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

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


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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