Paliperidone ER recommended therapeutic range is between 3 – 12 mg once daily. In this poster presentation we will describe a case in which, for self-medication, therapeutic efficacy was achieved at higher doses.

Mr. M.G. is a thirty-nine year old man that lives with his parents and has a diagnosis of borderline personality disorder (DSM-IV-TR) presenting paranoid ideation, instability, impulsivity, emptiness, sexual promiscuity, drugs consumption.

During the last hospitalization in his referral of Psychiatry unit (May 2011), routine blood tests were within normal range; at discharge in the community, Paliperidone ER 9 mg/day was prescribed. At the first out-patient visit, as the clinical picture appeared unchanged the psychiatrist continued with the same therapy. At the second check-up, severity of symptoms was reduced, and M.G. reported to have taken for more than a month, on his own initiative, the double dose of Paliperidone ER (18 mg per day divided into two daily intakes); as the therapy was effective and well tolerated the psychiatrist chose to continue with the same therapy at the same dosage.

After 4 months (September 2011) the clinical picture is further enhanced.

At each stage the client was assessed using: CGI (stage-one = 6,4,09; stage-two = 6,4,09; stage-three = 4,1,05; stage-four = 4,1,01), BPRS (95-94-62-41), HDRS (33-33-15-2), HARS (48-40-14-1), SOFAS (25-30-55-60), PSP (25-30-61-70); BPDSI: 476 at the admission, 163 actually.

This study highlights the case of the patient in achieving a significant improvement in symptoms at a dose of Paliperidone above the upper limit of the recommended range. Further studies are required.