Clozapine therapy in refractory affective disorders: polarity predicts response in long-term follow-up
Banov, M.D.; Zarate, C.A.; Tohen, M.; Scialabba, D.; Wines, J.D.; Kolbrener, M.; Kim, J.W.; Cole, J.O.
Journal of Clinical Psychiatry 55(7): 295-300
1994
ISSN/ISBN: 0160-6689 PMID: 8071289 Document Number: 425077
To determine the efficacy and tolerance of long-term clozapine therapy in refractory affective illness. Hospital records were reviewed for 193 treatment-resistant patients with a discharge diagnosis of bipolar disorder (N = 52), schizoaffective disorder (N = 81), unipolar depression (N = 14), schizophrenia (N = 40), or other disorders (N = 6) started on clozapine therapy as inpatients at McLean Hospital. An independent "best-estimate" diagnosis, based on DSM-III-R criteria, was established for each patient. Patients were contacted at least 6 months after clozapine initiation for structured follow-up interviews by raters blind to diagnosis. Patients were stratified by diagnosis, and a variety of patient characteristics and outcome measures were compared. Subjects were followed up a mean of 18.7 months after clozapine initiation. Bipolar manic and schizoaffective bipolar subjects had significantly better outcomes than unipolar, bipolar, and schizoaffective depressed patients on a variety of measures. One or more episodes of depression prior to clozapine predicted clozapine discontinuation (p = .01). Affective and schizoaffective subjects had baseline measures of social functioning similar to that of the schizophrenics but had significantly greater improvement in scores at follow-up. Clozapine is an efficacious and well-tolerated therapy for refractory affective illness. Manic symptomatology predicts a more favorable response than depression.