Clozapine–treatment–resistant schizophrenia successfully managed with brexpiprazole combination therapy and online meta-cognitive training: A case report

Clozapine is considered one of the best effective strategies in treatment-resistant schizophrenia (TRS), despite up to 60 % of clozapine-treated patients not adequately and/or fully achieving a clinical response either partial remission (clozapine-resistant treatment, CRT). Hence, several combination strategies to clozapine have been investigated in CRT. Hereby, we describe a 50-year-old CRT male patient successfully managed with brexpiprazole augmentation strategy. The patient was assessed at the baseline, weekly up to week 4 and monthly after that up to week 16, with the following psychopathological rating scales: Clinical Global Impression - Improvement (CGI-I), Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS) Calgary Depression Scale for Schizophrenia (CDSS), Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Anxiety (HRS-A), Barnes Akathisia Scale (BARS), and Abnormal Involuntary Movement Scale (AIMS). At 1-month follow-up, he already showed a considerable improvement at the psychopathological assessment (63 % total PANSS reduction). At 4-month follow-up, a further 50 % PANSS total reduction was observed from the baseline. After 1-year of clozapine-brexpiprazole treatment, the patient was also administered an online metacognitive training (MCT) as adjunctive intervention, by reporting a further clinical improvement.