CLOZAPINE FOR TREATMENT-REFRACTORY MANIA

Objective: The efficacy of clozapine for treatment-resistant mania was examined in a prospective trial for patients with bipolar or schizoaf fective disorder. Method: The subjects were 25 acutely manic patients with either bipolar disorder (N=10) or schizoaffective disorder-bipola r subtype (N=15) for whom lithium, anticonvulsants, and neuroleptics h ad been ineffective, had produced intolerable side effects, or both. A fter a 7-day washout, the patients were treated with clozapine monothe rapy. They were evaluated over 13 weeks with the Young Mania Rating Sc ale and the Brief Psychiatric Rating Scale (BPRS). Results: Of the 25 patients, 18 (72%) exhibited marked improvement on the Young Mania Rat ing Scale, and eight (32%) exhibited marked improvement on the BPRS. T he bipolar patients as compared to schizoaffective patients, and the n onrapid as compared to rapid cyclers, had significantly greater improv ement in total BPRS score. Conclusions: These results suggest that clo zapine is an effective therapy for treatment-resistant bipolar and sch izoaffective mania.