Suppes Trisha, Ozcan M Erkan, Carmody Thomas
Department of Psychiatry, Bipolar Disorder Clinic and Research Program, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9121, USA.
Bipolar Disord. 2004 Aug;6(4):329-32. doi: 10.1111/j.1399-5618.2004.00119.x.
Rapid cycling (RC) bipolar disorder (BD) patients often do not respond fully to mood-stabilizers. Atypical antipsychotics including clozapine may be good candidates as an alternative mood-stabilizer for these patients.
Twenty-eight treatment-resistant patients with either Bipolar Disorder Type I (n = 20), or Schizoaffective Disorder Bipolar Type (n = 8) received clozapine add-on therapy. Patients were followed for up to 1 year. Patients were seen monthly and assessed on a number of symptom domains.
Fifteen of 28 patients met RC criteria. Differences between groups was non-significant for reported age of onset, age at study entry, past history of treatment or hospitalization, or diagnosis. However, significantly more women were RC. More than 80% of patients in either group showed at least some improvement over the 1-year study. Random regression analyses found the non-rapid cycling (NRC) group experienced significantly greater improvement than RC patients (p < 0.0001).
Clozapine is more effective in NRC patients with a history of mania in comparison to patients with a recent history of RC.
快速循环（RC）双相情感障碍（BD）患者通常对心境稳定剂反应不完全。包括氯氮平在内的非典型抗精神病药物可能是这些患者替代心境稳定剂的良好选择。
28例难治性双相I型障碍患者（n = 20）或双相型分裂情感性障碍患者（n = 8）接受氯氮平附加治疗。对患者随访长达1年。每月对患者进行检查，并在多个症状领域进行评估。
28例患者中有15例符合RC标准。两组在报告的发病年龄、研究入组年龄、既往治疗或住院史或诊断方面差异无统计学意义。然而，女性RC患者明显更多。两组中超过80%的患者在1年的研究中至少有一些改善。随机回归分析发现，非快速循环（NRC）组的改善明显大于RC患者（p < 0.0001）。
与近期有RC病史的患者相比，氯氮平对有躁狂病史的NRC患者更有效。
