Efficacy of low-dose aripiprazole to treat clozapine-associated tardive dystonia in a patient with schizophrenia

Bong Ju Lee1, Lyang Huh1; 1Department of Psychiatry Inje University Haeundae Paik Hospital

Tardive dystonia (TDt) is a debilitating side effect of long-term antipsychotic treatment. Even though TDt is associated with increased psychiatric morbidity, mortality, and severely decreased quality of life, there is no definite treatment modality for TDt. Clozapine is one treatment option for TDt in patients with schizophrenia. We report a case of clozapine-associated tardive dystonia treated with low-dose aripiprazole (0.5 mg/day). The patient was a 51-year-old Korean woman with schizophrenia, who had been admitted to the psychiatric ward for her florid psychotic symptoms. Symptoms of tardive dystonia began to develop after 1 year of clozapine (200 mg/day) treatment. Her motor symptoms improved markedly after adding low-dose aripiprazole (0.5 mg/day) to clozapine (175 mg/day). Although clozapine is often used to treat tardive dystonia in patients with schizophrenia, several recent case reports have indicated that it can enhance or induce tardive dystonia. Aripiprazole is a dopamine D2 receptor partial agonist that exhibits partial agonistic activity against serotonin-1A (5-HT1A) receptors and full antagonistic activity against 5-HT2A receptors. The dopaminergic tone in the surrounding milieu is important for aripiprazole activity. Antioxidative effects of aripiprazole might be valuable in managing the neurotoxic effects of clozapine. Only one report describes clozapine-induced tardive dystonia treated with aripiprazole (10–15 mg). This case report may be the first report of low-dose aripiprazole treatment of clozapine-associated tardive dystonia. And this case report might suggest the modality of early intervention for TDt without changing ongoing antipsychotics.

Topic Area: Psychopharmacology

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