Kimmel S E, Calabrese J R, Woyshville M J, Meltzer H Y
Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Clin Psychiatry. 1994 Sep;55 Suppl B:91-3.
Lithium remains the mainstay of treatment for patients with bipolar affective disorder; however, nearly half of patients with bipolar disorder fail to respond to lithium. Recently, there have been an increasing number of preliminary clinical reports that clozapine, an atypical antipsychotic agent, has potential efficacy in patients with mood disorders. We review the available clinical data supporting the potential use of clozapine in these psychiatric disorders and report our preliminary data from a study that used clozapine in the acute treatment of mania in treatment-refractory patients. Twenty-five patients meeting the DSM-III-R criteria for the manic phase of either bipolar or schizoaffective disorder entered a 13-week open prospective trial of clozapine. These patients either had failed to respond to or had been intolerant to treatment with lithium, an anticonvulsant, and at least two typical neuroleptics. Eighteen of 25 patients demonstrated a greater than 50% decrease in the Young Mania Rating Scale score. These preliminary data as well as the clinical reports reviewed indicate that the efficacy of clozapine in treatment-resistant patients is not limited to patients with schizophrenia.
锂盐仍然是双相情感障碍患者治疗的主要药物；然而，近一半的双相情感障碍患者对锂盐治疗无反应。最近，越来越多的初步临床报告表明，非典型抗精神病药物氯氮平对心境障碍患者具有潜在疗效。我们回顾了支持氯氮平在这些精神疾病中潜在应用的现有临床数据，并报告了我们一项研究的初步数据，该研究使用氯氮平对难治性患者进行躁狂症的急性治疗。25名符合双相情感障碍或分裂情感性障碍躁狂相DSM-III-R标准的患者进入了一项为期13周的氯氮平开放前瞻性试验。这些患者要么对锂盐、抗惊厥药以及至少两种典型抗精神病药物治疗无反应，要么不能耐受这些治疗。25名患者中有18名在杨氏躁狂量表评分上下降超过50%。这些初步数据以及所回顾的临床报告表明，氯氮平在难治性患者中的疗效并不局限于精神分裂症患者。
