Citation

Lermanda V, Holmgren D, Fuentes C, Guerra R. D. J. Neuroeuropsychiatry (Santiago, Chile) 2010; 48(4): 335-343.

Copyright

(Copyright © 2010, Society of Neurology, Neurosurgery and Psychiatry, Chile)

DOI

10.4067/s0717-92272010000500008

PMID

unavailable

Abstract

BACKGROUND: The combination of multiple agents including lithium, mood stabilizers and antipsychotics, represents the most commonly strategy in bipolar disorder treatment. Lack of response, breakthrough episodes during adequate maintenance treatment, functional impairment, including re-hospitalization, suicide attempts and intolerance of medication are considered clinical inclusion criteria for treatment resistance in bipolar disorder. In bipolar disorder, Clozapine as mono-therapy or in combination treatment, remains as a effi cacious second line agent, with few clinical data available, mainly including short observational periods, small samples and uncontrolled trials.

METHODS: We analyze retrospectively clinical data about fi ve female bipolar refractory patients who were under combined treatment including atypical antipsychotics. Due to this combined fi rst line treatment resistance, Clozapine was indicated as an add-on agent. Equivalent analysis periods were established for each patient, previous and under Clozapine use. These periods extends from 8 months to 5 years and 2 months.

RESULTS: Clozapine average daily dose was 260 mgs. No adverse effects were noticed. Total hospitalization days decrease from 979 days to 118 days and suicide attempts decrease from 14 episodes in pre Clozapine period to 1 episode in the Clozapine treatment period. No re-hospitalization neither self harm attempts with Clozapine add on treatment were reported in 3 patients.

CONCLUSION: Clozapine effi cacy, in treatment resistance bipolar patients, should be considered as a second line option in combination therapy with insuffi cient response. Therapeutic benefi ts of Clozapine may include potential decrease of self harm conduct in bipolar patients as in schizophrenia and schizoaffective disorder.

Language: es

Keywords

Bipolar (Bipolar); Clozapine (Clozapina); Refractory (Refractariedad)