CLOZAPINE THERAPY IN REFRACTORY AFFECTIVE-DISORDERS - POLARITY PREDICTS RESPONSE IN LONG-TERM FOLLOW-UP

Background: To determine the efficacy and tolerance of long-term cloza pine therapy in refractory affective illness. Method: Hospital records were reviewed for 193 treatment-resistant patients with a discharge d iagnosis of bipolar disorder (N = 52), schizoaffective disorder (N = 8 1), unipolar depression (N = 14), schizophrenia (N = 40), or other dis orders (N = 6) started on clozapine therapy as inpatients at McLean Ho spital. An independent ''best-estimate'' diagnosis, based on DSM-III-R criteria, was established for each patient. Patients were contacted a t least 6 months after clozapine initiation for structured follow-up i nterviews by raters blind to diagnosis. Patients were stratified by di agnosis, and a variety of patient characteristics and outcome measures were compared. Results: Subjects were followed up a mean of 18.7 mont hs after clozapine initiation. Bipolar manic and schizoaffective bipol ar subjects had significantly better outcomes than unipolar, bipolar, and schizoaffective depressed patients on a variety of measures. One o r more episodes of depression prior to clozapine predicted clozapine d iscontinuation (p = .01). Affective and schizoaffective subjects had b aseline measures of social functioning similar to that of the schizoph renics but had significantly greater improvement in scores at follow-u p. Conclusion: Clozapine is an efficacious and well-tolerated therapy for refractory affective illness. Manic symptomatology predicts a more favorable response than depression.