Masi G, Milone A
Institute of Developmental Neurology, Psychiatry and Educational Psychology, University of Pisa, Scientific Institute Stella Maris, Italy.
Panminerva Med. 1998 Sep;40(3):254-7.
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.
一名15岁的青少年男性，患有严重的难治性I型双相情感障碍，最近一次发作是伴有精神病性症状的躁狂发作，此前曾多次住院，接受过锂盐和/或卡马西平以及高剂量标准抗精神病药物治疗，但均无反应。在医院环境中逐渐开始采用氯氮平-锂盐联合治疗（氯氮平300毫克/天；锂盐1350毫克/天）。15天后，情绪和精神病性症状有了显著改善。四周后，简明精神病评定量表（BPRS）评分改善了50%（从74降至37）。临床总体印象量表（CGAS）平均评分从25提高到72。在临床总体印象-疾病严重程度分量表中，明显下降了57%；在临床总体印象-总体改善分量表中，提高了75%。唯一显著的副作用是镇静和疲劳，但并不严重到需要减少剂量。该男孩三周后出院，成功重返学校，治疗方案未作调整。经过九个月的治疗，未再出现精神病性或躁狂症状。本文讨论了药物治疗对伴有精神病性症状的难治性躁狂发作的意义。
