Introduction

Schizophrenia is a chronic psychiatric disorder associated with high noncompliance and discontinuation rates.

Hyperprolactinaemia is a significant side effect of antipsychotic medications and may cause sexual dysfunction. We tell the

story of a nonadherent woman treated with LAI that developed hyperprolactinemia.

This patient was known by the Iseo CPS from April 2014.

We diagnosed a Schizophrenia, middle oligophrenia (Q.I. 52)

The first episode probably appared when she was a young woman with an obsessive syndrome, the first contact with a

private clinician probably happened around 1999 and continued till 2013.

She had different anthipsyotics therapies both oral and depot (Clopixol depot).

During 2014 some events modified the family structure, the patient showed worsening symptoms and was admitted in the

Iseo CPS.

In December 2015 relapsed and was hospitalized into the ISEO SPDC with delusions and persecutory symptoms. We

suspected a partial compliance to therapy and then we introduced a LAI (Risperidone LAI 37,5 mg every 2 weeks)

She was partial responder and developed hyperprolactinemia.

Objective

The aim of our study was to assess the effect of

switching from long-acting injectable (LAI) risperidone

to paliperidone palmitate (PP) on sexual function and

prolactin levels in one patient with psychosis. We

wanted also assess the possible global clinical

improvement.

Methods

We studied papers regarding the possibility to have

symptoms improvement switching to Paliperidone

Palmitate2,4 , functioning 1 and the possible, even if is

not so clear , improvement of prolactin levels3

We started with Paliperidone Palmitate 100mg/eq.

We evaluated functioning at baseline and after six

months with VGF-GAF.

Results After two injections the amenorrhea was yet a problem. We adjusted the therapy lowering the Paliperidone Palmitate dose to 75 mg/eq, and extending the time between two injections to five weeks. After 3-4 months from the baseline we observed a significant reduction of prolactin levels and disappeared her amenorrhea. Tha woman declared a clinical improvement with an increase of cognitive and social abilities VGF (Global functioning) from 21 al baseline to 55 after 6 months.

Conclusions

In this case, switching from Risperidone LAI to

Paliperidone Palmitate generated a global clinical

improvement and lower serum prolactin levels with

consequently improvement of associated symptoms.

The patient found a benefit from this therapy.

We need further informations to confirm this

experience.

Switching from Risperidone LAI to Paliperidone Palmitate, what’s the benefit? A Case report.

Licia Casilli, ASST Franciacorta. CPS Rovato

BIBLIOGRAFY 1-Y. Koshikawa et al. “The comparative effects of Risperidone Long-Acting Injection and Paliperidone Palmitate on social functioning in schizophrenia: A 6-month, open-label, randomized controlled pilot trial”. Neuropsychobiology 2016; 73:35-42 2-A. Shreiner et al. “Paliperidone Palmitate in non-acute patients with Schizophrenia previously unsuccessfully treated with risperidone long-acting therapy or frequently used conventional depot anti psychotics”. Journal of psychopharmacology 2015;1-13 3-I. Montalvo et al. “ Changes in prolactin levels and sexual function in young psychotic patients after switching from long-acting injectable Risperidone to Paliperidone palmitate”. Int. Clin. Psychopharmacology 2012; 28:46-49 4-L. Alphs et al. “Paliperidone Palmitate and Risperidone long-acting injectable in subjects with schizophrenia recently treated with oral Risperidone or other oral antipsychotics” Neuropsychiatric Disease and treatment 2013;9:341-350