title: Response to clozapine of rapid cycling versus non-cycling patients with a history of mania.
abstract: OBJECTIVE
  Rapid cycling (RC) bipolar disorder (BD) patients often do not respond fully to mood-stabilizers. Atypical antipsychotics including clozapine may be good candidates as an alternative mood-stabilizer for these patients.
  
  
  METHODS
  Twenty-eight treatment-resistant patients with either Bipolar Disorder Type I (n = 20), or Schizoaffective Disorder Bipolar Type (n = 8) received clozapine add-on therapy. Patients were followed for up to 1 year. Patients were seen monthly and assessed on a number of symptom domains.
  
  
  RESULTS
  Fifteen of 28 patients met RC criteria. Differences between groups was non-significant for reported age of onset, age at study entry, past history of treatment or hospitalization, or diagnosis. However, significantly more women were RC. More than 80% of patients in either group showed at least some improvement over the 1-year study. Random regression analyses found the non-rapid cycling (NRC) group experienced significantly greater improvement than RC patients (p < 0.0001).
  
  
  CONCLUSIONS
  Clozapine is more effective in NRC patients with a history of mania in comparison to patients with a recent history of RC.
authors.affiliation: Department of Psychiatry, Bipolar Disorder Clinic and Research Program, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9121, USA. trisha.suppes@utsouthwestern.edu
authors.forename: Trisha
authors.initials: T
authors.lastname: Suppes
authors.forename: M Erkan
authors.initials: ME
authors.lastname: Ozcan
authors.forename: Thomas
authors.initials: T
authors.lastname: Carmody
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology*; D003024:Clozapine / Q000627:therapeutic use*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine