No abstract

In cases of treatment-resistant schizophrenia the combined application of antipsychotic drugs often becomes necessary. Clozapine has been combined successfully with other atypical antipsychotic drugs such as risperidone or amisulpride in the past. We report the difficult treatment of a 28-year-old schizophrenic woman. Psychotic symptoms were found resistant to monotherapy with clozapine or ziprasidone. In contrast, combined application led to a marked improvement in both positive and negative symptoms of schizophrenia along with a decrease of side effects.The reported combination is a promising option in cases of treatment-resistant schizophrenia and should be further evaluated in prospective studies.

During the course of psychotic disorders, patients often suffer from intercurrent major depressive episodes (MDEs), and suicides frequently occur. This constellation challenges further improvements in psychopharmacological therapy. The antidepressant duloxetine was recently introduced as a novel reuptake inhibitor of serotonin and noradrenaline. We provide the first reports on duloxetine treatment of MDEs in the course of psychotic disorders. In two cases this substance was successfully involved as an add-on to antipsychotic treatment consisting of clozapine or amisulpride. We achieved a response of the MDEs, as reflected by psychopathological rating scales. A significant rise in the clozapine serum level was detected, most likely because of pharmacokinetic interactions. Overall, the application of duloxetine was well tolerated; therefore, further investigations in prospective studies seem to be recommendable.

The combined application of ziprasidone and clozapine follows a neurobiological rationale, seems able to reduce side effects, and should be further evaluated with respect to risk and benefit in prospective studies.