ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Clozapine in the Treatment of Bipolar and Schizoaffective Disorders


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ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Clozapine in the Treatment of Bipolar and Schizoaffective Disorders

Vol 1 - Iss 2 - Short Communication - Clozapine in the Treatment of Bipolar and Schizoaffective Disorders #33

Clozapine in the Treatment of Bipolar and Schizoaffective Disorders

S. Khaldi1* MD, A. Frikha2 MD, C. Kornreich1 MD, PhD, I. Pelc1MD, PhD.

1 C.H.U Brugmann. Department of Psychiatry. Brussels. Belgium. Email: Khaldislim@yahoo.fr. Tel: 003224772731.
2. Centre hospitalier Réné Dubos. Department of Psychiatry. France.

Background: Clozapine (CLZ) is a dibenzodiazepine antipsychotic. Its atypical profile is related to weak D2 receptor antagonism, strong affinity for D4 receptors, and potent serotonin and norepinephrine antagonism. Its mean recommended dosage is 200 to 450 mg/d with a maximum of 900 mg/d. CLZ is more effective than standard neuroleptic drugs to treat refractory schizophrenic patients, possesses fewer extrapyramidal side effects, and does not induce tardive dyskinesia nor prolactin elevation. However its use may be restricted by other adverse reactions, such as agranulocytosis, which occurs in 0.5 to 2% of patients, and seizures, especially at high dosage (Stahl, 2000). Studies examining efficacy of CLZ in affective disorders are rare but many authors suggest that clozapine may have mood-stabilizing properties (Green et al, 2000).

Objective: To evaluate the efficacy of clozapine monotherapy in the treatment of refractory depression and refractory psychotic mania in both bipolar (BD) and schizoaffective disorders (SCD).
To review data about eventual mood stabilizing properties.

Method: The MEDLINE was searched with a combination of each one of the following key words ^refractory mania, bipolar disorder, schizoaffective disorder, refractory depression and clozapine. ^

Results: Many case reports, open label, prospective and retrospective study reporting a follow-up of one to ten years confirm the efficiency of CLZ in BD and SCD especially in refractory depression and refractory psychotic mania. Some authors are also in favour of a mood-stabilizing properties of this molecule.

Conclusion: Studies concerning use of CLZ in BD and SCD confirmed:
- Acute antimanic properties of CLZ. (Suppes et al, 1999)
- Mood-stabilizing properties.
- Efficiency in the treatment of refractory depression. (Lorza et al, 2004)
CLZ should come to play an increasingly important role in the acute and long-term management of bipolar disorder and schizoaffective disorders, but there is a clear need for further controlled randomized double blind trials in this indication.

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