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Panminerva Medica 1998 September;40(3):254-7

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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