Zarate C A, Tohen M, Baldessarini R J
Bipolar and Psychotic Disorders Program, Mailman Research Center, McLean Hospital, Belmont, Mass 02178, USA.
J Clin Psychiatry. 1995 Sep;56(9):411-7.
A growing literature suggests that the atypical antipsychotic agent clozapine may be effective in schizoaffective and psychotic mood disorders.
To evaluate the efficacy and tolerability of clozapine in severe mood disorders, we reviewed published studies on clozapine in schizophrenia, bipolar disorder, schizoaffective disorder, major depression, and organic disorders with psychotic or major affective syndromes, identified through the MEDLINE data base.
Patients in manic or psychotic phases of schizoaffective or bipolar disorder were significantly more likely to respond to clozapine than patients with schizophrenia (p = .006) or severe depressive syndromes (unipolar, bipolar, and schizoaffective depression combined; p = .001). There was no significant difference in the side effect profile secondary to clozapine in patients with severe mood disorders compared to patients with schizophrenia.
Clozapine appears to be effective and well-tolerated in the short-term and maintenance treatment of severe or psychotic mood disorders, particularly in the manic-excited phases of schizoaffective and bipolar disorders, even in patients who have not responded well to conventional pharmacotherapies.
越来越多的文献表明，非典型抗精神病药物氯氮平可能对分裂情感性障碍和精神病性心境障碍有效。
为评估氯氮平在严重心境障碍中的疗效和耐受性，我们回顾了通过MEDLINE数据库检索到的关于氯氮平治疗精神分裂症、双相情感障碍、分裂情感性障碍、重度抑郁症以及伴有精神病性或重度情感综合征的器质性障碍的已发表研究。
与精神分裂症患者（p = 0.006）或重度抑郁综合征患者（包括单相、双相和分裂情感性抑郁；p = 0.001）相比，分裂情感性障碍或双相情感障碍的躁狂或精神病性发作期患者对氯氮平有反应的可能性显著更高。与精神分裂症患者相比，严重心境障碍患者因氯氮平导致的副作用情况无显著差异。
氯氮平在严重或精神病性心境障碍的短期和维持治疗中似乎有效且耐受性良好，特别是在分裂情感性障碍和双相情感障碍的躁狂兴奋期，即使是对传统药物治疗反应不佳的患者。
