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Clozapine for treatment-refractory mania
J R Calabrese1, S E Kimmel, M J Woyshville
1Mood Disorders Program, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Objective:
The efficacy of clozapine for treatment-resistant mania was examined in a prospective trial for patients with bipolar or schizoaffective disorder.
Method:
The subjects were 25 acutely manic patients with either bipolar disorder (N = 10) or schizoaffective disorder-bipolar subtype (N = 15) for whom lithium, anticonvulsants, and neuroleptics had been ineffective, had produced intolerable side effects, or both. After a 7-day washout, the patients were treated with clozapine monotherapy. They were evaluated over 13 weeks with the Young Mania Rating Scale and the Brief Psychiatric Rating Scale (BPRS).
Results:
Of the 25 patients, 18 (72%) exhibited marked improvement on the Young Mania Rating Scale, and eight (32%) exhibited marked improvement on the BPRS. The bipolar patients as compared to schizo-affective patients, and the nonrapid as compared to rapid cyclers, had significantly greater improvement in total BPRS score.
Conclusions:
These results suggest that clozapine is an effective therapy for treatment-resistant bipolar and schizoaffective mania.
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