18 ), including marked enhancements also in the “Personal & Social Performance” domain ( 9 ), as well as in the recovery of attentional cognitive processes ( 19 ).…”

The More, the Merrier…? Antipsychotic Polypharmacy Treatment Strategies in Schizophrenia From a Pharmacology Perspective

“…In addition, the earliest of the third generation antipsychotics (TGA), aripiprazole (ARI), appears to be a common APP add-on choice to many of the above FGA and SGA class drugs [see, e.g., (14)]. A number of recent case reports likewise suggest that cariprazine (CAR) may emerge as a beneficial option in the APP context [ (15)(16)(17)(18); vide infra], whereas so far there does not seem to be any reports of the use of the latest TGA brexpiprazole in APP combination approaches. A brief overview of antipsychotic target profiles toward APP is shown in…”

“…Interestingly, a recent single-patient case report suggests that CAR plus QUE may also be an attractive APP option ( 18 ). The combined treatment with these two antipsychotics resulted in successful alleviation of cognitive and negative impairments in a young male patient, whom previously had been through a variety of but partially efficacious FGA and SGA regimens.…”