A 34-year-old, Caucasian, male patient with a diagnosis of paranoid schizophrenia for 14 years was admitted for psychiatric examination with complaints of repeating some words and washing hands frequently. He was on clozapine 100 mg/day treatment for 2 years. He was hospitalized due to exacerbation of psychotic and OCS.\nA 10-mg/day dose of aripiprazole was added on to his ongoing 100-mg/day clozapine treatment. At the end of the first week, clozapine dose increased to 150 mg/day and aripiprazole dose to 30 mg/day gradually. The plasma clozapine and norclozapine levels were over therapeutic level as 746.1 and 519.1 ng/mL at the end of the third week, so clozapine dose decreased to 100 mg/day. The clozapine andaripiprazole doses, plasma drug levels, and the clinical rating scale scores are given at Table \n. During discharge, his scores of PANSS was 50 (141 at admission), BPRS was 20 (74 at admission), and YBOCS was 20 (40 at admission).
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.