title: Effectiveness of ultra-rapid dose titration of clozapine for treatment-resistant bipolar mania: case series.
abstract: Treatment of severe and refractory manic episodes in hospital settings can occasionally be very difficult. In particular, severely excited patients showing aggressive, hostile, impulsive behaviours frequently require physical restraint and seclusion, high doses of antipsychotics and benzodiazepines, and sometimes, electroconvulsive therapy. Hospital stay is generally prolonged and such patients cause great emotional distress for other patients in the ward and clinical staff involved in their care. Here we report on three patients with a diagnosis of bipolar disorder and one patient with a diagnosis of schizoaffective disorder bipolar subtype, all of whom were hospitalized for severe manic episodes with psychotic features. These patients were extremely difficult to manage in the ward as no response could be obtained in the first week of treatment despite high doses of antipsychotics and benzodiazepine administration. The introduction and rapid titration of clozapine proved remarkably effective and was well tolerated in the acute management of these patients. We observed that clozapine had a superior and fast mood stabilization effect with rapid titration and could be extremely helpful in the management of such patients.
authors: Department of Psychiatry, Cerrahpaşa Medical School, Halaskargazi cad. No: 81 Çiçek apt. daire: 8, Osmanbey Istanbul, Turkey.
authors: Cana
authors: C
authors: Aksoy Poyraz
authors: Department of Psychiatry, Cerrahpaşa Medical School, University of Istanbul, Turkey.
authors: Şenol
authors: Ş
authors: Turan
authors: Department of Psychiatry, Cerrahpaşa Medical School, University of Istanbul, Turkey.
authors: Ömer Faruk
authors: ÖF
authors: Demirel
authors: Department of Psychiatry, Cerrahpaşa Medical School, University of Istanbul, Turkey.
authors: Nazife Gamze
authors: NG
authors: Usta Sağlam
authors: Department of Psychiatry, Cerrahpaşa Medical School, University of Istanbul, Turkey.
authors: Nazım
authors: N
authors: Yıldız
authors: Department of Psychiatry, Cerrahpaşa Medical School, University of Istanbul, Turkey.
authors: Alaattin
authors: A
authors: Duran
keywords: bipolar disorder; clozapine; mania; rapid titration