A 28-year-old, Caucasian, male patient, with a diagnosis of residual schizophrenia, treated for 2 years with clozapine 100 mg/day was admitted because of the worsening of his psychotic symptoms. His OCS first was seen at age of 13. He had control and symmetry obsessions and compulsions. After 5 years of OCS, he had psychotic symptoms. He reported that he could not leave the house for the last 2 years, due to his persecution delusions, skepticism, and resentment. He was on a treatment of clozapine 100 mg/day for 2 years.\nHe was hospitalized with a dose of 10 mg/day aripiprazole added on to his ongoing 100-mg/day clozapine treatment. The plasma level of clozapine and norclozapine were lower than therapeutic level at the admission. At the end of the second week, clozapine dose increased to 200 mg/day and aripiprazole to 30 mg/day gradually. The clozapine, norclozapine, aripiprazole doses and the clinical rating scale scores are given at Table \n. During discharge, his scores of PANSS was 49 (78 at admission), BPRS was 27 (39 at admission), and Y-BOCS was 15 (40 at admission).
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.