Clozapine in the Treatment of Refractory Psychotic Mania

• Published in: The American journal of psychiatry 2000-06, Vol.157 (6), p.982-986
• Main Authors: Green, Alan I., Tohen, Maricio, Patel, Jayendra K., Banov, Michael, DuRand, Curtiss, Berman, Ileana, Chang, Howard, Zarate, Carlos, Posener, Joel, Lee, Hang, Dawson, Ree, Richards, Carol, Cole, Jonathan O., Schatzberg, Alan F.
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Antipsychotic Agents - administration & dosage; Antipsychotic Agents - therapeutic use; Bipolar affective disorder; Bipolar Disorder - drug therapy; Bipolar Disorder - psychology; Brief Psychiatric Rating Scale - statistics & numerical data; Clozapine; Clozapine - administration & dosage; Clozapine - therapeutic use; Drug Administration Schedule; Drug therapy; Efficacy; Female; Humans; Male; Manic depression; Patient Dropouts; Prospective Studies; Psychiatric Status Rating Scales - statistics & numerical data; Regression Analysis; Resistance; Sex Factors; Treatment; Treatment Outcome
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.157.6.982

OBJECTIVE: The efficacy of clozapine was examined in a group of patients with treatment-refractory bipolar disorder, manic type with psychotic features.METHOD: 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.