title: Clozapine in the treatment of refractory psychotic mania.
abstract: OBJECTIVE
  The efficacy of clozapine was examined in a group of patients with treatment-refractory bipolar disorder, manic type with psychotic features.
  
  
  METHODS
  Twenty-two subjects with treatment-refractory bipolar disorder with active manic and psychotic symptoms participated in a 12-week open-label trial of clozapine. After a 2-10-day drug washout period, patients began treatment with clozapine at 25 mg/day; the dose was increased 25 mg/day (as tolerated) to a maximum level of 550 mg/day. Patients were evaluated longitudinally over the course of the study with the Brief Psychiatric Rating Scale (BPRS), the Young Mania Rating Scale, and the Clinical Global Impressions (CGI) scale.
  
  
  RESULTS
  Fourteen of the 22 subjects in the study continued taking clozapine for at least 10 of the 12 weeks. Among the entire group, mean improvements of 56. 7%, 56.6%, and 39.1% were seen on the BPRS, Young Mania Rating Scale, and CGI, respectively. Seventeen of the 22 subjects (77.3%) experienced at least a 20% improvement in scores on all three scales.
  
  
  CONCLUSIONS
  The findings from this open-label study, which are consistent with previous retrospective studies, case reports, and one other open-label prospective study, suggest that clozapine is an effective agent for patients with treatment-refractory psychotic mania.
authors.affiliation: Commonwealth Research Center, Massachusetts Mental Health Center, Boston, MA 02115, USA. alan.green@hms.harvard.edu
authors.forename: A I
authors.initials: AI
authors.lastname: Green
authors.forename: M
authors.initials: M
authors.lastname: Tohen
authors.forename: J K
authors.initials: JK
authors.lastname: Patel
authors.forename: M
authors.initials: M
authors.lastname: Banov
authors.forename: C
authors.initials: C
authors.lastname: DuRand
authors.forename: I
authors.initials: I
authors.lastname: Berman
authors.forename: H
authors.initials: H
authors.lastname: Chang
authors.forename: C
authors.initials: C
authors.lastname: Zarate
authors.forename: J
authors.initials: J
authors.lastname: Posener
authors.forename: H
authors.initials: H
authors.lastname: Lee
authors.forename: R
authors.initials: R
authors.lastname: Dawson
authors.forename: C
authors.initials: C
authors.lastname: Richards
authors.forename: J O
authors.initials: JO
authors.lastname: Cole
authors.forename: A F
authors.initials: AF
authors.lastname: Schatzberg
mesh_terms: D000328:Adult; D000367:Age Factors; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D010054:Brief Psychiatric Rating Scale / Q000706:statistics & numerical data; D003024:Clozapine / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D010352:Patient Dropouts; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012044:Regression Analysis; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine