From the Guidelines
This patient requires immediate continuation of his Abilify injections to maintain stability and prevent decompensation of his psychiatric condition, as recommended by the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1. The patient's history of schizophrenia diagnosed at age 19, bipolar I disorder with psychosis, and recent psychiatric hospitalization following the loss of his son, highlights the importance of consistent treatment to reduce morbidity and mortality associated with schizophrenia 1. Key aspects of his care include:
- Continuation of Abilify injections without interruption, with the next injection scheduled within the next 6 days
- Verification of the current Abilify dosage and formulation to ensure proper continuation
- Referral to a local community mental health center to establish care and provide ongoing medication management
- Connection with a local psychiatrist for medication management and a therapist for support and grief counseling following the loss of his son
- A comprehensive treatment approach addressing both medication management and psychosocial interventions, such as cognitive-behavioral therapy for psychosis (CBTp) and psychoeducation, as recommended by the APA guideline 1 The patient's mother's report of his stability without medications for 6 years, followed by decompensation after a significant stressor, suggests that a comprehensive treatment plan incorporating both pharmacological and non-pharmacological interventions can help him achieve recovery and stability, as outlined in the APA practice guideline 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient History and Current Condition
- The patient is a 27-year-old with a history of schizophrenia, bipolar disorder, and psychosis.
- The patient was recently released from a state hospital and started on Abilify (aripiprazole) with good management of his psychiatric condition.
- The patient's mother reports that he was diagnosed with schizophrenia at 17, but it resolved, and he was not on medication.
- The patient has a history of being off all medications for 6 years, during which time he was reportedly fine.
Medication Management
- The patient is currently on Abilify injection, with the next injection due in 6 days.
- Studies have shown that aripiprazole can be effective in combination with mood stabilizers for the treatment of bipolar disorder 2, 3.
- Lithium and valproate are commonly used mood stabilizers, but their comparative efficacy is not well understood 4, 5.
- Aripiprazole may be more appropriate for stabilized patients with manic episodes 2.
Risk of Suicidality
- The patient has a history of losing his son 6-9 months ago, which may increase his risk of suicidality.
- Lithium has been shown to have significant anti-suicidal effects in patients with bipolar disorder 6.
- Clozapine has also been shown to reduce suicide risk in individuals with schizophrenia 6.
Treatment Considerations
- The patient's mother is seeking help in the area, as the patient is established with MHMR but it is 10 hours away.
- The combination of aripiprazole and mood stabilizers may offer an effective and relatively well-tolerated option for the treatment of acute mania and maintenance treatment of patients with bipolar I disorder 3.
- Further evaluation and consideration of the patient's individual needs and circumstances are necessary to determine the best treatment strategy 4, 5.