title: Clozapine for treatment-refractory schizophrenia, schizoaffective disorder, and psychotic bipolar disorder: a 24-month naturalistic study.
abstract: BACKGROUND
  The aim of this study was to evaluate the 24-month response to clozapine in patients with schizophrenia, schizoaffective disorder, or psychotic bipolar disorder.
  
  
  METHODS
  Ninety-one psychotic patients with a principal DSM-III-R diagnosis of schizophrenia (N = 31), schizoaffective disorder (N = 26), or bipolar disorder with psychotic features (N = 34) were treated naturalistically with clozapine at flexible dosages over a 24-month period. Improvement was assessed by the 18-item Brief Psychiatric Rating Scale and the Clinical Global Impressions-Severity of Illness scale.
  
  
  RESULTS
  All patients showed significant improvement 24 months from intake (p < .001). Such an improvement was significantly greater among patients with schizoaffective disorder or bipolar disorder than in patients with schizophrenia (p < .05). The presence of suicidal ideation at intake predicted greater improvement at endpoint.
  
  
  CONCLUSIONS
  Clozapine appears to be effective and relatively well tolerated in acute and long-term treatment of patients with psychotic bipolar disorder or schizoaffective disorder who have not responded to conventional pharmacotherapies.
authors.affiliation: Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ciapparelli
authors.forename: L
authors.initials: L
authors.lastname: Dell'Osso
authors.forename: S
authors.initials: S
authors.lastname: Pini
authors.forename: M C
authors.initials: MC
authors.lastname: Chiavacci
authors.forename: M
authors.initials: M
authors.lastname: Fenzi
authors.forename: G B
authors.initials: GB
authors.lastname: Cassano
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D003024:Clozapine / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000188:drug therapy*; D012559:Schizophrenia / Q000188:drug therapy*; D013405:Suicide / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine