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Antipsychotic Polypharmacy for Treatment Resistant Schizoaffective Disorder: A Case Report
Sydney E Moriarty1, Paria Parhami2, Jay Parikh3
1HOLO Labs - Simulation and Educational Technology, Edward Via College of Osteopathic Medicine, Blacksburg, USA.
Cureus
|April 7, 2025
Summary
Antipsychotic polypharmacy, using two or more antipsychotics, may improve psychotic symptoms in treatment-resistant schizoaffective disorder. This case study highlights potential benefits for residual psychosis management.
Area of Science:
- Psychiatry
- Pharmacology
Background:
- Schizoaffective disorder presents challenges in treatment resistance.
- Cannabis use disorder can complicate treatment efficacy.
- Patient exhibited persistent positive symptoms despite multiple antipsychotic trials.
Observation:
- A young male with schizoaffective disorder and cannabis use disorder showed inadequate symptom control.
- Hyper-religiosity, hallucinations, and agitation were prominent positive symptoms.
- Clozapine was not initiated due to monitoring concerns.
Findings:
- Concurrent administration of paliperidone long-acting injectable and haloperidol led to marked improvement.
- Reduced intensity of perceptual disturbances was observed after adding a second antipsychotic.
- Antipsychotic polypharmacy demonstrated potential benefits in managing residual psychosis.
Implications:
- Antipsychotic polypharmacy may be a viable strategy for treatment-resistant schizophrenia and schizoaffective disorder.
- Careful consideration of monitoring requirements and patient consent is crucial.
- This case informs clinical practice regarding complex psychiatric cases and polypharmacy.
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