A 27-year-old, Caucasian, male patient, diagnosed with substance-induced psychotic disorder, was hospitalized due to exacerbation of psychotic symptoms despite clozapine dose of 150 mg/day for two years. His family reported exacerbation of obsessive-compulsive symptoms, such as contamination obsessions and frequent handwashing, for 3 months. Clozapine and norclozapine plasma levels were lower than therapuetic level on admission. a 15-mg/day aripiprazole was added on and clozapine dose increased to 200 mg/day. At the end of the first week, aripiprazole dose was increased to 30 mg/day. Plasma clozapine and norclozapine levels were found to be higher than therapeutic level with a clozapine dose of 200 mg/day, and clozapine dose decreased to 100 mg/day. The clozapine and aripiprazole doses, plasma drug levels, and the clinical rating scale scores are given in Table \n. At the end of the fourth week, during discharge, his scores of PANSS was 46 (159 at admission), and YBOCS was 10 (30 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.