Cariprazine Augmentation and Sustained Remission of Physical Aggression in Clozapine‐Treated Treatment‐Resistant Schizophrenia: A Case Report

Persistent aggression may occur in treatment‐resistant schizophrenia (TRS) despite long‐term clozapine treatment and multiple augmentation strategies. We describe a male patient in his sixties with a decades‐long history of schizophrenia who required prolonged psychiatric inpatient care because of recurrent, unpredictable physical assaults toward other patients, staff, relatives, and police. This included treatment at a state forensic psychiatric hospital because of treatment complexity and safety concerns, not forensic legal status. Aggression persisted during adequately monitored high‐dose clozapine treatment and several augmentation strategies. The last documented physical assault occurred in October 2021. Cariprazine 1.5 mg/day was initiated in November 2021, primarily for longstanding negative symptoms. Within approximately seven weeks, mood and participation in communal ward activities improved. No further physical assaults were documented during more than 4 years of follow‐up. The patient subsequently transitioned to voluntary treatment and supported housing. Later somatic illnesses, temporary interruptions of oral medication, and substantial fluctuations in clozapine serum concentrations were not followed by renewed physical aggression. This case describes a prolonged temporal association between cariprazine augmentation and the absence of recurrent physical assaults, but the single‐case design, episodic pretreatment course, concomitant treatment changes, and absence of standardized ratings preclude causal inference.