Treatment-Resistant Schizoaffective Disorder in Alcohol Dependence: A Case Report

Schizophrenia and schizoaffective disorder are complex psychotic disorders characterized by symptoms such as delusions, hallucinations, and cognitive impairment. These disorders are often exacerbated by comorbid substance use disorder (SUD), leading to more severe disability and poorer outcomes compared to those without SUD. The frequent co-occurrence of schizophrenia with alcohol use disorder (AUD) or other substances may be linked to dysfunctions in brain reward circuitry and shared neurobiological pathways. Effective management typically involves a combination of pharmacological treatments and complementary therapeutic approaches to address both the psychotic disorder and the substance use disorder.This case report presents a 50-year-old man with a history of alcohol and tobacco dependence, who displayed increased alcohol consumption and neglect of pleasurable activities, alongside symptoms indicative of schizoaffective disorder. Medical investigations, including blood tests, chest X-ray and NCCT Head, revealed no significant abnormalities. Serial mental status examinations led to a diagnosis of Mental and Behavioral Disorder due to Alcohol Dependence Syndrome (ADS) with Schizoaffective Disorder. Initial treatment with second-generation antipsychotics and mood stabilizers provided limited improvement. A subsequent switch to first-generation antipsychotics yielded only a partial response, classifying the patient as treatment-resistant. The introduction of clozapine resulted in significant clinical improvement, enhancing social functioning and achieving remission, while avoiding polypharmacy and minimizing metabolic side effects.