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A Journal on Internal Medicine
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,6
Panminerva Medica 1998 September;40(3):254-7
Clozapine treatment in an adolescent with bipolar disorder
Masi G., Milone A.
From the Institute of Developmental Neurology, Psychiatry and Educational Psychology University of Pisa, Scientific Institute Stella Maris, Pisa, Italy
A 15 year-old adolescent boy with a severe treatment refractory bipolar disorder type I, most recent episode manic, severe with psychotic features had previously required hospitalizations and treatment with lithium and/or carbamazepine and high doses of standard neuroleptics without any response. A treatment with a combined clozapine-lithium therapy was progressively started in a hospital setting (clozapine 300 mg/day; lithium 1350 mg/day). After 15 days a dramatic improvement in mood and psychotic symptoms was evident. After four weeks there was 50% improvement on the BPRS (from 74 to 37). The mean CGAS score changed from 25 to 72. At the CGI- Severity of Illness subscale, a 57% decrease was evident; at the CGI-Global Improvement subscale there was a 75% increase. The only significant side effects were sedation and fatigue, but they were not so severe as to induce a reduction of dosage. The boy was discharged from the hospital after three weeks and successfully returned to school with no modifications in treatment. After a nine-month treatment there was no reoccurrence of psychotic or manic symptoms. The implications of pharmacological therapy in treatment refractory manic episodes with psychotic features are discussed.