Cariprazine Augmentation and Sustained Remission of Physical Aggression in Clozapine-Treated Treatment-Resistant Schizophrenia: A Case Report.
5 affiliations
- 1Department of Psychiatry South Ostrobothnia Wellbeing Services County Seinäjoki Finland.
- 2Department of Psychiatry Faculty of Medicine University of Turku Turku Finland utu.fi.
- 3Finnish Institute for Health and Welfare (THL) Helsinki Finland thl.fi.
- 4Faculty of Medicine and Health Technology Tampere University Tampere Finland uta.fi.
- 5Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden ki.se.
Abstract
Persistent aggression may occur in treatment-resistant schizophrenia (TRS) despite long-term clozapine treatment and multiple augmentation strategies. We describe a male patient in his sixties with a decades-long history of schizophrenia who required prolonged psychiatric inpatient care because of recurrent, unpredictable physical assaults toward other patients, staff, relatives, and police. This included treatment at a state forensic psychiatric hospital because of treatment complexity and safety concerns, not forensic legal status. Aggression persisted during adequately monitored high-dose clozapine treatment and several augmentation strategies. The last documented physical assault occurred in October 2021. Cariprazine 1.5 mg/day was initiated in November 2021, primarily for longstanding negative symptoms. Within approximately seven weeks, mood and participation in communal ward activities improved. No further physical assaults were documented during more than 4 years of follow-up. The patient subsequently transitioned to voluntary treatment and supported housing. Later somatic illnesses, temporary interruptions of oral medication, and substantial fluctuations in clozapine serum concentrations were not followed by renewed physical aggression. This case describes a prolonged temporal association between cariprazine augmentation and the absence of recurrent physical assaults, but the single-case design, episodic pretreatment course, concomitant treatment changes, and absence of standardized ratings preclude causal inference.
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BibTeX
@article{leijala2026cariprazine,
title = {{Cariprazine Augmentation and Sustained Remission of Physical Aggression in Clozapine-Treated Treatment-Resistant Schizophrenia: A Case Report.}},
author = {Juhani Leijala and Antti Mustonen},
journal = {Case reports in psychiatry},
year = {2026},
month = oct,
doi = {10.1155/crps/9943329},
url = {https://europepmc.org/article/MED/42928838},
note = {CC BY},
}
RIS
TY - JOUR
TI - Cariprazine Augmentation and Sustained Remission of Physical Aggression in Clozapine-Treated Treatment-Resistant Schizophrenia: A Case Report.
AU - Juhani Leijala
AU - Antti Mustonen
PY - 2026
DA - 2026/10/25
JO - Case reports in psychiatry
DO - 10.1155/crps/9943329
UR - https://europepmc.org/article/MED/42928838
AB - Persistent aggression may occur in treatment-resistant schizophrenia (TRS) despite long-term clozapine treatment and multiple augmentation strategies. We describe a male patient in his sixties with a decades-long history of schizophrenia who required prolonged psychiatric inpatient care because of recurrent, unpredictable physical assaults toward other patients, staff, relatives, and police. This included treatment at a state forensic psychiatric hospital because of treatment complexity and safety concerns, not forensic legal status. Aggression persisted during adequately monitored high-dose clozapine treatment and several augmentation strategies. The last documented physical assault occurred in October 2021. Cariprazine 1.5 mg/day was initiated in November 2021, primarily for longstanding negative symptoms. Within approximately seven weeks, mood and participation in communal ward activities improved. No further physical assaults were documented during more than 4 years of follow-up. The patient subsequently transitioned to voluntary treatment and supported housing. Later somatic illnesses, temporary interruptions of oral medication, and substantial fluctuations in clozapine serum concentrations were not followed by renewed physical aggression. This case describes a prolonged temporal association between cariprazine augmentation and the absence of recurrent physical assaults, but the single-case design, episodic pretreatment course, concomitant treatment changes, and absence of standardized ratings preclude causal inference.
SN - 2090-682X
SN - 2090-6838
ER -