Lurasidone in a Patient with Paranoid Schizophrenia and Asperger's Syndrome – A Case Study

Introduction

Schizophrenia is a very serious mental disorder within the spectrum of psychotic disorders. Its treatment is long-term and often very challenging. The pharmacotherapy mainly involves drugs from the antipsychotic group. Given the complexity of some patients' issues, therapy often needs to be conducted with multiple medications. An important and not negligible aspect of the therapy is also the side effects and their impact on the overall functioning of the patients.

In recent years, in the Czech Republic, we have had access to the atypical antipsychotic from the group of serotonin and dopamine antagonists (SDA), lurasidone. It is often compared to risperidone, which belongs to the same group of antipsychotics. However, current studies show a more favorable safety profile for lurasidone, especially in terms of cardiovascular safety and the absence of hyperprolactinemia. The effect of lurasidone on the symptoms of schizophrenia is similar to that of risperidone.

Case Description

History

This case study describes a 30-year-old male. He is single, somatically healthy, and has been living with his family for a long time. Since June 2023, he has had partial disability due to a psychiatric indication. He has a negative family history of mental disorders and does not use addictive substances. He graduated from high school and then continued to law school. He did not complete his law studies and switched to computer science. Unfortunately, after about six months, he had to end his studies and did not resume them. Between the ages of 25 and 27, he held six different jobs. He worked the longest as a salesclerk/warehouse worker for a year.

Interestingly, since the age of 19, he has been a member of Mensa. Anyone who scores within the top 2% of the general population on an IQ test approved by an international supervisory psychologist from Mensa International can become a member. Before being admitted to this organization, the patient's IQ was measured at 140, which is on the borderline of genius.

Psychiatric History

The patient first came into contact with psychiatry in May 2021. He was admitted to an acute psychiatric ward for acute psychotic disorder. According to his family, he developed delusional thinking within a week, exhibited formal thought disorders, behaved inappropriately (stood outside in the rain, threatened strangers), and self-acknowledged auditory hallucinations of a commenting nature.

After initial treatment with risperidone at a dose of 3 mg, the acute psychotic symptoms gradually subsided. However, elements of the autistic spectrum became prominent in his clinical picture. Based on additional history taken from the family, his clinical picture corresponded to Asperger's syndrome. He was discharged to outpatient care after three weeks of hospitalization with a combination of diagnoses – acute psychotic disorder with schizophrenia symptoms and Asperger's syndrome.

Six months after discharge, a psychological examination was conducted, which demonstrated cognitive deterioration and highlighted dominant negative symptoms: emotional flattening, social withdrawal, anhedonia, and hypobulia. Positive symptoms were not demonstrated. He underwent outpatient MRI imaging, which was negative in terms of findings.

He continued with regular outpatient check-ups; psychotic symptoms did not recur. His overall presentation was convoluted and rigid, which his family reported as his