Clozapine for treatment-refractory mania.
OBJECTIVE
The efficacy of clozapine for treatment-resistant mania was examined in a prospective trial for patients with bipolar or schizoaffective disorder.


METHODS
The subjects were 25 acutely manic patients with either bipolar disorder (N = 10) or schizoaffective disorder-bipolar subtype (N = 15) for whom lithium, anticonvulsants, and neuroleptics had been ineffective, had produced intolerable side effects, or both. After a 7-day washout, the patients were treated with clozapine monotherapy. They were evaluated over 13 weeks with the Young Mania Rating Scale and the Brief Psychiatric Rating Scale (BPRS).


RESULTS
Of the 25 patients, 18 (72%) exhibited marked improvement on the Young Mania Rating Scale, and eight (32%) exhibited marked improvement on the BPRS. The bipolar patients as compared to schizo-affective patients, and the nonrapid as compared to rapid cyclers, had significantly greater improvement in total BPRS score.


CONCLUSIONS
These results suggest that clozapine is an effective therapy for treatment-resistant bipolar and schizoaffective mania.
Calabrese
J R
JR
Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Kimmel
S E
SE
Woyshville
M J
MJ
Rapport
D J
DJ
Faust
C J
CJ
Thompson
P A
PA
Meltzer
H Y
HY
D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D003024:Clozapine / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome
D000927:Anticonvulsants; D014150:Antipsychotic Agents; D008094:Lithium; D003024:Clozapine