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Seventy-Two-Year-Old Male Becomes Non-Compliant with His Medication Routine

A 72-year-old male with a history of Parkinson's disorder, schizophrenia, hypertension and depression presents to you. Though he has typically been fairly compliant with his medication regime, this patient had decided to stop taking the 10 mg of aripiprazole he had been prescribed. After years of been tried on different antipsychotic drugs, this dosage of aripiprazole appeared to be working well for him. 

When the patient came to see you, he had stopped the aripiprazole several weeks prior. He noted that he felt like he didn't need the medication any longer so he stopped it on his own. 

Within that time frame, the patient began experiencing symptoms that you determine to be those of classic tardive dyskinesia: abnormal movements of his trunk and shoulder as well as troubling tongue and lip movements. 

What is your approach to this patient's mediation management?

  • from Generation NP 1 week 1 day
    I would first determine for sure that he is experiencing TD before starting Ingrezza, particularly because he also has Parkinson's (so it might be difficult to differentiate). If Abilify is the best drug of choice, I would evaluate him for the LAI Abilify Maintena and give a lower dose if necessary. If his schizophrenia is controlled, his compliance with everything else might be better.
  • from Generation NP 2 weeks 1 day
    Switch to anothet atypical antipsychotic and start Ingrezza immediately.
  • 3 weeks 1 day
    patients with true PD should not take abilify. This patient needs a cognitive assessment and thorough treatment plan
  • 3 weeks 2 days
    He is having withdrawal dyskinesia from stopping the aripiprazole; the movements will be best managed by restarting the aripiprazole. I would evaluate for any return of psychotic symptoms, and also get him to elaborate further - if he's been on antipsychotic medications for several decades, why did he decide to stop it now? Also evaluate for any dementia signs/symptoms; he might be forgetting to take it and is embarrassed to say that.
  • from Generation NP 3 weeks 2 days
    Implement community resources to enhance medication compliance. Would than initiate clozapine and monitor adherence closely given risk for seizure activity with rapid titration. Clozapine would be effective in managing psychosis of schizophrenia without compromising Parkinson's disorder symptoms. TD symptoms may also improve although ongoing consideration would be placed on if he is experiencing rebound TD symptoms and may need to consider augmentation with either Ingrezza, Austedo, or complete new challenge with Abilify Maintenna or other LAI Abilify.
  • 3 weeks 3 days
    The diagnosis of Schizohrenia, Abilify has worked, will continue the same.
  • 3 weeks 3 days
    I would consider starting clozapine for the schizophrenia symptoms. It would be the medication least likely to exacerbate his TD symptoms, as well as best control his psychosis.