RESPONSE TO CLOZAPINE IN ACUTE MANIA IS MORE RAPID THAN THAT OF CHLORPROMAZINE

The purpose of the present study was to compare the efficacy of clozap ine with that of chlorpromazine in an open label manner (both given in association with lithium salts) in the treatment of acute mania. Thir ty hospitalized manic patients were entered into the study. All patien ts met DSM-IV criteria for bipolar disorder, Manic Episode; 27 patient s completed the study and three patients dropped for noncompliance. Th e duration of the study was 3 weeks. Patients were randomly assigned t o two treatment groups; group 1 (n = 15) was treated with clozapine at a mean dose of 166 mg/day and group 2 (n = 12) was treated with chlor promazine at a mean dose of 310 mg/day. Manic symptomatology was rated on Young Rating Scale for Mania (YRSM) each week; side effects were r ecorded on dosage records and treatment emergent symptoms; extrapyrami dal acute side effects were rated on the Simpson-Angus Rating Scale pe rformed at the beginning of the study and after 3 weeks of treatment. A two-way repeated measures analysis of variance on YRMS scores showed a significant time effect (p < 0.0001) and a significant time-group i nteraction (p < 0.0001). Post-hoc comparison between the two groups sh owed a significant difference after 2 weeks of treatment (p = 0.0001), with clozapine treated patients showing lower YRSM scores than chlorp romazine treated patients. YRSM scores at the end of the study n;ere n ot significantly different. Patients treated with clozapine showed a m ore rapid trend toward amelioration. No clinically relevant side effec t was observed during the study.