Fehr Bettina S, Ozcan M Erkan, Suppes Trisha
VA Hospital, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Eur Arch Psychiatry Clin Neurosci. 2005 Feb;255(1):10-4. doi: 10.1007/s00406-004-0528-8. Epub 2004 Nov 12.
Open, uncontrolled studies suggest clozapine can have mood-stabilizing effects in treatment-resistant bipolar disorder. Unfortunately, the side effect profile limits clozapine's use at high doses. We report a series of nine bipolar I disorder patients who improved on relatively low doses of clozapine add-on therapy (250 mg or lower). Retrospectively abstracted clinical data identified nine patients with bipolar I disorder, as defined by DSMIV criteria, treated with low-dose clozapine at inpatient and outpatient settings. Monthly symptom evaluations were collected prospectively using standard assessments. Symptoms of mania and mood lability improved in all patients. Three patients demonstrated striking mood stabilization and returned to previous levels of functioning; five patients evidenced moderate improvement in mood stabilization and functioning; and one patient showed a minimal response. Overall, clozapine did not have a significant antidepressant effect. The mean clozapine dose at the end of the study was 156.3 +/- 77.6 mg/day, and duration of treatment was 12 months. Residual side effects were mild. The symptomatic improvement in these prospectively evaluated patients is consistent with our clinical impression in the majority of patients with bipolar disorder taking clozapine.
开放性、非对照研究表明，氯氮平对难治性双相情感障碍可能具有心境稳定作用。遗憾的是，其副作用限制了氯氮平在高剂量时的使用。我们报告了一系列9例双相I型障碍患者，他们在相对低剂量的氯氮平附加治疗（250毫克或更低）下病情有所改善。通过回顾性提取临床数据，确定了9例符合DSM-IV标准定义的双相I型障碍患者，他们在住院和门诊环境中接受了低剂量氯氮平治疗。前瞻性地使用标准评估方法收集每月症状评估数据。所有患者的躁狂症状和情绪不稳定症状均有所改善。3例患者表现出显著的心境稳定，并恢复到以前的功能水平；5例患者在心境稳定和功能方面有中度改善；1例患者反应甚微。总体而言，氯氮平没有显著的抗抑郁作用。研究结束时氯氮平的平均剂量为156.3±77.6毫克/天，治疗持续时间为12个月。残留副作用较轻。这些前瞻性评估患者的症状改善与我们对大多数服用氯氮平的双相情感障碍患者的临床印象一致。
