A 51-year-old, Caucasian, male patient, diagnosed with schizophrenia was admitted following an exacerbation of OCS. He had contamination obsessions and cleaning compulsions for 10 years. He had persecution delusions. He was thinking that he was followed by police. He was hoarding garbage. He was brought to the emergency room by his family. Both the patient and his family reported that he had benefitted most from clozapine treatment. He was on clozapine 100 mg/day for 4 years. However, when the dose of clozapine was increased to a dose of 150 mg/day, an increase in OCS was observed. His family reported that a year ago after he had 10 sessions of electroconvulsive therapy (ECT), his psychotic and OCS decreased; but for the last 5–6 months, there was an exacerbation in psychotic and obsessive symptoms. Patient was hospitalized. During admission, his Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), and Yale–Brown Obsessive Compulsive Scale (Y-BOCS) scores were 151, 74, and 40, respectively.\nA 30-mg/day dose of aripiprazole was added on to his ongoing 100-mg/day dose of clozapine treatment. After 2 weeks of combination treatment with 100 mg/day clozapine and 10 mg/day aripiprazole, plasma levels of both drugs were measured to be low. Clozapine dose increased to 250 mg/day and aripiprazole doze increased to 30 mg/day gradually. At the end of the sixth week, during discharge, his PANSS, BPRS, and Y-BOCS scores were 50, 20, and 20, respectively.
Mr. L, a 48-year-old man with a diagnosis of residual schizophrenia [] treated for many years with clozapine 500 mg/d was admitted because of the worsening of his anxiety. The clinical scores and the trough plasma concentrations of clozapine and norclozapine were: CGI : 4; total PANSS: 88; positive: 20/49; negative 25/49; excited component: 9/35; general 40/112. Hamilton-anxiety: 24/56; clozapine: 594 ng/mL; norclozapine: 470 ng/mL, respectively. Aripiprazole 10 mg/d was added to clozapine (dose unchanged) and lorazepam (1 mg/d) was discontinued. The patient was discharged three weeks after the aripiprazole addition.\nA followup over 3 months did not reveal any change in the CGI and PANSS scores (at 3 months: CGI : 4; total PANSS: 73; positive: 20/49; negative: 25/49; excited component: 7/35; general: 40/112), while the Hamilton-anxiety score diminished progressively to 19 and 15 after one and three months, respectively. The clozapine and norclozapine plasma concentrations at three months were 431 ng/mL and 343 ng/mL, respectively.