Successful rechallenge with paliperidone after clozapine treatment for a patient with dopamine supersensitivity psychosis.

We describe the case of a 49-year-old Japanese male patient successfully treated with a paliperidone rechallenge following 2-year treatment with clozapine for treatment-resistant schizophrenia. He had responded well to conventional antipsychotic treatment for the initial psychotic episode but gradually developed dopamine supersensitivity; even treatment with paliperidone and another antipsychotic medication (a total up to 1700 mg in chlorpromazine-equivalent dose) had not improved his psychotic symptoms. Clozapine treatment produced temporary symptomatic relief, but the clozapine dose could not be increased to > 150 mg due to the patient's intolerance. Following low-dose clozapine treatment for 2 years, a rechallenge with paliperidone monotherapy ameliorated his psychotic symptoms. This suggests that clozapine may have the potential to release the dopamine supersensitivity state. Our patient's case indicates that for patients with dopamine supersensitivity psychosis, a rechallenge with a previously ineffective antipsychotic after clozapine treatment may be successful.

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Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Oda received grant funding from the SENSHIN Medical Research Foundation. Dr. Sasaki has received speakers’ honoraria from Dai-ichi Sankyo, Eli Lilly, Glaxo Smith Kline, Kyowa, Novartis, Janssen, Otsuka, Shionogi, Shire, Taisho, and Tanabe Mitsubishi, and he has also received research support from Novartis, Otsuka, Shionogi, and Taisho (from April 2014 to March 2019). Dr. Iyo received consultant fees from Eli Lilly, Sumitomo Dainippon, Pfizer, and Abbott and reports honoraria from Janssen, Eli Lilly, Otsuka, Meiji Seika, Astellas, Sumitomo Dainippon, Ono, GlaxoSmithKline, Takeda, Mochida, Kyowa Hakko, MSD, Eisai, Daiichi-Sankyo, Novartis, Teijin, Shionogi, Hisamitsu, and Asahi Kasei. Dr. Kobayashi, Dr. Hayatsu, Dr. Ohki, Dr. Akutsu, Dr. Oiwa, Dr. Komatsu, and Dr. Niitsu have no potential conflicts of interest to report.