What is the best course of action for a 27-year-old patient with a past medical history (PMH) of schizophrenia, bipolar disorder, and psychosis, who was recently discharged from a state hospital and started on Abilify (aripiprazole) with good management of his psychiatric condition, and is now seeking a refill of the medication?

From the Guidelines

The patient should continue his current treatment with Abilify injections as they have been effective in managing his psychiatric condition, and discontinuation may lead to a relapse of symptoms, increasing morbidity and mortality risk. The patient's history of schizophrenia, bipolar I disorder, and psychosis, as well as his recent psychiatric crisis, suggests that ongoing treatment with an antipsychotic medication is necessary to manage his symptoms and prevent future episodes 1. According to the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia, patients with schizophrenia whose symptoms have improved with an antipsychotic medication should continue to be treated with an antipsychotic medication, and Abilify is a recommended treatment option 1.

The patient's recent discharge from a state hospital and his upcoming Abilify injection in 6 days indicate that his treatment plan is currently effective, and continuing this treatment is crucial to maintaining his mental health stability and preventing potential complications. The fact that the patient has been stable without medications for 6 years until the recent loss of his son, which precipitated a psychiatric crisis, highlights the importance of ongoing treatment and support to manage his condition.

Key aspects of the patient's history and current situation that support continuing his treatment with Abilify injections include:

• His history of schizophrenia and bipolar I disorder with manic depression and psychosis
• The effectiveness of Abilify injections in managing his psychiatric condition
• The recent psychiatric crisis precipitated by the loss of his son
• The impracticality of regular monthly visits to his established MHMR care facility due to distance
• The patient's denial of current suicidal or homicidal ideation, which suggests that his treatment plan is currently effective in managing his symptoms.

Given the potential risks associated with discontinuing antipsychotic medication, including increased morbidity and mortality, it is essential to prioritize the patient's ongoing treatment with Abilify injections. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia emphasizes the importance of ongoing treatment with antipsychotic medication to manage symptoms and prevent future episodes, and continuing the patient's current treatment with Abilify injections is the most appropriate course of action 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

History of Present Illness

The patient is a 27-year-old male with a past medical history of schizophrenia, bipolar disorder, and psychosis. He was recently released from a state hospital where he was started on Abilify (aripiprazole) with good management of his psychiatric condition. The patient denies any suicidal or homicidal ideation. His mother reports that he was diagnosed with schizophrenia at the age of 17, but it resolved, and he was not on medication. However, at the age of 19, he was diagnosed with bipolar disorder, manic depression, and psychosis.

Medication History

The patient was fine off all medications for six years, but six to nine months ago, he lost his son, and his mother had him sectioned. He was admitted to a psychiatric hospital, where he was prescribed Abilify injection. His mother reports that the next injection is due in six days. According to studies, aripiprazole (Abilify) is an effective treatment for schizophrenia and bipolar disorder, with a favorable tolerability profile 2, 3, 4.

Current Treatment

The patient is currently established with MHMR, but it is 10 hours away, and his mother cannot take him there every month. She is seeking help in the area. The patient's current treatment with Abilify injection is consistent with studies that show the efficacy of aripiprazole as a maintenance treatment for schizophrenia and bipolar disorder 2, 4. However, it is essential to monitor the patient's response to treatment and adjust the dosage as needed to minimize side effects 5, 6.

Key Points

• The patient has a history of schizophrenia, bipolar disorder, and psychosis.
• He was recently started on Abilify (aripiprazole) with good management of his psychiatric condition.
• The patient's mother reports that he was fine off all medications for six years, but he was admitted to a psychiatric hospital six to nine months ago.
• The patient is currently established with MHMR, but it is 10 hours away, and his mother is seeking help in the area.
• Studies show that aripiprazole (Abilify) is an effective treatment for schizophrenia and bipolar disorder, with a favorable tolerability profile 2, 3, 4.